title: Early functional echocardiogram and inhaled nitric oxide: usefulness in managing neonates born following extreme preterm premature rupture of membranes (PPROM).
abstract: OBJECTIVE
  Poor neonatal outcome of preterm premature rupture of membranes (PPROM) < 24 weeks' gestational age (GA) is probably a result of abnormalities in both airway and vascular developments, ventilation perfusion mismatch, and possibly persistent pulmonary hypertension of the newborn (PPHN). Perinatal mortality of 50-90% has been reported in the past, with recent literature reporting significant improvement in neonatal survival. We report our 8-year experience in this group of infants using early diagnostic functional echocardiography (fECHO), high-frequency ventilation (HFV) and inhaled nitric oxide (iNO).
  
  
  METHODS
  The obstetric and neonatal databases were searched to identify babies with PPROM (< 20 weeks' gestation) or rupture earlier than 25 weeks for more than 14 days.
  
  
  RESULTS
  Twenty-six infants were identified, of whom 20 were admitted to the neonatal intensive care unit (NICU; mean GA 27.8 weeks, mean birth weight (BW) 1207 g). Early echocardiographic data were available in 12/15 infants requiring mechanical ventilation of whom 10 had evidence of PPHN. All infants who received iNO therapy survived to discharge and only two infants died. Survival to discharge was 69% for the whole cohort of infants and 90% for infants admitted to the NICU. In contrast, for the cohort from pre-iNO and -HFV era, the overall survival to discharge was 62% and 66% for the infants admitted to the NICU.
  
  
  CONCLUSIONS
  Premature infants with PPROM and presumed severe hypoxemic respiratory failure because of hypoplastic lungs often have significant PPHN and may show improvement in oxygenation after treatment with HFV and iNO. Early fECHO results in earlier identification and treatment of infants with PPHN in this high-risk group.
authors.affiliation: Department of Neonatology, Royal North Shore Hospital Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia. dharmeshparul@yahoo.com
authors.forename: Dharmesh M
authors.initials: DM
authors.lastname: Shah
authors.forename: Martin
authors.initials: M
authors.lastname: Kluckow
mesh_terms: D000280:Administration, Inhalation; D004452:Echocardiography; D045462:Endothelium-Dependent Relaxing Factors / Q000627:therapeutic use*; D005260:Female; D005322:Premature Rupture of Fetal Membranes / Q000473:pathology*; D005865:Gestational Age; D006612:High-Frequency Ventilation; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D009569:Nitric Oxide / Q000627:therapeutic use*; D017063:Outcome Assessment, Health Care; D011247:Pregnancy; D011248:Pregnancy Complications; D012189:Retrospective Studies
chemical_list: D045462:Endothelium-Dependent Relaxing Factors; D009569:Nitric Oxide