title: Impact of early surfactant and inhaled nitric oxide therapies on outcomes in term/late preterm neonates with moderate hypoxic respiratory failure.
abstract: OBJECTIVE
  We conducted a post-hoc analysis of early inhaled nitric oxide (iNO)-randomized controlled trial data to identify associations pertinent to the management of moderate hypoxic respiratory failure in term/late preterm infants.
  
  
  METHODS
  Univariate and multivariate logistic regression analyses were used to determine risk factors for the progression of respiratory failure and extracorporeal membrane oxygenation (ECMO)/death.
  
  
  RESULTS
  Among the 299 enrolled infants, oxygenation index (OI) <20 at enrollment (odds ratio 0.52, confidence interval (CI) 0.27 to 0.97) and surfactant use before randomization (odds ratio 0.47, CI 0.24 to 0.91) were associated with decreased ECMO/death rates. Early surfactant use for respiratory distress syndrome, perinatal aspiration syndrome and pneumonia/sepsis was associated with lower risk of ECMO/death (P<0.001). Early iNO (OI 15 to 25) decreased the progression of respiratory failure to OI >30 (P=0.002) and to composite outcome of OI >30 or ECMO/death (P=0.02).
  
  
  CONCLUSIONS
  This post-hoc analysis suggests that early use of surfactant and iNO in moderate respiratory failure is associated with improved outcomes.
authors.affiliation: Division of Neonatology, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: G G
authors.initials: GG
authors.lastname: Konduri
authors.forename: G M
authors.initials: GM
authors.lastname: Sokol
authors.forename: K P
authors.initials: KP
authors.lastname: Van Meurs
authors.forename: J
authors.initials: J
authors.lastname: Singer
authors.forename: N
authors.initials: N
authors.lastname: Ambalavanan
authors.forename: T
authors.initials: T
authors.lastname: Lee
authors.forename: A
authors.initials: A
authors.lastname: Solimano
mesh_terms: D000280:Administration, Inhalation; D003131:Combined Modality Therapy; D004357:Drug Synergism; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects; D005260:Female; D006801:Humans; D000860:Hypoxia / Q000188:drug therapy; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000188:drug therapy / Q000401:mortality / Q000628:therapy; D016015:Logistic Models; D008297:Male; D009569:Nitric Oxide / Q000627:therapeutic use*; D010100:Oxygen / Q000097:blood; D011014:Pneumonia / Q000188:drug therapy / Q000628:therapy; D011663:Pulmonary Surfactants / Q000627:therapeutic use*; D012127:Respiratory Distress Syndrome, Newborn / Q000188:drug therapy* / Q000401:mortality / Q000628:therapy; D012307:Risk Factors
chemical_list: D011663:Pulmonary Surfactants; D009569:Nitric Oxide; D010100:Oxygen