title: Nitric therapy in preterm infants: rationalised approach based on functional neonatal echocardiography.
abstract: OBJECTIVE
  Use of inhaled nitric oxide (iNO) in preterm infants is not supported by current evidence. In 2013, in Australia and New Zealand, 14% infants' ≤25 weeks of gestations were administered iNO. Within the cohort administered iNO, we aimed to identify subgroups where it may be more efficacious and compared characteristics before and after the set-up of the functional echocardiography (fEcho) programme.
  
  
  METHODS
  A retrospective audit for the period 2000-2013 involving preterm infants administered iNO in the first four weeks of life was performed. Comparisons were made between the two time epochs: up to 2007 and post-2007.
  
  
  RESULTS
  Eighty-five infants fulfilled the inclusion criteria; 62 (73%) were ≤28 weeks of gestation; 51 (60%) survived. Amongst survivors, gestation and birthweight were higher and oxygenation index (OI) was lower. Fourteen (16.5%) infants weighed small for gestation age; survival was lower in this subgroup (6/14, 43%, p = 0.0005). The fEcho programme increased prenitric assessments for a definitive diagnosis and monitoring; iNO was started earlier, at a lower OI with a trend towards reduced usage (hours).
  
  
  CONCLUSIONS
  Characteristics of subgroups (within the cohort of infants ≤34 weeks of gestation) more likely to benefit from iNO therapy were identified. Use of fEcho could rationalise usage.
authors.affiliation: Monash Newborn, Monash Children's Hospital, Melbourne, Vic., Australia.
authors.forename: Daryl R
authors.initials: DR
authors.lastname: Cheng
authors.affiliation: Monash Newborn, Monash Children's Hospital, Melbourne, Vic., Australia.
authors.forename: Stacey
authors.initials: S
authors.lastname: Peart
authors.affiliation: Monash Newborn, Monash Children's Hospital, Melbourne, Vic., Australia.|Department of Paediatrics, Monash University, Melbourne, Vic., Australia.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Tan
authors.affiliation: Monash Newborn, Monash Children's Hospital, Melbourne, Vic., Australia.|Department of Paediatrics, Monash University, Melbourne, Vic., Australia.
authors.forename: Arvind
authors.initials: A
authors.lastname: Sehgal
mesh_terms: D000280:Administration, Inhalation; D004452:Echocardiography; D006801:Humans; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000188:drug therapy*; D009569:Nitric Oxide / Q000008:administration & dosage / Q000627:therapeutic use*; D010547:Persistent Fetal Circulation Syndrome / Q000188:drug therapy* / Q000401:mortality; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D009569:Nitric Oxide
keywords: Audit; Echocardiography; Nitric oxide; Preterm