Document Detail


Noninvasive delivery of inhaled nitric oxide therapy for late pulmonary hypertension in newborn infants with congenital diaphragmatic hernia.
MedLine Citation:
PMID:  12712057     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To determine the incidence of late pulmonary hypertension (late PH) in congenital diaphragmatic hernia (CDH) and whether prolonged treatment with noninvasive inhaled NO therapy delivered through a nasal cannula (NC) would sustain pulmonary vasodilation during a period of transition from mechanical ventilation to spontaneous breathing. STUDY DESIGN: We collected data on all patients with a diagnosis of CDH admitted to the Children's Hospital, Denver, from January 1996 through December 2001. Patients who had suprasystemic pulmonary hypertension when inhaled NO was discontinued before extubation were treated with inhaled NO delivered with the nasal cannula. RESULTS: Newborn infants (n = 47) with CDH were treated during this time period. Short-term (<3 months) and long-term (>1 year) survival was 85% and 75%, respectively; 30 newborn infants were treated with inhaled NO (64%). Inhaled NO was successfully discontinued in 16 patients before extubation, and 10 (21%) were treated with inhaled NO through NC after extubation because of pulmonary hypertension and marked hypoxemia when trials off inhaled NO were performed. Nasopharyngeal NO concentrations were 5.4 +/- 0.5 ppm and 2.4 +/- 0.4 ppm with inhaled NO measured proximally in the delivery device at 10 and 5 ppm, respectively. CONCLUSIONS: Late PH occurs in a significant subset of newborn infants with CDH. Noninvasive inhaled NO treatment may reduce the duration of mechanical ventilation while safely treating late PH.
Authors:
John P Kinsella; Thomas A Parker; D Dunbar Ivy; Steven H Abman
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Publication Detail:
Type:  Journal Article; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  The Journal of pediatrics     Volume:  142     ISSN:  0022-3476     ISO Abbreviation:  J. Pediatr.     Publication Date:  2003 Apr 
Date Detail:
Created Date:  2003-04-24     Completed Date:  2003-05-30     Revised Date:  2007-11-14    
Medline Journal Info:
Nlm Unique ID:  0375410     Medline TA:  J Pediatr     Country:  United States    
Other Details:
Languages:  eng     Pagination:  397-401     Citation Subset:  AIM; IM    
Affiliation:
Department of Pediatrics, Divisions of Neonatology, Cardiology, and Pulmonary and Critical Care Medicine, The Children's Hospital and the University of Colorado School of Medicine, Denver, Colorado 80218-1088, USA.
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MeSH Terms
Descriptor/Qualifier:
Administration, Inhalation
Female
Hernia, Diaphragmatic / complications*,  congenital*,  therapy
Humans
Hypertension, Pulmonary / drug therapy*,  epidemiology*,  etiology
Incidence
Infant, Newborn
Male
Nitric Oxide / administration & dosage*,  therapeutic use*
Outcome Assessment (Health Care)
Retrospective Studies
Time Factors
Vasodilator Agents / administration & dosage*,  therapeutic use*
Ventilator Weaning
Grant Support
ID/Acronym/Agency:
M01 RR00069/RR/NCRR NIH HHS; P50 HL 57144-03/HL/NHLBI NIH HHS
Chemical
Reg. No./Substance:
0/Vasodilator Agents; 10102-43-9/Nitric Oxide

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