Little is known about the pulmonary and neurodevelopmental outcomes of newborns treated with inhaled nitric oxide (NO) for respiratory failure. Between 1/1/93 and 12/31/94, 33 term neonates (19 outborn) with severe respiratory failure [Oxygenation Index (OI)=64±9.0 (mean±SE), alveolar to arterial oxygen gradient (AaDO2) =620±5.0] were treated with high frequency oscillatory ventilation (HFOV) and NO. Eight of the 33 patients had pulmonary hypoplasia [7-congenital diaphragmatic hernia(CDH), 1-renal dysgenesis] and were analyzed separately. The remaining diagnoses included meconium aspiration (12), idiopathic PPHN (6), respiratory distress syndrome (4), Group B Streptococcal sepsis (3).
In patients without pulmonary hypoplasia survival was 88% (22/25); 1 survivor received ECMO. Duration of NO therapy in survivors was 392±56 hr (74-920 hr). NO dose ranged from 5-80 ppm, with an average NO exposure of 31 ppm for the duration of therapy. Length of ventilation was 27±6 days(median 21 days) and of hospitalization was 46±32 days (median 34 days). Four out of 22 had abnormal findings on head ultrasound, CT scan, or MRI; 2 of these patients were congenitally impaired (CMV, CHARGE association); 1 was hearing impaired. Of the remaining 20 patients, 16 have had follow-up at an average age of 12 months (5-20 months), with 12% (2/16) neurologically impaired (developmental delay, hypotonia, cerebral palsy). Three of 7 patients with CDH (43%) responded to NO. All nonresponders died; 2/3 responders were electively removed from mechanical support secondary to multiple congenital anomalies, and the 1 survivor has developmental delay.
