Outcomes following the use of inhaled nitric oxide rescue therapy in preterm infants less than 30 weeks gestation

Abstract

Background: Inhaled nitric oxide (iNO) is increasingly used in preterm infants as rescue therapy. Whether to give iNO to infants <30 weeks remains unclear and long term outcome data is limited.

Aim: To assess outcomes for infants receiving rescue iNO on a UK network lead neonatal unit.

Method: A retrospective analysis was performed of infants <30 weeks gestation who received iNO at Leicester Royal infirmary (2010-2016). iNO therapy was observed in two phases: ‘early rescue’ (ER-in the first week) and ‘late rescue’ (LR-after a week).

Results: We identified 18 infants; 9 of whom received ER (gestational age (GA) 24+3 to 29+5), 8 received LR (GA 23+5 to 28+4) at median age of 99 days (range 39-167 days) and one infant had both ER and LR. A trend towards increased mortality in those receiving LR as compared to ER (50% vs 20%) is seen. All receiving ER following prolonged rupture of membranes (PROM)/oligohydramnios survived to discharge (n=5). At 2 years, with ER, three had normal development, three had mild cognitive delay and one had moderate isolated speech delay. With LR, five survived to discharge: one received ECMO and died post-discharge. Four had confirmed viral infections. At 2 years, one child continued to need home ventilation, one had home oxygen (until 6 years), one had global developmental delay with severe speech delay and one had moderate speech and cognitive delay.

Conclusion: Most had normal or mild delay outcomes with ER. These findings were consistent with previous reports regarding treatment of infants born following PROM/oligohydramnios. The main burden of respiratory and developmental morbidity and mortality appears to be with late rescue iNO.