Response categorization and outcomes in extremely premature infants born at 22-26 weeks gestation that received inhaled nitric oxide for hypoxic respiratory failure

AbstractObjective: To evaluate the outcomes of extremely premature infants who received inhaled nitric oxide (iNO) for hypoxic respiratory failure (HRF).Study Design: Retrospective analysis of 107 infants born 22-26 weeks gestation who received iNO for HRF at a single institution. Infants were categorized as positive, negative, or no responders based on change in FiO2or OI. Underlying physiology of HRF was determined.Results: 63% of infants had a positive response; they received iNO earlier and were more likely to have acute pulmonary hypertension. Positive response correlated with decreased incidence of death or grade 3 BPD at 36 weeks postmenstrual age, as compared to a negative response.Conclusions: Extremely premature infants have a positive response rate to iNO comparable to term infants when used for acute pulmonary hypertension in the transitional period. Infants with a negative response to iNO had worse outcomes, necessitating the determination of the underlying physiology of HRF prior to iNO initiation.