Inhaled nitric oxide usage in preterm infants in the NICHD neonatal research network

Inter-site variation and propensity evaluation

W. E. Truog, L. D. Nelin, A. Das, D. E. Kendrick, E. F. Bell, W. A. Carlo, R. D. Higgins, A. R. Laptook, P. J. Sanchez, S. Shankaran, B. J. Stoll, K. P. Van Meurs, M. C. Walsh

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Objective:The use of inhaled nitric oxide (iNO) in preterm infants remains controversial. In October 2010, a National Institutes of Health consensus development conference cautioned against use of iNO in preterm infants. This study aims (1) to determine the prevalence and variability in use of iNO in the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network (NICHD NRN) before and after the consensus conference and (2) separately, to examine associations between iNO use and severe bronchopulmonary dysplasia (BPD) or death.

Study design:The NICHD NRN Generic Database collects data including iNO use on very preterm infants. A total of 13 centers contributed data across the time period 2008 to 2011. Infants exposed or not to iNO were compared using logistic regression, which included factors related to risk as well as their likelihood of being exposed to iNO.

Result:A total of 4885 infants were assessed between 2008 and 2011; 128 (2.6%) received iNO before day 7, 140 (2.9%) between day 7 and 28, and 47 (1.0%) at >28 days. Center-specific iNO use during 2008 to 2010 ranged from 21.9 to 0.4%; 12 of 13 sites reduced usage and overall NRN iNO usage decreased from 4.6 to 1.6% (P<0.001) in 2011. The use of iNO started between day 7 and day 14 was more prevalent among younger infants with more severe courses in week 1 and associated with increased risk of severe BPD or death (odds ratio 2.24; 95% confidence interval 1.23 to 4.07).

Conclusion:The variability and total use of iNO decreased in 2011 compared with 2008 to 2010. iNO administration started at ≥day 7 was associated with more severe outcomes compared with infants without iNO exposure.

Original languageEnglish (US)
Pages (from-to)842-846
Number of pages5
JournalJournal of Perinatology
Volume34
Issue number11
DOIs
StatePublished - Nov 5 2014

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National Institute of Child Health and Human Development (U.S.)
Premature Infants
Nitric Oxide
Research
Bronchopulmonary Dysplasia
Consensus Development Conferences
National Institutes of Health (U.S.)

ASJC Scopus subject areas

  • Obstetrics and Gynecology
  • Pediatrics, Perinatology, and Child Health

Cite this

Truog, W. E., Nelin, L. D., Das, A., Kendrick, D. E., Bell, E. F., Carlo, W. A., ... Walsh, M. C. (2014). Inhaled nitric oxide usage in preterm infants in the NICHD neonatal research network: Inter-site variation and propensity evaluation. Journal of Perinatology, 34(11), 842-846. https://doi.org/10.1038/jp.2014.105

Inhaled nitric oxide usage in preterm infants in the NICHD neonatal research network : Inter-site variation and propensity evaluation. / Truog, W. E.; Nelin, L. D.; Das, A.; Kendrick, D. E.; Bell, E. F.; Carlo, W. A.; Higgins, R. D.; Laptook, A. R.; Sanchez, P. J.; Shankaran, S.; Stoll, B. J.; Van Meurs, K. P.; Walsh, M. C.

In: Journal of Perinatology, Vol. 34, No. 11, 05.11.2014, p. 842-846.

Research output: Contribution to journalArticle

Truog, WE, Nelin, LD, Das, A, Kendrick, DE, Bell, EF, Carlo, WA, Higgins, RD, Laptook, AR, Sanchez, PJ, Shankaran, S, Stoll, BJ, Van Meurs, KP & Walsh, MC 2014, 'Inhaled nitric oxide usage in preterm infants in the NICHD neonatal research network: Inter-site variation and propensity evaluation', Journal of Perinatology, vol. 34, no. 11, pp. 842-846. https://doi.org/10.1038/jp.2014.105
Truog, W. E. ; Nelin, L. D. ; Das, A. ; Kendrick, D. E. ; Bell, E. F. ; Carlo, W. A. ; Higgins, R. D. ; Laptook, A. R. ; Sanchez, P. J. ; Shankaran, S. ; Stoll, B. J. ; Van Meurs, K. P. ; Walsh, M. C. / Inhaled nitric oxide usage in preterm infants in the NICHD neonatal research network : Inter-site variation and propensity evaluation. In: Journal of Perinatology. 2014 ; Vol. 34, No. 11. pp. 842-846.
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abstract = "Objective:The use of inhaled nitric oxide (iNO) in preterm infants remains controversial. In October 2010, a National Institutes of Health consensus development conference cautioned against use of iNO in preterm infants. This study aims (1) to determine the prevalence and variability in use of iNO in the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network (NICHD NRN) before and after the consensus conference and (2) separately, to examine associations between iNO use and severe bronchopulmonary dysplasia (BPD) or death.Study design:The NICHD NRN Generic Database collects data including iNO use on very preterm infants. A total of 13 centers contributed data across the time period 2008 to 2011. Infants exposed or not to iNO were compared using logistic regression, which included factors related to risk as well as their likelihood of being exposed to iNO.Result:A total of 4885 infants were assessed between 2008 and 2011; 128 (2.6{\%}) received iNO before day 7, 140 (2.9{\%}) between day 7 and 28, and 47 (1.0{\%}) at >28 days. Center-specific iNO use during 2008 to 2010 ranged from 21.9 to 0.4{\%}; 12 of 13 sites reduced usage and overall NRN iNO usage decreased from 4.6 to 1.6{\%} (P<0.001) in 2011. The use of iNO started between day 7 and day 14 was more prevalent among younger infants with more severe courses in week 1 and associated with increased risk of severe BPD or death (odds ratio 2.24; 95{\%} confidence interval 1.23 to 4.07).Conclusion:The variability and total use of iNO decreased in 2011 compared with 2008 to 2010. iNO administration started at ≥day 7 was associated with more severe outcomes compared with infants without iNO exposure.",
author = "Truog, {W. E.} and Nelin, {L. D.} and A. Das and Kendrick, {D. E.} and Bell, {E. F.} and Carlo, {W. A.} and Higgins, {R. D.} and Laptook, {A. R.} and Sanchez, {P. J.} and S. Shankaran and Stoll, {B. J.} and {Van Meurs}, {K. P.} and Walsh, {M. C.}",
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AU - Nelin, L. D.

AU - Das, A.

AU - Kendrick, D. E.

AU - Bell, E. F.

AU - Carlo, W. A.

AU - Higgins, R. D.

AU - Laptook, A. R.

AU - Sanchez, P. J.

AU - Shankaran, S.

AU - Stoll, B. J.

AU - Van Meurs, K. P.

AU - Walsh, M. C.

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N2 - Objective:The use of inhaled nitric oxide (iNO) in preterm infants remains controversial. In October 2010, a National Institutes of Health consensus development conference cautioned against use of iNO in preterm infants. This study aims (1) to determine the prevalence and variability in use of iNO in the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network (NICHD NRN) before and after the consensus conference and (2) separately, to examine associations between iNO use and severe bronchopulmonary dysplasia (BPD) or death.Study design:The NICHD NRN Generic Database collects data including iNO use on very preterm infants. A total of 13 centers contributed data across the time period 2008 to 2011. Infants exposed or not to iNO were compared using logistic regression, which included factors related to risk as well as their likelihood of being exposed to iNO.Result:A total of 4885 infants were assessed between 2008 and 2011; 128 (2.6%) received iNO before day 7, 140 (2.9%) between day 7 and 28, and 47 (1.0%) at >28 days. Center-specific iNO use during 2008 to 2010 ranged from 21.9 to 0.4%; 12 of 13 sites reduced usage and overall NRN iNO usage decreased from 4.6 to 1.6% (P<0.001) in 2011. The use of iNO started between day 7 and day 14 was more prevalent among younger infants with more severe courses in week 1 and associated with increased risk of severe BPD or death (odds ratio 2.24; 95% confidence interval 1.23 to 4.07).Conclusion:The variability and total use of iNO decreased in 2011 compared with 2008 to 2010. iNO administration started at ≥day 7 was associated with more severe outcomes compared with infants without iNO exposure.

AB - Objective:The use of inhaled nitric oxide (iNO) in preterm infants remains controversial. In October 2010, a National Institutes of Health consensus development conference cautioned against use of iNO in preterm infants. This study aims (1) to determine the prevalence and variability in use of iNO in the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network (NICHD NRN) before and after the consensus conference and (2) separately, to examine associations between iNO use and severe bronchopulmonary dysplasia (BPD) or death.Study design:The NICHD NRN Generic Database collects data including iNO use on very preterm infants. A total of 13 centers contributed data across the time period 2008 to 2011. Infants exposed or not to iNO were compared using logistic regression, which included factors related to risk as well as their likelihood of being exposed to iNO.Result:A total of 4885 infants were assessed between 2008 and 2011; 128 (2.6%) received iNO before day 7, 140 (2.9%) between day 7 and 28, and 47 (1.0%) at >28 days. Center-specific iNO use during 2008 to 2010 ranged from 21.9 to 0.4%; 12 of 13 sites reduced usage and overall NRN iNO usage decreased from 4.6 to 1.6% (P<0.001) in 2011. The use of iNO started between day 7 and day 14 was more prevalent among younger infants with more severe courses in week 1 and associated with increased risk of severe BPD or death (odds ratio 2.24; 95% confidence interval 1.23 to 4.07).Conclusion:The variability and total use of iNO decreased in 2011 compared with 2008 to 2010. iNO administration started at ≥day 7 was associated with more severe outcomes compared with infants without iNO exposure.

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