Persistent pulmonary hypertension of the newborn in the era before nitric oxide: practice variation and outcomes.
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| Title: | Persistent pulmonary hypertension of the newborn in the era before nitric oxide: practice variation and outcomes. |
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| Authors: | Walsh-Sukys MC (AUTHOR), Tyson JE (AUTHOR), Wright LL (AUTHOR), Bauer CR (AUTHOR), Korones SB (AUTHOR), Stevenson DK (AUTHOR), Verter J (AUTHOR), Stoll BJ (AUTHOR), Lemons JA (AUTHOR), Papile L (AUTHOR), Shankaran S (AUTHOR), Donovan EF (AUTHOR), Oh W (AUTHOR), Ehrenkranz RA (AUTHOR), Fanaroff AA (AUTHOR) |
| Source: | Pediatrics. Jan2000 Part 1 of 3, Vol. 105 Issue 1, p14-20. 7p. |
| Abstract: | OBJECTIVES: In the era before widespread use of inhaled nitric oxide, to determine the prevalence of persistent pulmonary hypertension (PPHN) in a multicenter cohort, demographic descriptors of the population, treatments used, the outcomes of those treatments, and variation in practice among centers. STUDY DESIGN: A total of 385 neonates who received >/=50% inspired oxygen and/or mechanical ventilation and had documented evidence of PPHN (2D echocardiogram or preductal or postductal oxygen difference) were tracked from admission at 12 Level III neonatal intensive care units. Demographics, treatments, and outcomes were documented. RESULTS: The prevalence of PPHN was 1.9 per 1000 live births (based on 71 558 inborns) with a wide variation observed among centers (.43-6.82 per 1000 live births). Neonates with PPHN were admitted to the Level III neonatal intensive care units at a mean of 12 hours of age (standard deviation: 19 hours). Wide variations in the use of all treatments studied were found at the centers. Hyperventilation was used in 65% overall but centers ranged from 33% to 92%, and continuous infusion of alkali was used in 75% overall, with a range of 27% to 93% of neonates. Other frequently used treatments included sedation (94%; range: 77%-100%), paralysis (73%; range: 33%-98%), and inotrope administration (84%; range: 46%-100%). Vasodilator drugs, primarily tolazoline, were used in 39% (range: 13%-81%) of neonates. Despite the wide variation in practice, there was no significant difference in mortality among centers. Mortality was 11% (range: 4%-33%). No specific therapy was clearly associated with a reduction in mortality. To determine whether the therapies were equivalent, neonates treated with hyperventilation were compared with those treated with alkali infusion. Hyperventilation reduced the risk of extracorporeal membrane oxygenation without increasing the use of oxygen at 28 days of age. In contrast, the use of alkali infusion was associated with increased use of extracorporeal membrane oxygenation (odds ratio: 5.03, compared with those treated with hyperventilation) and an increased use of oxygen at 28 days of age. CONCLUSIONS: Hyperventilation and alkali infusion are not equivalent in their outcomes in neonates with PPHN. Randomized trials are needed to evaluate the role of these common therapies. [ABSTRACT FROM AUTHOR] |
| Copyright of Pediatrics is the property of American Academy of Pediatrics and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.) | |
| Database: | Psychology and Behavioral Sciences Collection |
| FullText | Text: Availability: 0 |
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| Header | DbId: pbh DbLabel: Psychology and Behavioral Sciences Collection An: 107100733 AccessLevel: 6 PubType: Academic Journal PubTypeId: academicJournal PreciseRelevancyScore: 0 |
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| Items | – Name: Title Label: Title Group: Ti Data: Persistent pulmonary hypertension of the newborn in the era before nitric oxide: practice variation and outcomes. – Name: Author Label: Authors Group: Au Data: <searchLink fieldCode="AR" term="%22Walsh-Sukys+MC%22">Walsh-Sukys MC</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Tyson+JE%22">Tyson JE</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Wright+LL%22">Wright LL</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Bauer+CR%22">Bauer CR</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Korones+SB%22">Korones SB</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Stevenson+DK%22">Stevenson DK</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Verter+J%22">Verter J</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Stoll+BJ%22">Stoll BJ</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Lemons+JA%22">Lemons JA</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Papile+L%22">Papile L</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Shankaran+S%22">Shankaran S</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Donovan+EF%22">Donovan EF</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Oh+W%22">Oh W</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Ehrenkranz+RA%22">Ehrenkranz RA</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Fanaroff+AA%22">Fanaroff AA</searchLink> (AUTHOR) – Name: TitleSource Label: Source Group: Src Data: <searchLink fieldCode="JN" term="%22Pediatrics%22">Pediatrics</searchLink>. Jan2000 Part 1 of 3, Vol. 105 Issue 1, p14-20. 7p. – Name: Abstract Label: Abstract Group: Ab Data: OBJECTIVES: In the era before widespread use of inhaled nitric oxide, to determine the prevalence of persistent pulmonary hypertension (PPHN) in a multicenter cohort, demographic descriptors of the population, treatments used, the outcomes of those treatments, and variation in practice among centers. STUDY DESIGN: A total of 385 neonates who received >/=50% inspired oxygen and/or mechanical ventilation and had documented evidence of PPHN (2D echocardiogram or preductal or postductal oxygen difference) were tracked from admission at 12 Level III neonatal intensive care units. Demographics, treatments, and outcomes were documented. RESULTS: The prevalence of PPHN was 1.9 per 1000 live births (based on 71 558 inborns) with a wide variation observed among centers (.43-6.82 per 1000 live births). Neonates with PPHN were admitted to the Level III neonatal intensive care units at a mean of 12 hours of age (standard deviation: 19 hours). Wide variations in the use of all treatments studied were found at the centers. Hyperventilation was used in 65% overall but centers ranged from 33% to 92%, and continuous infusion of alkali was used in 75% overall, with a range of 27% to 93% of neonates. Other frequently used treatments included sedation (94%; range: 77%-100%), paralysis (73%; range: 33%-98%), and inotrope administration (84%; range: 46%-100%). Vasodilator drugs, primarily tolazoline, were used in 39% (range: 13%-81%) of neonates. Despite the wide variation in practice, there was no significant difference in mortality among centers. Mortality was 11% (range: 4%-33%). No specific therapy was clearly associated with a reduction in mortality. To determine whether the therapies were equivalent, neonates treated with hyperventilation were compared with those treated with alkali infusion. Hyperventilation reduced the risk of extracorporeal membrane oxygenation without increasing the use of oxygen at 28 days of age. In contrast, the use of alkali infusion was associated with increased use of extracorporeal membrane oxygenation (odds ratio: 5.03, compared with those treated with hyperventilation) and an increased use of oxygen at 28 days of age. CONCLUSIONS: Hyperventilation and alkali infusion are not equivalent in their outcomes in neonates with PPHN. Randomized trials are needed to evaluate the role of these common therapies. [ABSTRACT FROM AUTHOR] – Name: AbstractSuppliedCopyright Label: Group: Ab Data: <i>Copyright of Pediatrics is the property of American Academy of Pediatrics and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.) |
| PLink | https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=pbh&AN=107100733 |
| RecordInfo | BibRecord: BibEntity: Identifiers: – Type: doi Value: 10.1542/peds.105.1.14 Languages: – Code: eng Text: English PhysicalDescription: Pagination: PageCount: 7 StartPage: 14 Titles: – TitleFull: Persistent pulmonary hypertension of the newborn in the era before nitric oxide: practice variation and outcomes. Type: main BibRelationships: HasContributorRelationships: – PersonEntity: Name: NameFull: Walsh-Sukys MC – PersonEntity: Name: NameFull: Tyson JE – PersonEntity: Name: NameFull: Wright LL – PersonEntity: Name: NameFull: Bauer CR – PersonEntity: Name: NameFull: Korones SB – PersonEntity: Name: NameFull: Stevenson DK – PersonEntity: Name: NameFull: Verter J – PersonEntity: Name: NameFull: Stoll BJ – PersonEntity: Name: NameFull: Lemons JA – PersonEntity: Name: NameFull: Papile L – PersonEntity: Name: NameFull: Shankaran S – PersonEntity: Name: NameFull: Donovan EF – PersonEntity: Name: NameFull: Oh W – PersonEntity: Name: NameFull: Ehrenkranz RA – PersonEntity: Name: NameFull: Fanaroff AA IsPartOfRelationships: – BibEntity: Dates: – D: 01 M: 01 Text: Jan2000 Part 1 of 3 Type: published Y: 2000 Identifiers: – Type: issn-print Value: 00314005 Numbering: – Type: volume Value: 105 – Type: issue Value: 1 Titles: – TitleFull: Pediatrics Type: main |
| ResultId | 1 |
