Two-Year Neurodevelopmental Outcomes of Ventilated Preterm Infants Treated with Inhaled Nitric Oxide
ABSTRACT In a randomized multi-center trial, we demonstrated that inhaled nitric oxide begun between 7 and 21 days and given for 24 days significantly increased survival without bronchopulmonary dysplasia (BPD) in ventilated premature infants weighing <1250 g. Because some preventative BPD treatments are associated with neurodevelopmental impairment, we designed a follow-up study to assess the safety of nitric oxide.
Our hypothesis was that inhaled nitric oxide would not increase neurodevelopmental impairment compared with placebo. We prospectively evaluated neurodevelopmental and growth outcomes at 24 months postmenstrual age in 477 of 535 surviving infants (89%) enrolled in the trial.
In the treated group, 109 of 243 children (45%) had neurodevelopmental impairment (moderate or severe cerebral palsy, bilateral blindness, bilateral hearing loss, or score <70 on the Bayley Scales II), compared with 114 of 234 (49%) in the placebo group (relative risk, 0.92; 95% CI, 0.75-1.12; P = .39). No differences on any subcomponent of neurodevelopmental impairment or growth variables were found between inhaled nitric oxide or placebo.
Inhaled nitric oxide improved survival free of BPD, with no adverse neurodevelopmental effects at 2 years of age.
Full-textDOI: · Available from: Avital Cnaan, May 30, 2015
SourceAvailable from: Emma Duerden[Show abstract] [Hide abstract]
ABSTRACT: Preterm births are rising in Canada and worldwide. As clinicians strive to identify preterm neonates at greatest risk of significant developmental or motor problems, accurate predictive tools are required. Infants at highest risk will be able to receive early developmental interventions, and will also enable clinicians to implement and evaluate new methods to improve outcomes. While severe white matter injury (WMI) is associated with adverse developmental outcome, more subtle injuries are difficult to identify and the association with later impairments remains unknown. Thus, our goal was to develop an automated method for detection and visualization of brain abnormalities in MR images acquired in very preterm born neonates. We have developed a technique to detect WMI in T1-weighted images acquired in 177 very preterm born infants (24–32 weeks gestation). Our approach uses a stochastic process that estimates the likelihood of intensity variations in nearby pixels; with small variations being more likely than large variations. We first detect the boundaries between normal and injured regions of the white matter. Following this we use a measure of pixel similarity to identify WMI regions. Our algorithm is able to detect WMI in all of the images in the ground truth dataset with some false positives in situations where the white matter region is not segmented accurately.02/2015; 156. DOI:10.1016/j.nicl.2015.02.015
Annals of Neurology 04/2014; 75(4). DOI:10.1002/ana.24132 · 11.91 Impact Factor
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ABSTRACT: New evidence indicates that nitric oxide inhalation leads to formation of new compounds which may be carried as thiol groups attached to protein in blood or act indirectly through nitrite and nitrate, metabolites which have been shown to elevate over time during exposure to inhaled NO. Additionally it has been shown that inhaled nitric oxide has no hemodynamic effects on normally perfused tissue, but increases blood flow selectively in ischemic tissue. It has a simple route of administration, safety profile and immediate action. Because of these properties, inhaled nitric oxide may serve as a rescue therapy for ischemic conditions in which collateral blood flow is important or until interventional or spontaneous reperfusion occurs. This review focuses on inhaled nitric oxide effects outside the lungs, and discusses its experimental and clinical applications, with particular attention to potential systemic effects of the gas.Polish journal of cardio-thoracic surgery 12/2012; 4(4):456-462. DOI:10.5114/kitp.2012.32684 · 0.21 Impact Factor