Original Article

Journal of Perinatology (2013) 33, 944–949; doi:10.1038/jp.2013.83; published online 18 July 2013

Impact of early surfactant and inhaled nitric oxide therapies on outcomes in term/late preterm neonates with moderate hypoxic respiratory failure

G G Konduri1, G M Sokol2, K P Van Meurs3, J Singer4, N Ambalavanan5, T Lee4 and A Solimano6 for the Neonatal Inhaled Nitric Oxide Study Group

  1. 1Division of Neonatology, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
  2. 2Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
  3. 3Department of Pediatrics, Stanford University, Palo Alto, CA, USA
  4. 4Center for Health Evaluation and Outcome Sciences, St Paul's Hospital, Vancouver, BC, Canada
  5. 5Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, USA
  6. 6Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada

Correspondence: Dr GG Konduri, Division of Neonatology, Department of Pediatrics, Children's Corporate Center Suite C410, 999N 92 Street, Wauwatosa, WI 53226, USA. E-mail: gkonduri@mcw.edu

Received 24 March 2013; Revised 23 May 2013; Accepted 7 June 2013
Advance online publication 18 July 2013





We conducted a post-hoc analysis of early inhaled nitric oxide (iNO)-randomized controlled trial data to identify associations pertinent to the management of moderate hypoxic respiratory failure in term/late preterm infants.

Study design:


Univariate and multivariate logistic regression analyses were used to determine risk factors for the progression of respiratory failure and extracorporeal membrane oxygenation (ECMO)/death.



Among the 299 enrolled infants, oxygenation index (OI) <20 at enrollment (odds ratio 0.52, confidence interval (CI) 0.27 to 0.97) and surfactant use before randomization (odds ratio 0.47, CI 0.24 to 0.91) were associated with decreased ECMO/death rates. Early surfactant use for respiratory distress syndrome, perinatal aspiration syndrome and pneumonia/sepsis was associated with lower risk of ECMO/death (P<0.001). Early iNO (OI 15 to 25) decreased the progression of respiratory failure to OI >30 (P=0.002) and to composite outcome of OI >30 or ECMO/death (P=0.02).



This post-hoc analysis suggests that early use of surfactant and iNO in moderate respiratory failure is associated with improved outcomes.


newborn; lung disease; persistent pulmonary hypertension of the newborn; PPHN; ECMO