We prospectively followed the neurodevelopmental (ND), hearing and pulmonary outcomes of 30 survivors (GA 31-42 wks) treated with inhaled nitric oxide (iNO). They met echocardiographic and clinical criteria for severe persistent pulmonary hypertension (PPHN) and were treated with 6 to 20 ppm NO(M = 76 hrs). Diagnoses were meconium aspiration (14), diaphragmatic hernia(1), asphyxia (4), sepsis (11), pulmonary hypoplasia (1), and congenital syndromes (2). Follow-up assessments were by Bayley Scales, auditory brainstem response or behavioral audiometry. The ND outcome was considered normal if both motor (PDI) and mental (MDI) scores were >84, suspect if either PDI or MDI was <84, and abnormal if both were <84. Three infants were lost to follow-up. The evaluations of the remaining 27 infants (median age = 20 mos) are shown below. Table
Of the 5 infants with abnormal hearing, one has a denovo unbalanced chromosomal translocation. One infant with a cleft palate has unilateral hearing loss. The other three have conductive hearing loss. The infant with the translocation also has an abnormal ND exam. Of the three infants with suspect ND exams, two had sepsis and one was exposed to in-utero cocaine and meconium aspiration. Two infants have residual lung disease and failure-to-thrive, but normal ND exams. At follow-up, 24/27 infants (90%) have both MDI and PDI > 84, and 22/27 (81.5%) have normal hearing. Our results suggest no identifiable pattern of long-term effects from iNO and reassuring ND and hearing outcomes.
(Spon. by Mikko Hallman).
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Infant lung function after inhaled nitric oxide therapy for persistent pulmonary hypertension of the newborn
Pediatric Pulmonology (1999)