Background: Despite lack of clear evidence for the benefit of iNO (inhaled nitric oxide) use in premature infants the rate of use in neonatal units around the world is rising.
1. Assess use of iNO in infants born ≤29/40 with hypoxic respiratory failure in two tertiary neonatal units in United Kingdom
2. Compare outcomes of babies born ≤29/40 who received iNO to babies ≤29/40 who didn’t receive iNO
3. Identify whether there are prognostic markers that influence outcomes in infants receiving iNO.
Method: Retrospective analysis of neonatal unit Badger Net (electronic patient record) data for all infants ≤29/40 admitted to two tertiary neonatal units in United Kingdom from 2010 to 2015 (total infants 1412).
Results: 108 (8%) infants received iNO over period of 6 years. There was no significant increase in use over the time period analysed. The majority of infants receiving iNO were 24 weeks gestation (26%). Overall mortality was 48%. At ≤29/40 the odds of dying are 6.3 times greater in infants who received iNO at any time (Odds ratio 6.3221, p<0.0001). No statistically significant prognostic markers influencing outcomes were identified. Survival curve suggests iNO delays death by approximately 10 days compared babies born ≤29/40 who died and did not receive iNO.
Conclusions: In our study infants who received iNO were 6.3 times more likely to die and hence is an indicator of disease severity. Further studies are needed to identify whether iNO use is independently associated with death or other adverse outcomes.