Published online June 1, 2007
PEDIATRICS Vol. 119 No. 6 June 2007, pp. 1159-1164 (doi:10.1542/peds.2006-2269)

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ARTICLE

Inhaled Nitric Oxide Therapy Decreases the Risk of Cerebral Palsy in Preterm Infants With Persistent Pulmonary Hypertension of the Newborn

Yuko Tanaka, MD^a, Tomoshige Hayashi, MD, PhD^b, Hiroyuki Kitajima, MD, PhD^a, Kiyoaki Sumi, MD^a, Masanori Fujimura, MD, PhD^a

^a Department of Neonatal Medicine, Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka, Japan
^b Department of Preventive Medicine and Environmental Health, Graduate School of Medicine, Osaka City University, Osaka, Japan

OBJECTIVE. The aim was to determine whether inhaled nitric oxide therapy improves neurodevelopmental outcomes for infants with preterm persistent pulmonary hypertension of the newborn.

METHODS. We conducted a historical cohort study to compare the 3-year incidence of cerebral palsy in preterm singleton infants (<34 gestational weeks) with hypoxemic respiratory failure caused by persistent pulmonary hypertension of the newborn who received inhaled nitric oxide (16 patients) or 100% oxygen (15 patients) therapy. All neonates had clinical and echocardiographic evidence of pulmonary hypertension without structural heart disease.

RESULTS. The incidence of cerebral palsy among patients treated with inhaled nitric oxide was 12.5%, whereas that among patients treated with 100% oxygen was 46.7%. After adjustment for maternal fever (38°C) during delivery, birth weight, Apgar score at 5 minutes, high-frequency oscillatory ventilation, and surfactant therapy, inhaled nitric oxide therapy, compared with 100% oxygen therapy, was associated with a decreased risk of cerebral palsy in preterm infants with persistent pulmonary hypertension of the newborn.

CONCLUSION. Inhaled nitric oxide therapy decreases the risk of cerebral palsy in preterm infants with persistent pulmonary hypertension of the newborn.

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Key Words: preterm persistent pulmonary hypertension of the newborn • inhaled nitric oxide • cerebral palsy

Abbreviations: PPHN—persistent pulmonary hypertension of the newborn • NO—nitric oxide • iNO—inhaled nitric oxide • CP—cerebral palsy • IQR—interquartile range • FIO₂—fraction of inspired oxygen

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Accepted Jan 18, 2007.

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