Smartest Doc
Transient Defect in Nitric Oxide Generation after Rupture of Fetal Membranes and Responsiveness to Inhaled Nitric Oxide in Very Preterm Infants with Hypoxic Respiratory Failure
The Journal of Pediatrics, 05/18/2012
Aikio O et al. – Seven percent of VLGA infants with preterm rupture of membranes and 15% of those with prolonged preterm rupture of membranes (PPROM) developed hypoxic respiratory failure (HRF), characterized by pulmonary hypertension that acutely responds to iNO. These infants may have a transient deficiency in the inflammatory response, including a defect in nitric oxide generation in airspaces.
Methods- Of a cohort of 765 VLGA infants, 144 required mechanical ventilation.
- Airway specimens from these patients were prospectively studied.
- Infants who developed HRF (oxygenation index >25) with echocardiographic diagnosis of pulmonary hypertension were treated with inhaled nitric oxide (iNO).
- Three gestation comparison groups were formed on the basis of specific antenatal complications: prolonged preterm rupture of membranes (PPROM), spontaneous preterm birth, and preeclampsia.
- Seventeen (2.2% of all VLGA infants) developed HRF.
- In all 17 cases, PPROM complicated the antenatal course; these infants responded to iNO, regardless of infection or PPROM.
- The chest radiographs of HRF and non-HRF PPROM infants were similar.
- Airway proinflammatory cytokines and nitrite + nitrate levels were low in infants with HRF, but they increased during iNO treatment and remained elevated after discontinuation of iNO.
- Each of the 3 comparison groups had different and characteristic patterns of airway cytokines and nitrite + nitrate levels.
