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Early Oxygenation and Mortality in Infants Treated with Inhaled Nitric Oxide (iNO) for Persistent Pulmonary Hypertension of the Newborn (PPHN)

Year: 2025

Type: article

Abstract: To evaluate if oxygenation levels and exposure to hyperoxemia in the first 12 postnatal hours are associated with death in neonates treated with inhaled nitric oxide (iNO) for persistent pulmonary hypertension of newborn (PPHN). Retrospective study of neonates ≥35 weeks with PPHN treated with iNO. The cohort was divided into four groups based on maximum PaO 2 within the first 12 hours: hypoxemia (< 60 mmHg), normoxemia (60-99 mmHg), mild-moderate (100-199mmHg) and severe hyperoxemia (≥200mmHg). The primary outcome was death before discharge. 118 neonates were included. Hypoxemia, normoxemia, mild-moderate and severe hyperoxemia were present in 14%, 36%, 32% and 17% of infants, respectively. Mortality followed a U-shaped relationship, with significantly higher rates in hypoxemia (23%) and the severe hyperoxemia (30%) groups and and no deaths in the normoxemia group (p< 0.05). In multivariable Firth logistic regression controlling for confounders, both hypoxemia [OR 29.0 (95% CI 2.8 – 3937.2, p<0.01)] and severe hyperoxemia [OR 39.0 (95% CI 4.2 – 5204.3, p<0.01)] remained significantly associated with increased odds of death compared to normoxemia. Early hypoxemia and severe hyperoxemia were associated with mortality in infants with PPHN. These findings underscore the importance of cautious oxygen titration. Prospective studies are needed to establish optimal oxygen management strategies in this population.

Source: The Journal of Pediatrics Clinical Practice

DOI: 10.1016/j.jpedcp.2025.200189