The outcome of very low birth weight neonates (<= 1500g) rescued by inhaled nitric oxide: Neurodevelopment in early childhood

Although inhaled nitric oxide (INO) improves oxygenation in critically ill neonates, the neurodevelopmental outcome of premature neonates with severe hypoxemic respiratory failure treated with INO has not been reported. Morta lity and prospective neurodevelopmental assessment in early childhood were studied in a cohort of 24 very low birth weight neonates (less than or equa l to 1500 g) consecutively admitted from 1993 to 1997 and rescued with INO because of severe hypoxemic respiratory failure (oxygenation index 28 to 52 ) unresponsive to aggressive conventional treatment. Significant improvemen ts in arterial oxygen tension and oxygenation index with lower inspired oxy gen concentration and less ventilator support after initiating INO were obs erved (P < .05, analysis of variance). Despite the dramatic improvement in systemic oxygenation, the mortality rate was high (14 of 24, 58%). Only 6 o f 23 had normal cranial ultrasonographies. At 13 to 40 (22 +/- 10) months o f adjusted age, 10 survivors had Bayley Scales mental and psychomotor devel opmental indexes of 81 +/- 21 and 64 +/- 22, respectively. Of the 10 childr en, 5 (50%) were disabled, 2 (20%) were developmentally delayed, and 3 (30% ) had normal development. In view of the poor outcome in very low-birth-wei ght neonates rescued by INO, randomized con trolled trials are required to examine the role of INO in premature neonates. Before, during, and after IN O therapy, cranial ultrasonography is recommended.