LONGITUDINAL FOLLOW-UP OF A COHORT OF NEWBORN-INFANTS TREATED WITH INHALED NITRIC-OXIDE FOR PERSISTENT PULMONARY-HYPERTENSION

Objective: To describe the outcome of a group of term newborn infants treated with inhaled nitric oxide for severe persistent pulmonary hype rtension. Study design: We performed a prospective longitudinal medica l and neurodevelopmental follow-up of 51 infants treated as neonates f or persistent pulmonary hypertension of the newborn with inhaled nitri c oxide. The original number of treated infants was 87, of whom 25 die d in the neonatal period; of 62 infants who survived, 51 were seen at 1 year of age and 33 completed a 2-year evaluation. Statistical analys is used population medians, means, and standard deviations for paramet ers assessed. Paired 1 tests and chi-square analysis were used to comp are outcomes measured at 1 year with assessments at 2 years for the 32 infants seen at both 1- and 2-year visits. Results: At 1-year follow- up median growth percentiles were 20%, 72.5%, and 50% for weight, leng th, and occipitofrontal circumference, respectively. Thirteen of 51 in fants (25.5%) were <5th percentile in weight. Nine of 51 infants (17.6 %) had feeding problems (need for gastrostomy feeding or gastroesophag eal reflux), and 14 (27.5%) had a clinical diagnosis of reactive airwa ys disease. Infant development as measured by the Bayley Scales of Inf ant Development was 104 +/- 16 for the mental development index and 97 +/- 20 for the psychomotor index. Six of 51 infants (11.8%) were foun d to have severe neurologic handicaps, defined as a Bayley score on ei ther the mental development or psychomotor index of <68, abnormal find ings on neurologic examination, or both. Fewer children (6.1% vs 15.7% ) required supplemental oxygen at 2 years compared with 1 year, and pe rformance on the psychomotor index of the Bayley Scales improved signi ficantly. Conclusions: One- and 2-year follow-up of a cohort of infant s with persistent pulmonary hypertension of the newborn who were treat ed with inhaled nitric oxide had an 11.8% (1 year) and 12.1% (2-year) rate of severe neurodevelopmental disability. There are ongoing medica l problems in these infants including reactive airways disease and slo w growth that merit continued close longitudinal follow-up.