Dataset Information

Increase in the use of inhaled nitric oxide in neonatal intensive care units in England: a retrospective population study.

ABSTRACT:

Objective

To describe temporal changes in inhaled nitric oxide (iNO) use in English neonatal units between 2010 and 2015.

Design

Retrospective analysis using data extracted from the National Neonatal Research Database.

Setting

All National Health Service neonatal units in England.

Patients

Infants of all gestational ages born 2010-2015 admitted to a neonatal unit and received intensive care.

Main outcome measures

Proportion of infants who received iNO; age at initiation and duration of iNO use.

Results

4.9% (6346/129 883) of infants received iNO; 31% (1959/6346) were born <29 weeks, 18% (1152/6346) 29-33 weeks and 51% (3235/6346)>34 weeks of gestation. Between epoch 1 (2010-2011) and epoch 3 (2014-2015), there was (1) an increase in the proportion of infants receiving iNO: <29 weeks (4.9% vs 15.9%); 29-33 weeks (1.1% vs 4.8%); >34 weeks (4.5% vs 5.0%), (2) increase in postnatal age at iNO initiation: <29 weeks 10 days vs 18 days; 29-33 weeks 2 days vs 10 days, (iii) reduction in iNO duration: <29 weeks (3 days vs 2 days); 29-33 weeks (2 days vs 1 day).

Conclusions

Between 2010 and 2015, there was an increase in the use of iNO among infants admitted to English neonatal units. This was most notable among the most premature infants with an almost fourfold increase. Given the cost of iNO therapy, limited evidence of efficacy in preterm infants and potential for harm, we suggest that exposure to iNO should be limited, ideally to infants included in research studies (either observational or randomised placebo-controlled trial) or within a protocolised pathway. Development of consensus guidelines may also help standardise practice.

SUBMITTER: Subhedar NV

PROVIDER: S-EPMC7903123 | biostudies-literature | 2021

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Increase in the use of inhaled nitric oxide in neonatal intensive care units in England: a retrospective population study.

Subhedar Nimish V NV Jawad Sena S Oughham Kayleigh K Gale Chris C Battersby Cheryl C

BMJ paediatrics open 20210222 1

<h4>Objective</h4>To describe temporal changes in inhaled nitric oxide (iNO) use in English neonatal units between 2010 and 2015.<h4>Design</h4>Retrospective analysis using data extracted from the National Neonatal Research Database.<h4>Setting</h4>All National Health Service neonatal units in England.<h4>Patients</h4>Infants of all gestational ages born 2010-2015 admitted to a neonatal unit and received intensive care.<h4>Main outcome measures</h4>Proportion of infants who received iNO; age at ...[more]

PMID: 33705500

Similar Datasets

Project description:ObjectivesTo characterize contemporary use of inhaled nitric oxide in pediatric acute respiratory failure and to assess relationships between clinical variables and outcomes. We sought to study the relationship of inhaled nitric oxide response to patient characteristics including right ventricular dysfunction and clinician responsiveness to improved oxygenation. We hypothesize that prompt clinician responsiveness to minimize hyperoxia would be associated with improved outcomes.DesignAn observational cohort study.SettingEight sites of the Collaborative Pediatric Critical Care Research Network.PatientsOne hundred fifty-one patients who received inhaled nitric oxide for a primary respiratory indication.Measurements and main resultsClinical data were abstracted from the medical record beginning at inhaled nitric oxide initiation and continuing until the earliest of 28 days, ICU discharge, or death. Ventilator-free days, oxygenation index, and Functional Status Scale were calculated. Echocardiographic reports were abstracted assessing for pulmonary hypertension, right ventricular dysfunction, and other cardiovascular parameters. Clinician responsiveness to improved oxygenation was determined. One hundred thirty patients (86%) who received inhaled nitric oxide had improved oxygenation by 24 hours. PICU mortality was 29.8%, while a new morbidity was identified in 19.8% of survivors. Among patients who had echocardiograms, 27.9% had evidence of pulmonary hypertension, 23.1% had right ventricular systolic dysfunction, and 22.1% had an atrial communication. Moderate or severe right ventricular dysfunction was associated with higher mortality. Clinicians responded to an improvement in oxygenation by decreasing FIO2 to less than 0.6 within 24 hours in 71% of patients. Timely clinician responsiveness to improved oxygenation with inhaled nitric oxide was associated with more ventilator-free days but not less cardiac arrests, mortality, or additional morbidity.ConclusionsClinician responsiveness to improved oxygenation was associated with less ventilator days. Algorithms to standardize ventilator management may improve signal to noise ratios in future trials enabling better assessment of the effect of inhaled nitric oxide on patient outcomes. Additionally, confining studies to more selective patient populations such as those with right ventricular dysfunction may be required.

Project description:ObjectiveTo identify the primary reasons for term admissions to neonatal units in England, to determine risk factors for admissions for jaundice and to estimate the proportion who can be cared for in a transitional setting without separation of mother and baby.DesignRetrospective observational study using neonatal unit admission data from the National Neonatal Research Database and data of live births in England from the Office for National Statistics.SettingAll 163 neonatal units in England 2011-2013.Participants133?691 term babies born ?37 weeks gestational age and admitted to neonatal units in England.Primary and secondary outcomesPrimary reasons for admission, term babies admitted for the primary reason of jaundice, patient characteristics, postnatal age at admission, total length of stay, phototherapy, intravenous fluids, exchange transfusion and kernicterus.ResultsRespiratory disease was the most common reason for admission overall, although jaundice was the most common reason for admission from home (22% home vs 5% hospital). Risk factors for admission for jaundice include male, born at 37 weeks gestation, Asian ethnicity and multiple birth. The majority of babies received only a brief period of phototherapy, and only a third received intravenous fluids, suggesting that some may be appropriately managed without separation of mother and baby. Admission from home was significantly later (3.9 days) compared with those admitted from elsewhere in the hospital (1.7 days) (p<0.001).ConclusionAround two-thirds of term admissions for jaundice may be appropriately managed in a transitional care setting, avoiding separation of mother and baby. Babies with risk factors may benefit from a community midwife postnatal visit around the third day of life to enable early referral if necessary. We recommend further work at the national level to examine provision and barriers to transitional care, referral pathways between primary and secondary care, and community postnatal care.

Dataset Information

Increase in the use of inhaled nitric oxide in neonatal intensive care units in England: a retrospective population study.

Objective

Design

Setting

Patients

Main outcome measures

Results

Conclusions

Publications

Increase in the use of inhaled nitric oxide in neonatal intensive care units in England: a retrospective population study.

Similar Datasets

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