Safety of withdrawing inhaled nitric oxide therapy in persistent pulmonary hypertension of the newborn.

Abstract:

OBJECTIVE:Because of case reports describing hypoxemia on withdrawal of inhaled nitric oxide (I-NO), we prospectively examined this safety issue in newborns with persistent pulmonary hypertension who were classified as treatment successes or failures during a course of I-NO therapy. METHODS:Randomized, placebo-controlled, double-masked, dose-response clinical trial at 25 tertiary centers from April 1994 to June 1996. Change in oxygenation and outcome (death and/or extracorporeal membrane oxygenation) during or immediately after withdrawing I-NO were the principal endpoints. Patients (n = 155) were term infants, <3 days old at study entry with echocardiographic evidence of persistent pulmonary hypertension of the newborn. Exclusion criteria included previous surfactant treatment, high-frequency ventilation, or lung hypoplasia. Withdrawal from treatment gas (0, 5, 20, or 80 ppm) started once treatment success or failure criteria were met. Withdrawal of treatment gas occurred at 20% decrements at <4 hours between steps. RESULTS:The patient profile was similar for placebo and I-NO groups. Treatment started at an oxygenation index (OI) of 25 +/- 10 (mean +/- SD) at 26 +/- 18 hours after birth. For infants classified as treatment successes (mean duration of therapy = 88 hours, OI <10), decreases in the arterial partial pressure of oxygen (PaO(2)) were observed only at the final step of withdrawal. On cessation from 1, 4, and 16 ppm, patients receiving I-NO demonstrated a dose-related reduction in PaO(2) (-11 +/- 23, -28 +/- 24, and -50 +/- 48 mm Hg, respectively). For infants classified as treatment failures (mean duration of therapy = 10 hours), no change in OI occurred for the placebo group (-13 +/- 36%, OI of 31 +/- 11 after the withdrawal process); however a 42 +/- 101% increase in OI to 46 +/- 21 occurred for the pooled nitric oxide doses. One death was possibly related to withdrawal of I-NO. CONCLUSION:For infants classified as treatment successes, a dose response between the I-NO dose and decrease in PaO(2) after discontinuing I-NO was found. A reduction in I-NO to 1 ppm before discontinuation of the drug seems to minimize the decrease in PaO(2) seen. For infants failing treatment, discontinuation of I-NO could pose a life-threatening reduction in oxygenation should extracorporeal membrane oxygenation not be readily available or I-NO cannot be continued on transport.

journal_name

Pediatrics

journal_title

Pediatrics

authors

Davidson D,Barefield ES,Kattwinkel J,Dudell G,Damask M,Straube R,Rhines J,Chang CT

doi

10.1542/peds.104.2.231

subject

Has Abstract

pub_date

1999-08-01 00:00:00

pages

231-6

issue

2 Pt 1

eissn

0031-4005

issn

1098-4275

journal_volume

104

pub_type

临床试验,杂志文章,多中心研究,随机对照试验
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    journal_title:Pediatrics

    pub_type: 杂志文章

    doi:10.1542/peds.2010-3664

    authors: Jago R,Davison KK,Thompson JL,Page AS,Brockman R,Fox KR

    更新日期:2011-09-01 00:00:00

  • Erythromelalgia.

    abstract::Erythromelalgia is an extraordinary disease which remains elusive in its pathophysiology and management. Victims suffer intense burning and redness of the hands and feet. In what appears to be the antithesis of Raynaud's disease, the pain is relieved by emersion in cold. A child with erythromelalgia is described whose...

    journal_title:Pediatrics

    pub_type: 杂志文章

    doi:

    authors: Mandell F,Folkman J,Matsumoto S

    更新日期:1977-01-01 00:00:00

  • Iodine deficiency, pollutant chemicals, and the thyroid: new information on an old problem.

    abstract::Many women of reproductive age in the United States are marginally iodine deficient, perhaps because the salt in processed foods is not iodized. Iodine deficiency, per se, can interfere with normal brain development in their offspring; in addition, it increases vulnerability to the effects of certain environmental pol...

    journal_title:Pediatrics

    pub_type: 杂志文章,评审

    doi:10.1542/peds.2014-0900

    authors: Council on Environmental Health.,Rogan WJ,Paulson JA,Baum C,Brock-Utne AC,Brumberg HL,Campbell CC,Lanphear BP,Lowry JA,Osterhoudt KC,Sandel MT,Spanier A,Trasande L

    更新日期:2014-06-01 00:00:00

  • Subcutaneous fat necrosis after moderate therapeutic hypothermia in neonates.

    abstract::Therapeutic moderate hypothermia in newborns with hypoxic-ischemic encephalopathy is rapidly becoming standard clinical practice. We report here 12 cases of subcutaneous fat necrosis among 1239 cases registered with a national registry of newborns treated with moderate whole-body hypothermia. All the infants suffered ...

    journal_title:Pediatrics

    pub_type: 杂志文章

    doi:10.1542/peds.2010-3508

    authors: Strohm B,Hobson A,Brocklehurst P,Edwards AD,Azzopardi D,UK TOBY Cooling Register.

    更新日期:2011-08-01 00:00:00

  • Readmissions among children previously hospitalized with pneumonia.

    abstract:BACKGROUND AND OBJECTIVES:Pneumonia is a leading cause of hospitalization and readmission in children. Understanding the patient characteristics associated with pneumonia readmissions is necessary to inform interventions to reduce avoidable hospitalizations and related costs. The objective of this study was to characte...

    journal_title:Pediatrics

    pub_type: 杂志文章,多中心研究

    doi:10.1542/peds.2014-0331

    authors: Neuman MI,Hall M,Gay JC,Blaschke AJ,Williams DJ,Parikh K,Hersh AL,Brogan TV,Gerber JS,Grijalva CG,Shah SS

    更新日期:2014-07-01 00:00:00

  • The vulnerability of the medical student: posthumous presentation of L.L. Stephens' ideas.

    abstract::L.L. Stephens described several critical issues in medical professionalization. The encounter with morbidity and mortality heightens the student's feelings of vulnerability. If he over-identifies with patients, he may suffer more and be unable to provide rational medical care. If he protects himself by dehumanizing pa...

    journal_title:Pediatrics

    pub_type: 传,历史文章,杂志文章

    doi:

    authors: Werner ER,Korsch BM

    更新日期:1976-03-01 00:00:00

  • Hypertension and Neuroimaging Changes After Bevacizumab for Retinopathy of Prematurity.

    abstract::Bevacizumab is a human monoclonal immunoglobulin G1 antibody to vascular endothelial growth factor indicated in several adult diseases. Emerging literature and expert opinion support the off-label use of intravitreal bevacizumab in the treatment of retinopathy of prematurity (ROP), a common disease process seen in pre...

    journal_title:Pediatrics

    pub_type: 杂志文章

    doi:10.1542/peds.2019-1814

    authors: Twitty G,Weiss M,Albayram MS,O'Mara K,Mowitz ME

    更新日期:2020-01-01 00:00:00

  • Risk of respiratory illness associated with day-care attendance: a nationwide study.

    abstract::The risk of respiratory and other illnesses in children (age groups: 6 weeks through 17 months, 18 through 35 months, and 36 through 59 months) in various types of day-care facilities was studied. Children considered exposed to day care were those who were enrolled in day care with at least one unrelated child for at ...

    journal_title:Pediatrics

    pub_type: 杂志文章

    doi:

    authors: Hurwitz ES,Gunn WJ,Pinsky PF,Schonberger LB

    更新日期:1991-01-01 00:00:00

  • Universal hepatitis B immunization.

    abstract:OBJECTIVE:To determine the practices of US nurseries, neonatal intensive care units (NICUs), and pediatricians regarding universal hepatitis B vaccination. DESIGN:Descriptive cross-sectional survey. PARTICIPANTS:One hundred forty term nurseries, 152 NICUs, and 157 pediatricians. Selection procedure. Nurseries and NIC...

    journal_title:Pediatrics

    pub_type: 杂志文章

    doi:

    authors: Kim SC,Sinai LN,Casey R,Pinto-Martin JA

    更新日期:1995-05-01 00:00:00

  • Imbalance between production and conjugation of bilirubin: a fundamental concept in the mechanism of neonatal jaundice.

    abstract:OBJECTIVE:The objective of this study was to evaluate the roles of production and conjugation of bilirubin, individually and in combination, in the mechanism of neonatal jaundice. METHODS:A cohort of healthy, term male newborns was sampled on the third day of life, coincident with routine metabolic screening, for bloo...

    journal_title:Pediatrics

    pub_type: 杂志文章

    doi:10.1542/peds.110.4.e47

    authors: Kaplan M,Muraca M,Hammerman C,Rubaltelli FF,Vilei MT,Vreman HJ,Stevenson DK

    更新日期:2002-10-01 00:00:00

  • Early intervention improves cognitive outcomes for preterm infants: randomized controlled trial.

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    journal_title:Pediatrics

    pub_type: 杂志文章,随机对照试验

    doi:10.1542/peds.2010-0778

    authors: Nordhov SM,Rønning JA,Dahl LB,Ulvund SE,Tunby J,Kaaresen PI

    更新日期:2010-11-01 00:00:00

  • Social factors associated with prolonged hospitalization among diabetic children.

    abstract:OBJECTIVE:To determine social factors associated with increased risk of hospital admission from diabetic ketoacidosis (DKA) or diabetic coma as well as risk of prolonged hospital stay. METHODS:A cohort of all children (

    journal_title:Pediatrics

    pub_type: 杂志文章

    doi:10.1542/peds.109.1.40

    authors: Keenan HT,Foster CM,Bratton SL

    更新日期:2002-01-01 00:00:00

  • Accuracy and precision of low-dose insulin administration.

    abstract:OBJECTIVE:To determine the lowest dose of concentrated (U100) insulin that can be reproducibly delivered. METHODS:A telephone survey was used to determine current practices in major pediatric hospitals regarding the administration of low doses of concentrated insulin. A sensitive gravitometric technique was used to de...

    journal_title:Pediatrics

    pub_type: 杂志文章

    doi:

    authors: Casella SJ,Mongilio MK,Plotnick LP,Hesterberg MP,Long CA

    更新日期:1993-06-01 00:00:00

  • Annual summary of vital statistics--1980.

    abstract::Data for this article, as in previous reports, are drawn principally from the Monthly Vital Statistics Report, published by the National Center for Health Statistics. The international data come from the Demographic Yearbook and the quarterly Population and Vital Statistics Report, both published by the Statistical Of...

    journal_title:Pediatrics

    pub_type: 杂志文章

    doi:

    authors: Wegman ME

    更新日期:1981-12-01 00:00:00

  • Comparison of urinary lactic dehydrogenase with antibody-coated bacteria in the urine sediment as means of localizing the site of urinary tract infection.

    abstract::Two noninvasive methods of localizing the site of urinary tract infection, urinary lactic dehydrogenase (LDH) isoenzymes and antibody coating of bacteria in the urinary sediment, have been prospectively compared with the bladder washout technique in a series of children with urinary tract infection. Fifteen children h...

    journal_title:Pediatrics

    pub_type: 杂志文章

    doi:

    authors: Lorentz WB Jr,Resnick MI

    更新日期:1979-11-01 00:00:00

  • Computer-based documentation: effects on parent-provider communication during pediatric health maintenance encounters.

    abstract:OBJECTIVE:The goal was to investigate the impact of a computer-based documentation tool on parent-health care provider communication during a pediatric health maintenance encounter. METHODS:We used a quasiexperimental study design to compare communication dynamics between clinicians and parents/children in health main...

    journal_title:Pediatrics

    pub_type: 杂志文章

    doi:10.1542/peds.2007-3005

    authors: Johnson KB,Serwint JR,Fagan LA,Thompson RE,Wilson ME,Roter D

    更新日期:2008-09-01 00:00:00

  • Racial and ethnic disparities in medical and dental health, access to care, and use of services in US children.

    abstract:BACKGROUND:Not enough is known about the national prevalence of racial/ethnic disparities in children's medical and dental care. OBJECTIVE:The purpose of this work was to examine racial/ethnic disparities in medical and oral health, access to care, and use of services in a national sample. METHODS:The National Survey...

    journal_title:Pediatrics

    pub_type: 杂志文章

    doi:10.1542/peds.2007-1243

    authors: Flores G,Tomany-Korman SC

    更新日期:2008-02-01 00:00:00

  • Effect of phototherapy on nitrogen and electrolyte levels and water balance in jaundiced preterm infants.

    abstract::Twenty-four-hour metabolic balance studies were performed in ten jaundiced preterm infants, five light-treated (phototherapy) and five controls. Each of the light-treated infants was studied twice, once during phototherapy (period I) and once 48 hours after phototherapy (period II). Control infants were similarly stud...

    journal_title:Pediatrics

    pub_type: 杂志文章

    doi:

    authors: Wu PY,Moosa A

    更新日期:1978-02-01 00:00:00

  • Prevention and management of positional skull deformities in infants. American Academy of Pediatrics Committee on Practice and Ambulatory Medicine, Section on Plastic Surgery and Section on Neurological Surgery.

    abstract::Cranial asymmetry may be present at birth or may develop during the first few months of life. Over the past several years, pediatricians have seen an increase in the number of children with cranial asymmetry, particularly unilateral flattening of the occiput. This increase likely is attributable to parents following t...

    journal_title:Pediatrics

    pub_type: 指南,杂志文章,实务指引

    doi:10.1542/peds.112.1.199

    authors: Persing J,James H,Swanson J,Kattwinkel J,American Academy of Pediatrics Committee on Practice and Ambulatory Medicine, Section on Plastic Surgery and Section on Neurological Surgery.

    更新日期:2003-07-01 00:00:00

  • Clinical comparison of localized intestinal perforation and necrotizing enterocolitis in neonates.

    abstract:OBJECTIVE:To better define the prognosis of neonates with gastrointestinal perforation and improve their management. METHODS:We reviewed the results of physical examinations, laboratory results, and radiographic tests of 42 patients in whom gastrointestinal perforation was diagnosed in our neonatal intensive care unit...

    journal_title:Pediatrics

    pub_type: 杂志文章

    doi:

    authors: Buchheit JQ,Stewart DL

    更新日期:1994-01-01 00:00:00

  • Probability of coincident vaccination in the 24 or 48 hours preceding sudden infant death syndrome death in Australia.

    abstract:OBJECTIVE:Vaccination does not cause sudden infant death syndrome (SIDS). However, SIDS peaks at 2 months of age, when vaccination encounters are frequent. There are no published estimates using population data on age of death and immunization coverage to indicate to practitioners how often coincident vaccination may o...

    journal_title:Pediatrics

    pub_type: 杂志文章

    doi:10.1542/peds.2004-2185

    authors: Brotherton JM,Hull BP,Hayen A,Gidding HF,Burgess MA

    更新日期:2005-06-01 00:00:00

  • Breastfeeding, Cognitive and Noncognitive Development in Early Childhood: A Population Study.

    abstract:BACKGROUND AND OBJECTIVES:There is mixed evidence from correlational studies that breastfeeding impacts children's development. Propensity score matching with large samples can be an effective tool to remove potential bias from observed confounders in correlational studies. The aim of this study was to investigate the ...

    journal_title:Pediatrics

    pub_type: 杂志文章

    doi:10.1542/peds.2016-1848

    authors: Girard LC,Doyle O,Tremblay RE

    更新日期:2017-04-01 00:00:00

  • Otitis media in developing countries.

    abstract:OBJECTIVE:This article reviews the available information concerning the disease burden, epidemiology, and etiology of otitis media in developing countries and the likelihood that case management with appropriate antibiotic therapy can reduce the burden of this disease. METHODOLOGY:The available literature was reviewed...

    journal_title:Pediatrics

    pub_type: 杂志文章,评审

    doi:

    authors: Berman S

    更新日期:1995-07-01 00:00:00

  • A method for evaluating performance of ambulatory pediatric tasks.

    abstract::Four evaluations of ambulatory pediatric tasks were used for quality assurance in eight pediatric group practices situated in two teaching hospitals and six related health centers. The evaluations used criteria incorporating branching logic to judge the quality of care revealed in data abstracted from medical records....

    journal_title:Pediatrics

    pub_type: 杂志文章

    doi:

    authors: Palmer RH,Strain R,Maurer JV,Thompson MS

    更新日期:1984-03-01 00:00:00

  • Impact of a bronchiolitis guideline on ED resource use and cost: a segmented time-series analysis.

    abstract:OBJECTIVE:Bronchiolitis is a major cause of infant morbidity and contributes to millions of dollars in health care costs. Care guidelines may cut costs by reducing unnecessary resource utilization. Through the implementation of a guideline, we sought to reduce unnecessary resource utilization and improve the value of c...

    journal_title:Pediatrics

    pub_type: 杂志文章

    doi:10.1542/peds.2013-1991

    authors: Akenroye AT,Baskin MN,Samnaliev M,Stack AM

    更新日期:2014-01-01 00:00:00

  • Nosocomial transmission of group B Streptococci in a newborn nursery.

    abstract::Group B streptococcal colonization of normal newborn infants increased from 22.5% within 20 hours of birth to 65.4% at the time of hospital discharge (P less than .001). In contrast, colonization in mothers did not change significantly between the time of admission to labor and delivery (27.7%) and the time of dischar...

    journal_title:Pediatrics

    pub_type: 杂志文章

    doi:

    authors: Paredes A,Wong P,Mason EO Jr,Taber LH,Barrett FF

    更新日期:1977-05-01 00:00:00

  • Pediatric residents' continuity clinics: how are we really doing?

    abstract::The Accreditation Council for Graduate Medical Education (ACGME) established guidelines in 1989 requiring pediatric residents to attend a continuity clinic (CC) one half-day per week. OBJECTIVE. To assess pediatric residents' CCs, with an emphasis on those factors potentially affecting house staff education and patien...

    journal_title:Pediatrics

    pub_type: 杂志文章

    doi:

    authors: Dumont-Driscoll MC,Barbian LT,Pollock BH

    更新日期:1995-10-01 00:00:00

  • Exemptions From Mandatory Immunization After Legally Mandated Parental Counseling.

    abstract:BACKGROUND:The success of health care provider counseling-based interventions to address vaccine hesitancy is not clear. In 2011, Washington State implemented Senate Bill 5005 (SB5005), requiring counseling and a signed form from a licensed health care provider to obtain an exemption. Evaluating the impact of a counsel...

    journal_title:Pediatrics

    pub_type: 杂志文章

    doi:10.1542/peds.2017-2364

    authors: Omer SB,Allen K,Chang DH,Guterman LB,Bednarczyk RA,Jordan A,Buttenheim A,Jones M,Hannan C,deHart MP,Salmon DA

    更新日期:2018-01-01 00:00:00

  • Effect of allopurinol on postasphyxial free radical formation, cerebral hemodynamics, and electrical brain activity.

    abstract:OBJECTIVE:Free radical-induced postasphyxial reperfusion injury has been recognized as an important cause of brain tissue damage. We investigated the effect of high-dose allopurinol (ALLO; 40 mg/kg), a xanthine-oxidase inhibitor and free radical scavenger, on free radical status in severely asphyxiated newborns and on ...

    journal_title:Pediatrics

    pub_type: 临床试验,杂志文章

    doi:10.1542/peds.101.2.185

    authors: Van Bel F,Shadid M,Moison RM,Dorrepaal CA,Fontijn J,Monteiro L,Van De Bor M,Berger HM

    更新日期:1998-02-01 00:00:00

  • Hepatitis B virus infection in Honolulu students.

    abstract:OBJECTIVES:To determine hepatitis B virus (HBV) carrier and infection rates and HBV epidemiology in Honolulu students. DESIGN:Cross-sectional survey. SETTING:Honolulu public elementary, intermediate, and high schools. PATIENTS:A volunteer sample of 4936 students from 43 Honolulu schools. MAIN OUTCOME MEASURES:HBV c...

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    pub_type: 杂志文章

    doi:

    authors: Pon EW,Ren H,Margolis H,Zhao Z,Schatz GC,Diwan A

    更新日期:1993-10-01 00:00:00