Background

Use of nitric oxide in preterm infants is controversial. Even though there is no good evidence, the use of nitric oxide has increased significantly in preterm population over the last decade.

Objectives

To review survival and neurodevelopmental outcome of preterm infants requiring nitric oxide in a tertiary Neonatal Intensive Care Unit.

Methods

Retrospective observational study over 10 year period from Jan 2009 to Dec 2018. Preterm infants needing Nitric oxide for pulmonary hypertension were recruited to the study. All data was collected from Badger (neonatal patient database). Neurodevelopmental outcomes of the survivors were analysed by Bayley’s III scale.

Results

7406 preterm infants <36 weeks were admitted to NICU during study period. 35 needed nitric oxide for pulmonary hypertension. Median gestation was 30+5 (25+2 to 36+1) weeks. Median birth weight was 1635 g (630g to 3380g). 21 (60%) were males and 14 (40%) were females. Echocardiography findings were available for 21 cases (60%) of which 71.4% had confirmed evidence of pulmonary hypertension. Severe respiratory distress syndrome was the leading cause for pulmonary hypertension. Overall survival to discharge was 68.5%.

Neurodevelopmental outcome was available for 15 babies of which 46.6% had a normal neurodevelopment. 26.6% were mildly delayed, 20% were moderately delayed and only 6.6% had severe delay.

Conclusion

The usage of nitric oxide in preterm infants is still very small. Nearly 73% had normal or mild developmental delay. Careful selection of cases is required by echocardiography to improve the outcomes.

Background

Large Patent Ductus Arteriosus (PDA) can cause significant haemodynamic problems to preterm infants. It can increase burden on pulmonary circulation which in turn increases work of breathing, leading to increased calorie consumption. Poor nutrition can lead to poor neurodevelopmental outcome and increases the risk of CLD.

Objectives

To review the PDA ligation in preterm infants and its link to the weight gain.

Methods

Retrospective observational study over a period of 10 years from Jan 2019 to Dec 2018. Data was collected from Badger database (Neonatal patient record database). Data on gestational age, birth weight, PDA ligation weight, discharge weight and oxygen requirement at 36 weeks were collected among the infants who required PDA ligation.

Results

18 preterm infants needed surgical PDA ligation during study period. The mean gestation at birth was 25 weeks. Mean birth weight was 650 grams. Mean gestational age for PDA ligation was 32 weeks with mean weight of 1060 grams. The mean discharge gestational age was 47.5 weeks with mean weight of 3230 grams.100% of the babies had a diagnosis of chronic lung disease at 36 weeks and 83% went home on oxygen. The mean growth rate before duct ligation 54.3 grams/week which increased to 167.3 grams/week after ligation.

Conclusion

The results show PDA ligation hasn’t had noticeable effect on babies as 100% were diagnosed were diagnosed with CLD at 36 weeks corrected gestational age with the majority discharge home on oxygen. However, growth rates have markedly increased. Babies with large PDA need more calorie requirement to have optimal growth.

Background

Pulmonary hypoplasia is common in the perinatal period and a significant cause of death in newborn infants. Definitive diagnosis is by histopathology. Clinical diagnosis and management is often challenging. There are no studies describing outcomes of the neonates with clinically suspected pulmonary hypoplasia.

Objectives

Outcomes of preterm and term infants with clinical diagnosis of pulmonary hypoplasia

Methods

Retrospective observational study over a period of 10 years from January 2009 to December 2018. Data was collected from Badger database (Neonatal patient record database) on gestational age, birth weight, ventilator support, use of nitric oxide, CLD ( Chronic Lung Disease), mortality and two year neurodevelopmental outcome

Results

Total number of infants identified with clinical diagnosis of pulmonary hypoplasia: 27; with mortality of 19/26 (73%), survival of 7/26 (26%) 1 outcome unknown. The proportion of infants with associated anomalies and survival: anhydramnios/oligohydramnios due to PROM (Prolonged Rupture of Membranes) (11/5), skeletal dysplasia (2/0), renal anomalies (7/1), multiple congenital anomalies (5/0), postnatal diagnosis of Congenital Diaphragmatic Hernia (1/1). Among the survivors 3/7 had CLD. Two year neurodevelopmental outcome showed, 2 with no or mild delay, 1 with moderate delay and none had severe delay.

Anhydramnios/ Oligohydramnios secondary to PROM: n- 11

Conclusion

In non-surgical tertiary NICU, PROM leading to anhydramnios/oligohydramnios is the most common cause for pulmonary hypoplasia. Mortality remains very high in infants born with pulmonary hypoplasia. Aggressive treatment for pulmonary hypoplasia secondary to PROM and anhydramnios/oligohydramnios is required to improve the outcomes.