Prospective Multicenter Registry for Preterm Newborns With Severe Pulmonary Hypertension

Brief Summary

Detailed Description

There is a lack of consensus on the role of inhaled nitric oxide (iNO) therapy and other pulmonary vasodilators for the treatment of severe pulmonary hypertension (PH) in premature newborns (\<34 weeks gestation). However, a proper randomized, controlled trial of iNO in premature newborns with severe PH has not been completed. Some practices embrace the American Academy of Pediatrics (AAP) statement that there is no condition for which iNO should be used in the premature newborn, and others selectively treat premature infants with inhaled nitric oxide (iNO) who suffer life threatening hypoxemia due to suprasystemic PH and right-to-left veno-arterial admixture across the arterial duct and/or oval foramen. The number of neonatal intensive care units (NICUs) adopting each of these approaches is currently unknown, but it is possible that the former group is increasing due to administrative pressure to reduce uncompensated off-label iNO use. A prospective registry collection of treatment strategies and outcomes for this subset of premature newborns will help define current treatment strategies and yield important information about safety and efficacy of the different approaches to management, and would inform the debate more effectively than a series of iNO treated infants alone. Data collected includes maternal age, race/ethnicity, pregnancy and delivery complications, prenatal medications, infant characteristics such as Apgar scores, birthweight, congenital anomalies, respiratory status, pharmacologic therapy used for PH and its side effects, and blood gas data. Up to 100 sites in North America will be invited to monitor for appropriate cases.

Primary Outcomes

Secondary Outcomes

• Number of Days Hospitalized(From birth through hospital discharge or death, whichever occurs first, assessed up to one year)
• Number of Days on Ventilation(From birth through hospital discharge or death, whichever occurs first, assessed up to one year)
• Patent Ductus Arteriosus (PDA) Ligation(From birth through hospital discharge or death, whichever occurs first, assessed up to one year)
• Development of Necrotizing Enterocolitis (NEC)(From birth through surgical repair of NEC, assessed up to one year)
• Development of Early Bacterial Sepsis(From Birth through 3 days of life)
• Classification of Bronchopulmonary Dysplasia (BPD)(At 36 weeks after birth)
• Pneumothorax(From birth through hospital discharge or death, whichever occurs first, assessed up to one year)
• Development of Late Bacterial Sepsis(From Day 4 of life through hospital discharge or death, whichever occurs first, assessed up to one year)
• Intracranial hemorrhage(From birth through hospital discharge or death, whichever occurs first, assessed up to one year)
• Cystic Periventricular Leukomalacia (PVL)(From birth through hospital discharge or death, whichever occurs first, assessed up to one year)
• Neurological Exam(The most recent exam immediately prior to discharge or death, whichever occurs first, assessed up to one year)
• Surgery for Retinopathy of Prematurity (ROP)(From birth through hospital discharge or death, whichever occurs first, assessed up to one year)