641 - Is it worthwhile to spend precious dollars on inhaled nitric oxide for neonatal persistent pulmonary hypertension in regions with limited resources?

Poster Number: 641
Publication Number: 641.316

Augusto Sola, Ibero American Society of Neonatology-, Wellington, FL, United States; Marcelo Cardetti, Sociedad Iberoamericana de Neonatología, San Luis, San Luis, Argentina; Susana Rodriguez, SIBEN, Buenos Aires, Ciudad Autonoma de Buenos Aires, Argentina; Sergio G. Golombek, SUNY Downstate Health Sciences University, Brooklyn, NY, United States

Background: Inhaled nitric oxide (iNO) has been well studied in large randomized clinical trials (RCT’s) and is the standard of
care for persistent pulmonary hypertension of the newborn (PPHN) in developed nations. RCT’s on oral sildenafil
(oS) are of much smaller sample size and there is no RCT comparing oS vs iNO. iNO is more expensive than oS
and many neonatal units (NICU) in Latin America do not have iNO availability and use oS for PPHN.

Objective: To evaluate the use of iNO and oS in newborns (NB) with PPHN and their outcomes in 28 Latin American NICU’s
reporting to the Ibero American Society of Neonatology (SIBEN) neonatal network.

Design/Methods: Descriptive study of data reported to SIBEN’s neonatal network over 5 years (2017-2021) from 28 NICU’s of 5
different Latin American countries. Study population included NB > 34 weeks with diagnosis of PPHN.
Demographics include many factors such as birth weight (BW), gestational age (GA), gender, availability of iNO and
others. Diagnosis of PPHN was made by clinicians with echocardiogram documentation, following SIBEN’s
procedures’ manual. The use of iNO and/or oS was a clinical decision made in each individual NICU. We performed
descriptive statistics (frequencies, mean, SD, median and IQR as appropriate).

Results: Over 5 years, there were 12,577 NB’s > 34 weeks and 738 NB’s had confirmed PPHN (5.9%) of varying severity,
with median oxygenation index of 30 (13-65). BW 3,008 ± 637 g, GA 37.7 ± 2 weeks and 278 (38%) were females.
Mechanical ventilation was used in 92% and high frequency in 15%; 445 (60%) NB survived. Only 9 of the 28
NICU’s had iNO available and 3 had contact with other NICU’s to transfer NBs in case they felt iNO was indicated.
Of the 738 NB’s, 519 (70%) received one and/or the other vasodilator: 488 (94%) were treated with oS only, 12
(2.1%) iNO alone and 19 (3.4%) received iNO + oS. Five received ECMO. BW, GA and % females were similar.
Survival with oS alone was 52%, with iNO 42% (5/12) and with iNO + oS was 63% (12/19).

Conclusion(s): PPHN is a frequent condition with negative impact on neonatal survival in 28 Latin American NICU’s reporting to
SIBEN’s neonatal network. Oral sildenafil is widely used and considered standard practice for NB’s with PPHN and
access to iNO is limited in these units. These findings suggest that quality improvement measures are urgently
required, including specific protocols for PPHN treatment with or without vasodilators and improvements in
regionalization of neonatal care.