Supplementary Material for: Outcome of Preterm Neonates with a Birth Weight <1,500 g with Severe Hypoxemic Respiratory Failure Rescued by Inhaled Nitric Oxide Therapy and High-Frequency Oscillatory Ventilation

Background: Despite being an experimental therapy in
preterm neonates, inhaled nitric oxide (iNO) is used as a rescue therapy
when high-frequency oscillatory ventilation (HFOV) and other
conventional therapies fail. Objective: We aimed to
determine the outcomes of very-low-birth-weight (VLBW) neonates with
hypoxemic respiratory failure (HRF) who had received iNO after maximal
conventional therapies. Methods: We retrospectively
reviewed preterm neonates (<33 weeks of gestation with a birth weight
<1,500 g) who had all received HFOV and then iNO from March 1, 2009
to April 1, 2014 at the Royal Alexandra Hospital. We collected
demographic and clinical parameters, doses, duration and response to
iNO, survival to neonatal intensive care unit (NICU) discharge, major
complications, and neurodevelopmental outcome at 18-24 months of
corrected age. Results: During the study period, 1,168
eligible preterm neonates were admitted; 155 (13%) had HRF treated with
HFOV, of whom 47 (30%) received iNO. The baseline characteristics
between the 24 survivors and 23 nonsurvivors were not different.
Survivors had a greater decrease in oxygenation index than nonsurvivors
(61 vs. 33%) after 6 h of iNO (p = 0.003). The causes of death
were refractory hypoxemia (8), multi-organ failure (7), treatment
withdrawal (6), and others (2). During the NICU stay, 23 survivors (96%)
developed complications. At 18-24 months, 7 (29%) had significant
disabilities. Conclusions: Of the VLBW neonates with
severe HRF rescued by HFOV and iNO, many survived without
neurodevelopmental disability at early childhood, despite multiple
short-term complications. Further research is necessary to understand
the clinical course and risk factors of adverse outcomes and to improve
the management care of these critically ill neonates.