Marina S. Oren, Kikelomo Babata, June Hu, Venkatakrishna Kakkilaya, Patti J. Burchfield, Michelle Hagans, L. Steven Brown, Satyan Lakshminrusimha, Vishal Kapadia
University of Texas Southwestern Medical Center. Texas Health Presbyterian Hospital of Dallas. Parkland Health & Hospital System. University of California Davis Children’s Hospital.
United States
Journal of Pediatrics: Clinical Practice
J Pediatr Clin Pract 2025; 18:
DOI: 10.1016/j.jpedcp.2025.200189
Abstract
Objective: To evaluate whether oxygenation levels and exposure to hyperoxemia in the first 12 postnatal hours are associated with death in neonates treated with inhaled nitric oxide for persistent pulmonary hypertension of newborn (PPHN).
Study design: This was a retrospective study of neonates ≥35 weeks with PPHN treated with inhaled nitric oxide. The cohort was divided into 4 groups on the basis of maximum Pao2 within the first 12 hours: hypoxemia (<60 mm Hg), normoxemia (60-99 mm Hg), mild-moderate (100-199 mm Hg), and severe hyperoxemia (≥200 mm Hg). The primary outcome was death before discharge.
Results: In total, 118 neonates were included. Hypoxemia, normoxemia, and mild-to-moderate and severe hyperoxemia were present in 14%, 36%, 32%, and 17% of infants, respectively. Mortality followed a U-shaped relationship, with significantly greater rates in hypoxemia (23%) and the severe hyperoxemia (30%) groups and no deaths in the normoxemia group (P < .05). In multivariable Firth logistic regression controlling for confounders, both hypoxemia (OR 29.0; 95% CI 2.8-3937.2, P < .01) and severe hyperoxemia (OR 39.0; 95% CI 4.2-5204.3, P < .01) remained significantly associated with increased odds of death compared with normoxemia.
Conclusions: Early hypoxemia and severe hyperoxemia were associated with mortality in infants with PPHN. These findings underscore the importance of cautious oxygen titration. Prospective studies are needed to establish optimal oxygen management strategies in this population.
Category
Class I. Persistent Pulmonary Hypertension of the Newborn
Medical Therapy. Efficacy or Lack of Efficacy
Medical Therapy. Adverse Effects or Lack of Adverse Effects
Age Focus: Pediatric Pulmonary Vascular Disease
Fresh or Filed Publication: Fresh (PHresh). Less than 1-2 years since publication
Article Access
Free PDF File or Full Text Article Available Through PubMed or DOI: Yes