J. Wesley Diddle, Jason Patregnani, Claudia A. Algaze, Mousumi, Banerjee, John Berger, Garrett Reichle, James St. Louis, Jun Sasaki, Kurt R. Schumacher, Jamie Sinton, William Stigall, Joshua Wolovits, Wenying Zhang, Sarah Tabbutt
Children’s Hospital of Philadelphia and University of Pennsylvania. Barbara Bush Children’s Hospital. Lucile Packard Children’s Hospital and Stanford University. University of Michigan. Children’s National Hospital and George Washington University School of Medicine. CS Mott Children’s Hospital and University of Michigan. Children’s Hospital of Georgia and Augusta University. Boston Children’s Hospital and Harvard Medical School. Dell Medical School and University of Texas at Austin. Cook Children’s Health Care System. University of Texas Southwestern Medical Center. University of California San Francisco School of Medicine.
United States
Pediatric Cardiology
Pediatr Cardiol 2025;
DOI: 10.1007/s00246-026-04457-z
Abstract
Inhaled nitric oxide (iNO) lowers pulmonary vascular resistance and improves pulmonary gas exchange. It has become a common therapy following pediatric cardiac surgery, but there are limited data on its current use or clinical impact in this population. This retrospective analysis reviewed all patients within the Pediatric Cardiac Critical Care Consortium (PC4) clinical registry, representing 63 North American cardiac intensive care units (CICU), who underwent cardiac surgery from August 2014 to August 2023, to describe contemporary iNO use and its relationship to patient characteristics and outcomes. We also investigated the relationship between timing of iNO therapy for postoperative pulmonary hypertension (PH) and mortality. Of 63,582 non-neonatal patients admitted to the CICU following cardiac surgery, 12.2% received iNO, with 34.8% of those receiving it for PH. Of 17,792 neonates who underwent cardiac surgery, 26.6% received iNO, with 29.3% of those receiving it for PH. Single ventricle surgeries and heart transplant were the most common operations associated with iNO use. iNO use has increased over time, and utilization varies widely across centers, ranging from 0% to 65% of neonates, and 4% to 47% of infants. In a multivariable logistic regression model of patients who received iNO postoperatively for PH, initiation of therapy during the CICU stay, as compared to at CICU admission, was associated with increased mortality (odds ratio 1.54). Using contemporary multicenter registry data, we identify patient and operative characteristics associated with iNO use. Variations by center and by timing suggest opportunities to optimize use of the therapy.
Category
Class I. Pulmonary Hypertension Associated with Congenital Cardiovascular Disease
Medical Therapy. Efficacy or Lack of Efficacy
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: No