The purpose of this prospective research registry is to collect data on treatment strategies and outcomes for premature newborns with severe pulmonary hypertension (PH).
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.
Study Type
OBSERVATIONAL
Enrollment
232
University of Colorado
Aurora, Colorado, United States
Mortality
Occurrence of death
Time frame: From birth through hospital discharge or death, whichever occurs first, assessed up to one year
Cause of death
The cause, if death occurred
Time frame: From birth through hospital discharge or death, whichever occurs first, assessed up to one year
Number of Days Hospitalized
Total number of days in hospital
Time frame: From birth through hospital discharge or death, whichever occurs first, assessed up to one year
Number of Days on Ventilation
Total number of days on mechanical ventilation
Time frame: From birth through hospital discharge or death, whichever occurs first, assessed up to one year
Classification of Bronchopulmonary Dysplasia (BPD)
BPD classification
Time frame: At 36 weeks after birth
Development of Necrotizing Enterocolitis (NEC)
Occurrence of surgical repair of NEC
Time frame: From birth through surgical repair of NEC, assessed up to one year
Development of Early Bacterial Sepsis
Early Occurrence of Bacterial sepsis, e.g. 3 days or less
Time frame: From Birth through 3 days of life
Development of Late Bacterial Sepsis
Late Occurrence of Bacterial sepsis, e.g. \>3 days
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Time frame: From Day 4 of life through hospital discharge or death, whichever occurs first, assessed up to one year
Intracranial hemorrhage
Occurrence and severity of intracranial hemorrhage
Time frame: From birth through hospital discharge or death, whichever occurs first, assessed up to one year
Cystic Periventricular Leukomalacia (PVL)
Occurrence of PVL
Time frame: From birth through hospital discharge or death, whichever occurs first, assessed up to one year
Surgery for Retinopathy of Prematurity (ROP)
Occurrence of surgical repair of ROP
Time frame: From birth through hospital discharge or death, whichever occurs first, assessed up to one year
Patent Ductus Arteriosus (PDA) Ligation
Occurrence of surgical repair of PDA
Time frame: From birth through hospital discharge or death, whichever occurs first, assessed up to one year
Pneumothorax
Occurrence of pneumothorax
Time frame: From birth through hospital discharge or death, whichever occurs first, assessed up to one year
Neurological Exam
Results of neurological exam: Normal, Abnormal, Suspect
Time frame: The most recent exam immediately prior to discharge or death, whichever occurs first, assessed up to one year