Impact of early surfactant and inhaled nitric oxide therapies on outcomes in term/late preterm neonates with moderate hypoxic respiratory failure

OBJECTIVE: We conducted a post-hoc analysis of early inhaled nitric oxide (iNO)-randomized controlled trial data to identify associations pertinent to the management of moderate hypoxic respiratory failure in term/late preterm infants. STUDY DESIGN: Univariate and multivariate logistic regression analyses were used to determine risk factors for the progression of respiratory failure and extracorporeal membrane oxygenation (ECMO)/death. RESULT: Among the 299 enrolled infants, oxygenation index (OI) <20 at enrollment (odds ratio 0.52, confidence interval (CI) 0.27 to 0.97) and surfactant use before randomization (odds ratio 0.47, CI 0.24 to 0.91) were associated with decreased ECMO/death rates. Early surfactant use for respiratory distress syndrome, perinatal aspiration syndrome and pneumonia/sepsis was associated with lower risk of ECMO/death (P<0.001). Early iNO (OI 15 to 25) decreased the progression of respiratory failure to OI >30 (P=0.002) and to composite outcome of OI >30 or ECMO/death (P=0.02). CONCLUSION: This post-hoc analysis suggests that early use of surfactant and iNO in moderate respiratory failure is associated with improved outcomes

Evidence based neonatal surgery

Surgical intervention has, quite rightly, a well-established role in the management of a number of congenital and acquired neonatal conditions. Surgical approaches have been developed over a period of time, from the initial endeavours of pioneering neonatal surgeons, to the procedures commonly in everyday use today. Such development has been predominantly a result of necessity, learning from past experience and translation of techniques in use in other surgical fields into neonatal surgery. As neonatal surgical experience has grown, surgeons have begun to develop alternatives to what were once thought to be traditional techniques such that for a number of conditions we now have the luxury of choice in the treatment of these often fragile infants. With choice, there comes a dilemma. Which approach should be used? How should we make the decision