Early use of combined exogenous surfactant and inhaled nitric oxide reduces treatment failure in persistent pulmonary hypertension of the newborn: a randomized controlled trial

Objective To evaluate whether combined surfactant with inhaled nitric oxide (iNO) use will prevent newborns with hypoxemic respiratory failure (HRF) from developing an Oxygenation Index (OI) > 40. Methods 100 term newborns with acute HRF (OI >= 20) were randomized to: Surfactant+iNO: received iNO plus up to two doses of surfactant or iNO-Controls: received iNO+placebo. Main outcome was the development of severe HRF (OI > 40) despite iNO use. Results Baseline mean +/- SD OI was 37.4 +/- 14 for the Surfactant+iNO group and 38.2 +/- 16 for the controls. Infants receiving surfactant+iNO improved their oxygenation faster, resulting in lower OI at 24 h: 12.9 +/- 9 vs 18.7 +/- 11 of controls,p < 0.05; and a lower proportion developing OI > 40: 24%(12/50) vs 50%(25/50) of controls,p < 0.02. Fewer infants receiving surfactant+iNO presented the combined outcome of death or ECMO: 16%(8/50) compared to 36%(18/50) of controls,p < 0.05. Conclusions Early use of combined surfactant+iNO improves oxygenation preventing the progression to severe HRF. This may reduce mortality and ECMO need.

Automated summary

The study showed that the early use of combined surfactant with inhaled nitric oxide (iNO) can significantly improve oxygenation in newborns with hypoxemic respiratory failure (HRF), reducing Oxygenation Index (OI) and the risk of developing severe HRF.