WIP 13 - Effect of Stewardship on Inhaled Nitric Oxide use in a Preterm Infant Population

Poster Number: WIP 13
Publication Number: WIP 13.2509

Background: Persistent pulmonary hypertension of the newborn (PPHN) is caused by failure to transition from fetal to neonatal physiology. Inhaled nitric oxide (iNO) is a therapeutic intervention approved by the Food and Drug Administration for the treatment of PPHN in term (≥ 37 weeks) and near-term (≥ 34 weeks) infants but does not include use in early preterm infants (≤ 33 6/7 weeks). Current recommendations among pediatric specialty organizations are incongruent and iNO continues to be used off-label for early preterm infants across institutions. Non-targeted continuation of this therapy can cause patient harm and generate unnecessary medical expense.

Objective: To evaluate if stewardship toward more targeted iNO use in early preterm infants leads to beneficial practice changes in initiation and duration of therapy.

Design/Methods: This is a prospective observational interrupted time-series study of infants born ≤ 33 6/7 admitted to the neonatal intensive care unit (NICU). Retrospective data collected on iNO recipient patients from 2015-2020. A best practice “iNO Use in Preterm Infants” guideline, developed in collaboration with cardiology and neonatal hemodynamics specialists, was implemented as a clinical pathway within the NICU. Prospective observational data then collected utilizing the same data collection tools. Outcomes of the iNO recipient cohort within each series were compared to one another, as well as to a control group from the same period matched for age and disease severity. (IRB No. 21-472, 22-294)

Preliminary retrospective analysis shows historical predisposition to start iNO on the most critically ill patients. Prospective analysis supports adoption of a more targeted approach after guideline implementation. These findings suggest standardization toward targeted care may have a beneficial impact on clinical practice and patient outcomes as they relate to iNO use in early preterm infants. We anticipate inclusion of more cases into our final analysis; data collection phase ends Dec 2023. Data analysis will be complete prior to the presentation date.