ArticlePediatric research2023
Early nitric oxide is not associated with improved outcomes in congenital diaphragmatic hernia.
Article in Pediatric research, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 13 papers.
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Who cites it
13 citing papers in PubMed, 34 citations in OpenAlex.
- Preliminary Report of a Nationwide Prospective Cohort of Congenital Diaphragmatic Hernia in Korea.Journal of Korean medical science · 2026Article
- Diastolic function in newborn infants: understanding pathophysiology, diagnosis and clinical relevance.Pediatric research · 2026Review
- Early postnatal echocardiographic characteristics impact survival and extracorporeal life support in congenital diaphragmatic hernia.Pediatric research · 2026Article
- Early left ventricular diastolic function and disease severity in congenital diaphragmatic hernia.Pediatric research · 2025Article
- Clinical outcomes after implementation of a physiologic pre-operative management strategy in neonates with congenital diaphragmatic hernia.Journal of perinatology : official journal of the California Perinatal Association · 2025Article
- Infants With a Congenital Diaphragmatic Hernia Had Favourable Pulmonary Hypertension Outcomes at 1 Year of Age.Acta paediatrica (Oslo, Norway : 1992) · 2025Article
- Hemodynamic precision to guide surgical timing for neonates with congenital diaphragmatic hernia: a narrative review.Journal of perinatology : official journal of the California Perinatal Association · 2025Review
- Respiratory Support Strategies for Surgical Neonates: A Review.Children (Basel, Switzerland) · 2025Review
- Enhancing the Survival of Congenital Diaphragmatic Hernia: Quality Improvement Initiative With a Multidisciplinary Extracorporeal Membrane Oxygenation Team Approach.Journal of Korean medical science · 2024Article
- Management advances for congenital diaphragmatic hernia: integrating prenatal and postnatal perspectives.Translational pediatrics · 2024Review
- Hemodynamic management of congenital diaphragmatic hernia: the role of targeted neonatal echocardiography.World journal of pediatric surgery · 2024Review
- Diagnosis, management and long term cardiovascular outcomes of phenotypic profiles in pulmonary hypertension associated with congenital diaphragmatic hernia.Frontiers in pediatrics · 2024Review
- Longitudinal Trajectory of Ventricular Function and Pulmonary Hypertension in Congenital Diaphragmatic Hernia.The Journal of pediatrics · 2023Article
Corrections and comments
- Erratum issued
Authors and funding
11 authors at 5 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundInhaled nitric oxide (iNO) is widely used for the management of infants with congenital diaphragmatic hernia (CDH); however, evidence of benefit is limited.
methodsThis is a multicenter cohort study using data from the Congenital Diaphragmatic Hernia Study Group between 2015 and 2020. The impact of early iNO use in the first 3 days of life prior to ECLS use on mortality or ECLS use was explored using multivariate logistic regression models and subgroup analyses.
resultsOf the 1777 infants, 863 (48.6%) infants received early iNO treatment. Infants receiving iNO had lower birth weight, larger defect size, more severe pulmonary hypertension, and abnormal ventricular size and function. After controlling for these factors, early iNO use was associated with increased mortality (aOR 2.06, 95% CI 1.05-4.03, P = 0.03) and increased ECLS use (aOR 3.44, 95% CI 2.11-5.60, P < 0.001). Subgroup analyses after stratification by echocardiographic characteristics and defect size revealed no subgroup with a reduction in mortality or ECLS use.
conclusionsUse of iNO in the first 3 days of life prior to ECLS was not associated with a reduction in mortality or ECLS use in either the regression models or the subgroup analyses. The widespread use of iNO in this vulnerable population requires reconsideration. IMPACT: Evidence to support widespread use of iNO for infants with congenital diaphragmatic hernia is limited. The use of iNO in the first 3 days of life was associated with significantly increased mortality and ECLS use. Stratification by echocardiographic characteristics and defect size did not reveal a subgroup that benefited from iNO. Even the subset of patients with R-to-L shunts at both ductal and atrial levels, a surrogate for elevated pulmonary arterial pressures in the absence of significantly decreased LV compliance, did not benefit from early iNO use. Early iNO therapy was of no benefit in the management of acute pulmonary hypertension in infants with congenital diaphragmatic hernia, supporting reconsideration of its use in this population.
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