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| ==Overview== | | ==Overview== |
| There are no established measures for the secondary prevention of [disease name].
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| Effective measures for the secondary prevention of [disease name] include [strategy 1], [strategy 2], and [strategy 3].
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| ==Secondary Prevention== | | ==Secondary Prevention== |
| OUTCOME — The incidence in developed countries ranges from 1 to 2 per 1000 live births with an estimated mortality rate of 10 percent [1,55].
| | All infants with severe PPHN who have been treated with inhaled nitric oxide (iNO) and/or extracorporeal membrane oxygenation (ECMO) should have neurodevelopmental follow-up [15]. Assessment should be performed through infancy at 6- to 12-month intervals, and longer if abnormalities are present. Hearing should be tested prior to hospital discharge and at 18 to 24 months corrected age. |
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| Survivors of severe PPHN and/or extracorporeal membrane oxygenation (ECMO) treatment are at increased risk of developmental delay, motor disability, and hearing deficits [56-62]. In one study, survivors of PPHN compared with a matched control group were more likely to have sensorineural hearing loss (SNHL) based upon audiologic evaluation and chronic health problems (eg, cerebral palsy [CP], developmental delay, the use of bronchodilator therapy, and remedial education) by parental report at 5 to 11 years of age [62].
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| Inhaled nitric oxide — Inhaled nitric oxide (iNO) does not appear to increase the risk of adverse outcomes:
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| ●In one report, 87 percent of surviving infants enrolled in the National Institute of Child Health and Human Development (NICHD) Neonatal Research Network trial of iNO were evaluated at 18 to 24 months of age [56]. Approximately one-third of the infants had at least one disability. Abnormal outcomes included SNHL (14 percent) and moderate to severe CP (7.5 percent), but were not different between iNO and control groups. Mental and psychomotor developmental scores also were not different.
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| ●In a report from a single tertiary center, 109 of 187 children who were term infants treated for PPHN were evaluated at school age (mean age 7.1 years) [63]. Overall, 9 percent of the cohort had an intelligence quotient (IQ) score less than 70, and 7 percent had an IQ score between 70 and 84. There was no difference in the medical and neurodevelopmental outcome between the 77 children who had received iNO, of whom 12 were also treated by ECMO, and those who did not receive iNO.
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| ●The previously mentioned systematic review of infants with respiratory failure also reported no additional adverse effect on neurodevelopmental outcome with the use of iNO [32].
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| ●Treatment with iNO does not appear to alter lung function in later infancy, as illustrated in a study in which 22 infants who had severe PPHN (15 treated with iNO) and 18 healthy controls were evaluated 4 to 12 months after discharge from the neonatal intensive care unit (NICU) [64]. No differences between groups were detected in functional residual capacity or respiratory system compliance.
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| FOLLOW-UP — All infants with severe PPHN who have been treated with inhaled nitric oxide (iNO) and/or extracorporeal membrane oxygenation (ECMO) should have neurodevelopmental follow-up [15]. Assessment should be performed through infancy at 6- to 12-month intervals, and longer if abnormalities are present. Hearing should be tested prior to hospital discharge and at 18 to 24 months corrected age.
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| ==References== | | ==References== |