1. Price, Cynthia

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According to this study:


* Inhaled nitric oxide therapy improves pulmonary outcome in premature infants at risk for bronchopulmonary dysplasia.



Preterm infants requiring mechanical ventilation and at risk for bronchopulmonary dysplasia were found to have improved pulmonary outcome and no short-term adverse effects when inhaled nitric oxide therapy was initiated between seven and 21 days after birth-findings that could quiet the controversy concerning use of this treatment.


The study was conducted at 21 infant ICUs in premature infants of a gestational age of 26 weeks and birth weight of 1,250 g or less who needed mechanical ventilation seven to 21 days after birth. The intervention treatment consisted of decreasing concentrations of inhaled nitric oxide, beginning at 20 ppm, for a minimum of 24 days, to 294 of 582 infants; 288 received a placebo.


The primary outcome was the rate of survival without bronchopulmonary dysplasia at a postmenstrual age of 36 weeks; this rate was 43.9% among infants in the nitric oxide therapy group and 36.8% among those in the placebo group. The infants who underwent nitric oxide therapy also were discharged sooner without any short-term safety concerns, had less severe disease when it did develop, and needed supplemental oxygen therapy for shorter durations. Further, it appears the effectiveness of the treatment is associated with the timing of its initiation. The study found that infants between the ages of seven and 14 days at the time of enrollment derived significant benefit from inhaled nitric oxide therapy while those between 15 and 21 days did not; researchers hypothesized that the older group might have already sustained lung damage before treatment began.


The present study findings challenge those of previous studies, including one that found that not only was there no overall benefit to a brief course of inhaled nitric oxide therapy in infants with severe respiratory failure, but there were greater rates of complications and death when the therapy was initiated in infants weighing less than 1,000 g. It should be noted that in the present study the infants were given nitric oxide therapy at an older age and for a longer duration.


Finally, while the authors acknowledge that long-term neurodevelopmental follow-up is necessary before definitive recommendations can be made, it appears that the use of inhaled nitric oxide in infants at high risk for bronchopulmonary dysplasia within the recommended age range could ultimately result in shorter hospitalizations and decreased apparent long-term pulmonary problems.




Ballard RA, et al. N Engl J Med 2006;355(4):343-53.