Inhaled Nitric Oxide in Preterm Infants Undergoing Mechanical Ventilation

نویسنده

  • Yahya Al Ethawi
چکیده

BACKGROUND Bronchopulmonary dysplasia in premature infants is associated with prolonged hospitalization, as well as abnormal pulmonary and neurodevelopmental outcome. In animal models, inhaled nitric oxide improves both gas exchange and lung structural development, but the use of this therapy in infants at risk for bronchopulmonary dysplasia is controversial. METHODS We conducted a randomized, stratified, double-blind, placebo-controlled trial of inhaled nitric oxide at 21 centers involving infants with a birth weight of 1250 g or less who required ventilatory support between 7 and 21 days of age. Treated infants received decreasing concentrations of nitric oxide, beginning at 20 ppm, for a minimum of 24 days. The primary outcome was survival without bronchopulmonary dysplasia at 36 weeks of postmenstrual age. RESULTS Among 294 infants receiving nitric oxide and 288 receiving placebo birth weight (766 g and 759 g, respectively), gestational age (26 weeks in both groups), and other characteristics were similar. The rate of survival without bronchopulmonary dysplasia at 36 weeks of postmenstrual age was 43.9 percent in the group receiving nitric oxide and 36.8 percent in the placebo group (P=0.042). The infants who received inhaled nitric oxide were discharged sooner (P=0.04) and received supplemental oxygen therapy for a shorter time (P=0.006). There were no short-term safety concerns. CONCLUSIONS Inhaled nitric oxide therapy improves the pulmonary outcome for premature infants who are at risk for bronchopulmonary dysplasia when it is started between 7 and 21 days of age and has no apparent short-term adverse effects. (ClinicalTrials.gov number, NCT00000548 [ClinicalTrials.gov] .).

برای دانلود متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید

ثبت نام

اگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید

منابع مشابه

Infants With Persistent Pulmonary Hypertension of the Newborn Inhaled Nitric Oxide Therapy Decreases the Risk of Cerebral Palsy in Preterm

OBJECTIVE. The aim was to determine whether inhaled nitric oxide therapy improves neurodevelopmental outcomes for infants with preterm persistent pulmonary hypertension of the newborn. METHODS.We conducted a historical cohort study to compare the 3-year incidence of cerebral palsy in preterm singleton infants ( 34 gestational weeks) with hypoxemic respiratory failure caused by persistent pulmon...

متن کامل

Plasma ADMA concentrations at birth and mechanical ventilation in preterm infants: a prospective pilot study.

RATIONALE Nitric oxide (NO) produced in the lung is an important mediator of normal lung development, vascular smooth muscle relaxation, and ventilation perfusion matching. NO is synthesized from arginine by the action of NO-synthase (NOS). Asymmetric dimethylarginine (ADMA), an endogenous derivate of arginine, inhibits NOS and is thereby a determinant of NO synthesis. We compared ADMA and argi...

متن کامل

Inhaled Nitric Oxide in preterm infants: a systematic review and individual patient data meta-analysis

BACKGROUND Preterm infants requiring assisted ventilation are at significant risk of both pulmonary and cerebral injury. Inhaled Nitric Oxide, an effective therapy for pulmonary hypertension and hypoxic respiratory failure in the full term infant, has also been studied in preterm infants. The most recent Cochrane review of preterm infants includes 11 studies and 3,370 participants. The results ...

متن کامل

Combining medical gases in the treatment of pulmonary interstitial emphysema: novel, yes: but is it safe?

Helium-oxygen mixture (heliox) has been used with some success in the treatment of severe airflow obstruction associated with upper and lower airway abnormalities in infants and children.1 RESPIRATORY CARE, in the special June 2006 issue, provided a thoughtful review of the clinical application of heliox and its associated technical challenges.2 Inhaled nitric oxide (INO) has also been an impor...

متن کامل

Inhaled nitric oxide in the treatment of preterm infants.

Inhaled nitric oxide (iNO) has been used successfully in select term and near-term infants with respiratory failure. The use of iNO in the premature infant population, however, remains controversial. This article will review some of the current literature regarding the use of iNO in premature infants and discuss current recommendations and future research directions.

متن کامل

ذخیره در منابع من


  با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید

برای دانلود متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید

ثبت نام

اگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید

عنوان ژورنال:

دوره 1  شماره 

صفحات  -

تاریخ انتشار 2006