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Nitric oxide therapy for the newborn infant
1Department of Pediatrics, University of California, San Diego Medical Center, 92103-8774, USA. nfiner@ucsd.edu
Seminars in Perinatology
|March 10, 2000
Summary
Inhaled nitric oxide (INO) improves oxygenation and reduces death or need for ECMO in term newborns with hypoxic respiratory failure. Long-term outcomes show no increased neurodevelopmental issues, but benefits for premature infants remain unproven.
Area of Science:
- Neonatology
- Pediatric Critical Care
- Pulmonary Medicine
Background:
- Hypoxic respiratory failure and persistent pulmonary hypertension of the newborn (PPHN) are critical conditions in neonates.
- Inhaled nitric oxide (INO) is a selective pulmonary vasodilator with potential benefits in neonatal respiratory distress.
Purpose of the Study:
- To evaluate the efficacy and safety of inhaled nitric oxide (INO) in neonates with hypoxic respiratory failure.
- To assess the impact of INO on oxygenation, need for extracorporeal membrane oxygenation (ECMO), mortality, and neurodevelopmental outcomes.
Main Methods:
- Meta-analysis of 10 prospective randomized controlled trials involving near-term neonates with hypoxic respiratory failure.
- Review of existing prospective trials in premature infants and long-term follow-up studies.
Main Results:
- INO significantly improved PaO2 and decreased the oxygenation index in term neonates.
- Treatment with INO significantly reduced the incidence of death or need for ECMO (RR 0.72).
- No significant clinical benefit was observed in premature infants, and infants with congenital diaphragmatic hernia did not appear to benefit.
Conclusions:
- Inhaled nitric oxide is an effective therapy for hypoxic term neonates, reducing mortality and the need for ECMO.
- Long-term neurodevelopmental sequelae were not increased in infants treated with INO.
- Further research is needed to determine the benefits of INO in hypoxic preterm infants.