Inhaled nitric oxide in preterm infants undergoing mechanical ventilation

Area of Science:

• Neonatal Medicine
• Pediatric Pulmonology
• Critical Care

Background:

• Bronchopulmonary dysplasia (BPD) is a significant complication in premature infants, leading to prolonged hospitalization and adverse neurodevelopmental outcomes.
• While animal studies suggest inhaled nitric oxide (iNO) benefits lung development and gas exchange, its use in at-risk infants remains debated.

Purpose of the Study:

• To evaluate the efficacy and safety of inhaled nitric oxide (iNO) in preventing bronchopulmonary dysplasia (BPD) in very low birth weight infants requiring ventilatory support.

Main Methods:

• A randomized, double-blind, placebo-controlled trial was conducted across 21 centers.
• Infants with birth weight ≤1250g needing ventilatory support between 7-21 days received iNO (starting at 20 ppm, decreasing) or placebo for ≥24 days.
• The primary endpoint was survival without BPD at 36 weeks postmenstrual age.

Main Results:

• Survival without BPD was significantly higher in the iNO group (43.9%) compared to placebo (36.8%) (P=0.042).
• Infants receiving iNO experienced shorter hospital discharge times (P=0.04) and reduced supplemental oxygen use (P=0.006).
• No short-term safety concerns were identified with iNO administration.

Conclusions:

• Inhaled nitric oxide therapy is effective in improving pulmonary outcomes for premature infants at risk for BPD.
• Initiating iNO between 7 and 21 days of age appears beneficial and safe in the short term.
• This therapy offers a potential strategy to reduce BPD-related morbidity in vulnerable neonates.