Inhaled nitric oxide for respiratory failure in preterm infants.

Area of Science:

• Neonatal Medicine
• Pediatric Critical Care
• Respiratory Medicine

Background:

• Inhaled nitric oxide (iNO) is effective for term infants with hypoxic respiratory failure.
• Preterm infants have different pathophysiology and risks for respiratory failure.
• Analysis of iNO efficacy and toxicity in preterm infants (<35 weeks gestation) is crucial.

Purpose of the Study:

• To evaluate the effect of iNO on mortality, bronchopulmonary dysplasia (BPD), intraventricular hemorrhage (IVH), and neurodevelopmental disability in preterm infants.
• To assess the safety and efficacy of iNO in neonates with respiratory disease.

Main Methods:

• Systematic review and meta-analysis of randomized and quasi-randomized controlled trials.
• Searched MEDLINE, EMBASE, Healthstar, CENTRAL, and Pediatric Academic Societies abstracts (1985-2006).
• Included studies compared iNO administration versus control in preterm infants with respiratory disease.

Main Results:

• Eleven trials involving preterm infants were analyzed, categorized by treatment timing and criteria.
• Early rescue iNO showed no significant effect on mortality or BPD but a trend towards increased severe IVH.
• Routine early iNO in intubated preterm infants showed a marginal reduction in death or BPD and possibly reduced severe IVH or periventricular leukomalacia (PVL).
• Later iNO use for BPD prevention showed no significant benefit.

Conclusions:

• iNO as rescue therapy for critically ill preterm infants is ineffective and may increase severe IVH risk.
• Late iNO use to prevent BPD is not effective.
• Early routine iNO in mildly ill preterm infants may reduce serious brain injury and improve survival without BPD.
• Further research is needed to confirm findings and identify optimal patient groups.