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Inhaled nitric oxide in the management of preterm infants with severe respiratory failure

P H Su1, J Y Chen

  • 1Department of Pediatrics, Division of Neonatology, Chung Shan Medical University Hospital, Taichung, Taiwan.

Journal of Perinatology : Official Journal of the California Perinatal Association
|November 9, 2007
PubMed

Insights

Inhaled nitric oxide (iNO) improved oxygenation in preterm infants with severe respiratory distress syndrome (RDS). However, iNO did not significantly reduce mortality or long-term complications like chronic lung disease.

Area of Science:

  • Neonatology
  • Pediatric Pulmonology
  • Critical Care Medicine

Background:

  • Severe respiratory distress syndrome (RDS) in preterm infants often involves high pulmonary vascular resistance and poor ventilation-perfusion matching.
  • Inhaled nitric oxide (iNO) is known to improve gas exchange and decrease pulmonary vascular resistance.

Purpose of the Study:

  • To evaluate the efficacy of inhaled nitric oxide (iNO) therapy in improving oxygenation in preterm infants suffering from severe RDS and respiratory failure.
  • To assess potential short-term side effects of iNO therapy in this vulnerable population.

Main Methods:

  • A randomized study involving 65 preterm infants (birth weight <1500g, gestational age <31 weeks) with severe RDS and respiratory failure (Oxygenation Index [OI] ≥25).
  • Infants were randomly assigned to receive either iNO therapy (starting at 5 ppm, max 20 ppm) or a placebo (inhaled oxygen).
  • The study was randomized but not blinded, with management by neonatologists independent of data analysis.

Main Results:

  • The iNO therapy group demonstrated a significantly lower OI compared to the control group at multiple time points (30 min, 3, 12, and 24 hours) post-initiation (P<0.01).
  • Mortality rates were 6/32 in the iNO group and 10/33 in the control group.
  • No significant differences were observed in the incidences of chronic lung disease (CLD), intracranial hemorrhage (ICH), patent ductus arteriosus (PDA), retinopathy of prematurity (ROP), or duration of intubation between groups.

Conclusions:

  • iNO therapy effectively improves oxygenation in preterm infants with severe RDS and respiratory failure.
  • The therapy was not associated with significant short-term adverse effects.
  • iNO therapy did not demonstrate a significant reduction in mortality rates or the incidence of major morbidities including CLD, ICH, PDA, or ROP.
Abstract

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