Use of inhaled nitric oxide in preterm infants: a regional survey of practices

To conduct a regional survey of neonatal intensive care unit (NICU) Directors in Australia and New Zealand (ANZ) to ascertain current practice.

Use of inhaled nitric oxide (iNO) therapy in infants < 34 weeks gestational age is not supported by current evidence.

A cross-sectional electronic survey based on structured questionnaire was conducted amongst the Directors of all the tertiary neonatal intensive care units in Australia and New Zealand Neonatal Network (ANZNN). Information was collected on indications, dosage, monitoring response and weaning for iNO therapy.

The survey was sent to 28 units, of which 2 were quaternary units' not routinely admitting preterm infants, hence were excluded from analysis. The response rate was 77% (20/26). Majority of units (16; 80%) did not have preterm specific protocol. In almost all units nitric was used as early rescue for hypoxemic respiratory failure (95%; 19/20). Neonatologist performed functional echocardiography (fECHO) was frequently used for prior assessment (90%) and monitoring (65%). Variations were noted regarding initiating criteria, dosage and weaning strategies.

Wide variation in practice was noted highlighting the need for the formulation of consensus guidelines.