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Inhaled nitric oxide usage in preterm infants in the NICHD Neonatal Research Network: inter-site variation and
Summary
Inhaled nitric oxide (iNO) use in preterm infants decreased after 2010 NIH guidelines. Starting iNO later in treatment was linked to worse outcomes, including severe bronchopulmonary dysplasia or death.
Area of Science:
- Neonatal medicine
- Pediatric respiratory research
- Clinical trial methodology
Background:
- Inhaled nitric oxide (iNO) use in preterm infants is controversial, with a 2010 NIH consensus conference recommending caution.
- Variability in iNO application exists across neonatal intensive care units.
Purpose of the Study:
- To assess the prevalence and variability of iNO use in the NICHD Neonatal Research Network (NRN) before and after the 2010 NIH consensus conference.
- To examine the association between iNO use and severe bronchopulmonary dysplasia (BPD) or death in very preterm infants.
Main Methods:
- Analysis of data from the NICHD NRN Generic Database (2008-2011) for 4885 very preterm infants.
- Comparison of infants exposed to iNO versus those not exposed using logistic regression, controlling for risk factors.
Main Results:
- Overall NRN iNO usage decreased from 4.6% (2008-2010) to 1.6% (2011), with 12 of 13 centers reducing use.
- iNO initiated between days 7-14 was associated with increased risk of severe BPD or death (OR 2.24; 95% CI 1.23-4.07).
Conclusions:
- The use and variability of iNO in the NICHD NRN significantly decreased in 2011.
- Delayed initiation of iNO (≥ day 7) in preterm infants is linked to more severe outcomes.
