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A Novel Inhalation Mask System to Deliver High Concentrations of Nitric Oxide Gas in Spontaneously Breathing Subjects
Published on: May 4, 2021
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Inhaled nitric oxide for respiratory failure in preterm infants
Keith J Barrington1, Neil Finer2, Thomas Pennaforte3
1Department of Pediatrics, CHU Ste-Justine, 3175 Cote Ste Catherine, Montreal, QC, Canada, H3T 1C5.
The Cochrane Database of Systematic Reviews
|January 4, 2017
Summary
Inhaled nitric oxide (iNO) did not improve outcomes for preterm infants with respiratory failure. Studies found no significant benefits in reducing death, bronchopulmonary dysplasia (BPD), or brain injury, indicating iNO is not effective for this population.
Area of Science:
- Neonatal Medicine
- Respiratory Physiology
- Clinical Trials
Background:
- Inhaled nitric oxide (iNO) is a proven treatment for hypoxic respiratory failure in term infants.
- Preterm infants have different pathophysiology and risks, requiring specific investigation for iNO efficacy.
- Existing research highlights the need to evaluate iNO's impact on mortality, bronchopulmonary dysplasia (BPD), and neurodevelopmental outcomes in preterm neonates.
Purpose of the Study:
- To determine the effects of inhaled nitric oxide (iNO) on mortality, BPD, intraventricular hemorrhage (IVH), brain injury, and neurodevelopmental outcomes in preterm infants.
- To analyze iNO efficacy based on treatment timing and criteria: early rescue for oxygenation defects, routine use for pulmonary disease, and later use for BPD risk.
Main Methods:
- Conducted a systematic review of randomized and quasi-randomized controlled trials.
- Searched major databases (MEDLINE, Embase, Healthstar, Cochrane Library) and conference abstracts through January 2016.
- Grouped 17 eligible trials post hoc into three treatment categories for analysis, assessing outcomes like mortality, BPD, IVH, and neurodevelopmental impairment.
Main Results:
- Early rescue iNO treatment (within 3 days) showed no significant effect on mortality or BPD (RR 0.94, 95% CI 0.87-1.01).
- Routine iNO use in preterm infants with pulmonary disease did not significantly reduce death or BPD (RR 0.94, 95% CI 0.87-1.02).
- Later iNO treatment (after 3 days) for BPD risk also showed no significant benefit (RR 0.92, 95% CI 0.85-1.01); no clear effect on IVH or neurodevelopmental impairment was found.
Conclusions:
- Inhaled nitric oxide (iNO) is not effective as rescue therapy for critically ill preterm infants.
- Early routine iNO use does not prevent severe brain injury or improve survival without BPD in preterm neonates.
- While later iNO use to prevent BPD warrants further study, current evidence suggests a small, non-significant effect.
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