The Controversy Persists: Is There a Qualification Criterion to Utilize Inhaled Nitric Oxide in Pre-term Newborns?

Area of Science:

• Neonatal Medicine
• Respiratory Physiology

Background:

• Inhaled nitric oxide (iNO) use in premature newborns is controversial.
• Guidelines do not support routine iNO use, yet it persists in clinical practice.
• Recent evidence suggests potential benefits in specific pre-term infant subgroups.

Purpose of the Study:

• To review the rationale and controversies surrounding iNO use in premature infants.
• To explore potential benefits of iNO in specific pre-term populations.
• To discuss novel approaches for iNO treatment in high-risk pre-term neonates.

Main Methods:

• Literature review of studies on iNO in premature newborns.
• Analysis of Cochrane reviews and non-randomized controlled trials.
• Discussion of clinical response and outcomes in pre-term infants.

Main Results:

• No major advantages of iNO in pre-term newborns were confirmed by recent reviews.
• A subset of pre-term infants, especially those with pulmonary hypertension (PHTN), may benefit from iNO.
• Clinical response to iNO correlated with increased survival without disability in specific groups.

Conclusions:

• Further research is needed for iNO in pre-term infants with hypoxemic respiratory failure and PHTN.
• iNO may offer therapeutic value for select pre-term neonates, particularly those with PHTN.
• Novel applications of iNO in perinatal asphyxia and resuscitation warrant investigation.