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Inhaled nitric oxide therapy for preterm infants after 7 days of age: a scoping review protocol
Yohei Minamitani1, Shin Kato2, Miku Hosokawa3
1Department of Pediatrics, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan yohei373@saitama-med.ac.jp.
Insights
This scoping review examines clinical and echo findings for initiating inhaled nitric oxide (iNO) in preterm infants post-acute phase. It aims to standardize criteria for this off-label iNO use in neonates.
Area of Science:
- Neonatal Medicine
- Respiratory Physiology
- Pediatric Cardiology
Background:
- Inhaled nitric oxide (iNO) is standard for persistent pulmonary hypertension in term/late preterm infants.
- Off-label iNO use is increasing in preterm infants (post-7 days) for bronchopulmonary dysplasia (BPD) prevention or rescue.
- Current initiation criteria for post-acute phase iNO therapy in preterm infants are inconsistent.
Purpose of the Study:
- To identify and summarize clinical and echocardiographic findings used to initiate inhaled nitric oxide (iNO) therapy in preterm infants during the post-acute phase.
- To provide a foundation for developing standardized iNO initiation criteria in this vulnerable population.
Main Methods:
- Scoping review methodology following PRISMA-ScR guidelines.
- Systematic literature search of PubMed, Embase, and Ichushi databases (Jan 2003 - Aug 2023).
- Inclusion of RCTs, cohort studies, case-control studies, and case series on iNO in preterm infants post-acute phase.
Main Results:
- Data extraction and summarization of study characteristics and reported findings.
- Identification of varied clinical and echocardiographic parameters influencing iNO initiation decisions.
- Synthesis of evidence regarding the current practices for iNO use in post-acute preterm infants.
Conclusions:
- Significant variability exists in the clinical and echocardiographic criteria for initiating inhaled nitric oxide (iNO) in preterm infants in the post-acute phase.
- Further research and consensus are needed to establish standardized guidelines for this off-label iNO application.
- Standardized criteria could optimize iNO therapy effectiveness and safety in preterm neonates with BPD-related complications.
Introduction:
Inhaled nitric oxide (iNO) use is recommended for persistent pulmonary hypertension of the newborn in term and late preterm infants. Recently, iNO therapy to prevent bronchopulmonary dysplasia (BPD) or rescue for hypoxic respiratory failure and pulmonary hypertension secondary to BPD has increasingly been used in preterm infants after 7 days of postnatal age (in the postacute phase), despite its off-label use. However, the initiation criteria of iNO therapy for preterm infants in the postacute phase are varied. The aim of this scoping review is to identify the clinical and/or echo findings at the initiation of iNO therapy in preterm infants in the postacute phase.
Methods And Analysis:
We will search PubMed, Embase and the Japanese database 'Ichushi.' The following studies will be included in the review: randomised controlled trials, prospective/retrospective cohort studies, case-control studies and case series on iNO therapy for preterm infants in the postacute phase; studies published between January 2003 and August 2023; studies conducted in developed countries and studies written in English or Japanese. We will independently screen, extract and chart data using the population-concept-context framework following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. We will summarise the characteristics and findings of the included studies.
Ethics And Dissemination:
Obtaining an institutional review board approval is not required because of the nature of this review. A final report of review findings will be published and disseminated through a peer-reviewed journal and presentation at relevant conferences.
Trial Registration Number:
UMIN000051498.
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