Inhaled nitric oxide in the management of preterm infants with severe respiratory failure

Objective: Elevated pulmonary vascular resistance and poor ventilation-perfusion matching are commonly found in preterm infants with severe respiratory distress syndrome (RDS) and respiratory failure. Inhaled nitric oxide (INO) can improve gas exchange and decrease pulmonary vascular resistance. This study was conducted to determine whether INO therapy improves oxygenation in such infants. Study Design: Between July 2000 and 2006, 65 preterm infants (birth weight, < 1500 g: gestational age, < 31 weeks) with severe RDS and respiratory failure requiring mechanical ventilation and an oxygenation index (01) >= 25 were randomly divided into two groups. Group A infants (n = 32) received INO therapy. INO was started at a dose of five parts per million (p.p.m.). The maximal dose of NO was 20p.p.m. Group B infants (17 = 33) did not receive INO therapy, receive inhaled oxygen placebo only, was served as control group. Mechanical ventilation and iNO therapy were managed by neonatologists who were not involved in safety monitoring, data analysis and interpretation, or manuscript preparation. This study was randomized but not blinded. Result: The 01 was significantly lower (P < 0.01) in the iNO therapy group than in the control group at 30min, 3, 12 and 24h after initiating iNO therapy. Six infants in the M-treated group and 10 infants in the control group died. Post hoc analyses did not reveal any significant differences ill the incidences of chronic lung disease (CLD), intracranial hemorrhage (ICH), patent ductus arteriosus (PDA), retinopathy of prematurity (ROP) or duration of intubation between the iNO-treated and the control groups. Conclusion: Vie conclude that iNO therapy leads to all improvement ill oxygenation without short-term side effects (such as pulmonary hemorrhage. intracranial hemorrhage, pneumothorax or acute deterioration) in premature infants with severe RDS and respiratory failure. However, iNO therapy does not significantly reduce mortality rate or the incidences of CIA ICH, PDA or ROP.