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Copyright © 2007 Massachusetts Medical Society. All rights reserved.

Nitric oxide in preterm infants?

Nitric oxide is not ready for widespread use.

Reducing the occurrence of bronchopulmonary dysplasia (BPD) in preterm infants will improve both morbidity and mortality rates, but to date few benefits of nitric oxide in reducing BPD have been demonstrated in preterm infants in clinical trials. In two multisite, double-blind, randomized trials, researchers evaluated the safety and efficacy of nitric oxide in preterm infants undergoing mechanical ventilation.

In the first trial, investigators randomized 582 infants (mean birth weight, 760 g) to receive either inhaled nitric oxide or placebo (beginning 7 to 21 days after birth for at least 24 days). Compared with infants in the placebo group, infants in the treatment group were significantly more likely to survive without BPD (36.8% vs. 43.9%) and to be discharged sooner. Death rates did not differ significantly between groups.

In the second study, 793 infants (mean birth weight, 792 g) received either low-dose, inhaled nitric oxide (5 ppm) or placebo for 21 days or until extubation. Overall, the incidence of BPD or death did not differ significantly between groups. However, among infants who weighed between 1000 and 1250 g at birth, the incidence of BPD was lower in treated infants compared with the placebo group (29.8% vs. 59.6%). Overall, rates of central nervous system findings, such as periventricular leukomalacia, were significantly lower in the treatment group (17.5% vs. 23.9%).

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