Nitric oxide inhalation in infants with respiratory distress syndrome☆,☆☆,★,★★
Section snippets
Enrollment
The following procedures were approved by the University of Florida Institutional Review Board before we conducted the studies. Infants were considered candidates for enrollment into this study if they were admitted to the University of Florida neonatal nursery at any time between ages 24 and 168 hours and born at less than 36 weeks of gestation. Candidates for enrollment were excluded from the study if they were (1) identified as having a congenital cardiopulmonary anomaly, (2) breathing
RESULTS
We identified 350 infants who had less than 36 weeks of gestation and who were receiving supplemental oxygen therapy at the University of Florida between ages 24 and 168 hours. Of these 350 “candidates,” we enrolled 23 infants. The results of our exclusion algorithm are shown in Table I . Twelve infants received 20 ppm nitric oxide, and 11 infants received 5 ppm nitric oxide. The mean gestational age of the enrolled patients was 28.0 ± 0.6 weeks, and the mean postnatal age during treatment was
DISCUSSION
The results of this study show that nitric oxide inhalation causes an increase in the Pa o2 of preterm newborn infants with RDS. This finding is consistent with previously published reports that showed that nitric oxide inhalation increases the arterial blood oxygen tensions of prematurely delivered lambs. 6, 28 Our finding that the responses to nitric oxide inhalation in the range of 5 to 20 ppm are relatively dose independent is consistent with the findings of others who studied the effects
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Cited by (82)
Just Say No to iNO in Preterms—Really?
2020, Journal of PediatricsPulmonary Vascular Development and the Neonatal Circulation
2018, The Newborn Lung: Neonatology Questions and Controversies, Third EditionPathophysiology of Persistent Pulmonary Hypertension of the Newborn
2017, Fetal and Neonatal Physiology, 2-Volume SetPhysiology of Nitric Oxide in the Developing Lung
2011, Fetal and Neonatal Physiology E-Book, Fourth EditionInhaled Nitric Oxide for Preterm Neonates
2009, Clinics in PerinatologyCitation Excerpt :Investigation of iNO in term neonates was followed by early case reports of improved oxygenation in preterm neonates with iNO therapy. The major concern with the use of iNO in these babies is an increased incidence of intracranial hemorrhage attributable to inhibition of platelet aggregation by NO.27,66–68 Although some pilot studies showed an increased IVH rate with iNO, these studies had a small sample size, included critically ill preterm infants, and did not obtain cranial imaging before administering iNO. The efficacy and safety of iNO in this group of babies were tested in three large multicenter trials and a large single-center trial.59,69–71
Inhaled Nitric Oxide and Neuroprotection in Preterm Infants
2008, Clinics in PerinatologyCitation Excerpt :The observation, therefore, that IVH rates were not significantly higher in iNO-treated infants compared with control infants, although far from definitive proof that iNO did not increase the risk of IVH, nonetheless provided an indication that it might be safe in this population. A lack of increase in IVH after iNO treatment in preterm infants was also found in several other studies.34–36 Finally, a small (N = 34) randomized, placebo-controlled trial of iNO treatment37 was performed to ascertain safety of iNO in preterm infants.
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From the Department of Pediatrics, University of Florida College of Medicine, Gainesville.
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Supported by grants from the American Heart Association, Florida Affiliate (AHA awards 93CRF/6) and the Children's Miracle Network (CMN award 94-F-040).
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Reprint requests: J. W. Skimming, MD University of Florida College of Medicine, Department of Pediatrics, Division of Cardiology, PO Box 100296, JHMHC, Gainesville, FL 32610-0296.
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