Elsevier

The Journal of Pediatrics

Volume 130, Issue 2, February 1997, Pages 225-230
The Journal of Pediatrics

Nitric oxide inhalation in infants with respiratory distress syndrome,☆☆,,★★

https://doi.org/10.1016/S0022-3476(97)70347-0Get rights and content

Abstract

Objective: This study was designed to test the hypothesis that nitric oxide inhalation increases systemic arterial blood oxygen tension of prematurely delivered infants with respiratory distress syndrome. Methods: Nitric oxide was administered to 23 preterm infants with a diagnosis of respiratory distress syndrome. The infants were randomly assigned to receive either 5 or 20 ppm of nitric oxide and were studied between 24 and 168 hours after delivery. The treatment period for each infant lasted 15 minutes and was preceded by and followed by a 15-minute control period. We evaluated all outcome variables by using two-way repeated measures analysis of variance; p values less than 0.01 were considered significant. Results: Nitric oxide inhalation caused significant increases in the following: arterial blood oxygen tension, directly measured arterial oxyhemoglobin saturation, and transcutaneously measured arterial oxyhemoglobin saturation. No differences between the effects of the two nitric oxide concentrations were detected, nor were residual effects detected 15 minutes after either dose of nitric oxide was discontinued. Conclusions: Inhalation of both 5 and 20 ppm nitric oxide causes concentration-independent increases in the blood oxygen tensions of preterm infants with respiratory distress syndrome. We speculate that nitric oxide inhalation may be a useful adjunctive therapy for these patients. (J Pediatr 1997;130:225-30)

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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    From the Department of Pediatrics, University of Florida College of Medicine, Gainesville.

    ☆☆

    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).

    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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