Inhaled nitric oxide in infants &gt;1500 g and &lt;34 weeks gestation with severe respiratory failure

Meurs, Krisa P. Van; Hintz, Susan R.; Ehrenkranz, Richard A.; Lemons, James A.; Ball, Michelle; Poole, W. Kenneth; Perritt, Rebecca; Das, Abhik; Higgins, Rosemary D.; Stevenson, David K.

doi:10.1038/sj.jp.7211690

Cited by 31 publications

(53 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…[10][11][12][13][14][15] Subsequently, several randomized clinical trials were undertaken. [16][17][18][19][20][21][22][23] Table 1 outlines the study population, entry criteria, and dose and duration of iNO treatment and summarizes the outcomes for all published randomized controlled trials. Only 1 small trial of 40 patients reported a beneficial effect on survival (Table 1).…”

Section: Use Of Ino In Preterm Infants With Respiratory Failurementioning

confidence: 99%

Use of Inhaled Nitric Oxide in Preterm Infants

Kumar¹,

Papile²,

Polin³

et al. 2014

Pediatrics

123

View full text Add to dashboard Cite

Nitric oxide, an important signaling molecule with multiple regulatory effects throughout the body, is an important tool for the treatment of full-term and late-preterm infants with persistent pulmonary hypertension of the newborn and hypoxemic respiratory failure. Several randomized controlled trials have evaluated its role in the management of preterm infants ≤34 weeks' gestational age with varying results. The purpose of this clinical report is to summarize the existing evidence for the use of inhaled nitric oxide in preterm infants and provide guidance regarding its use in this population. Pediatrics 2014;133:164-170 INTRODUCTIONNitric oxide (NO) is an important signaling molecule with multiple regulatory effects throughout the body. In perinatal medicine, inhaled nitric oxide (iNO) was initially studied for its pulmonary vasodilating effects in infants with pulmonary hypertension and has since become an important tool for the treatment of full-term and late-preterm infants with persistent pulmonary hypertension of the newborn and hypoxemic respiratory failure. 1 Inhaled NO also has multiple and complex systemic and pulmonary effects. In animal models of neonatal chronic lung disease, iNO stimulates angiogenesis, augments alveolarization, improves surfactant function, and inhibits proliferation of smooth muscle cells and abnormal elastin deposition. [2][3][4][5][6] Although the evidence for similar benefits in preterm infants is lacking, the off-label use of iNO in this population has escalated. 7 A study published in 2010 reported a sixfold increase (from 0.3% to 1.8%) in the use of iNO among infants born at less than 34 weeks' gestation between 2000 and 2008. 7 The greatest increase occurred among infants who were born at 23 to 26 weeks' gestation (0.8% to 6.6%). The National Institutes of Health convened a consensus panel in October 2010 to evaluate the evidence for safety and efficacy of iNO therapy in preterm infants. After reviewing the published evidence, the panel concluded that the available evidence does not support the use of iNO in early routine, early rescue, or later rescue regimens in the care of infants born at less than 34 weeks' gestation and that hospitals, clinicians, and the pharmaceutical industry should avoid marketing iNO for this group of infants. 8 An individual-patient data meta-analysis of 14 randomized controlled trials reached similar conclusions. 9 The purpose of this clinical report is to summarize the Praveen Kumar MD, FAAP, and COMMITTEE ON FETUS AND NEWBORN KEY WORDS inhaled nitric oxide, preterm infants, hypoxic respiratory failure, bronchopulmonary dysplasia ABBREVIATIONS BPD-bronchopulmonary dysplasia iNO-inhaled nitric oxide NO-nitric oxide NOCLD-Nitric

show abstract

Section: Use Of Ino In Preterm Infants With Respiratory Failurementioning

confidence: 99%

Use of Inhaled Nitric Oxide in Preterm Infants

Kumar¹,

Papile²,

Polin³

et al. 2014

Pediatrics

123

View full text Add to dashboard Cite

show abstract

“…The respiratory state of these VLBW neonates was serious and life threatening with a mean OI of 36, hypercapnia (PaCO 2 71 mm Hg), and acidosis (arterial pH 7.11), in contrast to many clinical studies on patients with mild or moderate HRF [8,9,10,11,12,13,14,15,16]. Their cardiovascular status was also compromised.…”

Section: Discussionmentioning

confidence: 78%

“…However, there were limited improvements in the survival rate, incidence of chronic lung disease, and neurodevelopmental outcome of preterm neonates treated with iNO at different postnatal ages, doses, and durations [8,9,10,11,12,13,14,15,16]. The use of iNO remains experimental in preterm neonates [1,17,18,19].…”

Section: Introductionmentioning

confidence: 99%

Outcome of Preterm Neonates with a Birth Weight <1,500 g with Severe Hypoxemic Respiratory Failure Rescued by Inhaled Nitric Oxide Therapy and High-Frequency Oscillatory Ventilation

Golfar

Bhogal²,

Kamstra³

et al. 2017

Neonatology

View full text Add to dashboard Cite

Background: Despite being an experimental therapy in preterm neonates, inhaled nitric oxide (iNO) is used as a rescue therapy when high-frequency oscillatory ventilation (HFOV) and other conventional therapies fail. Objective: We aimed to determine the outcomes of very-low-birth-weight (VLBW) neonates with hypoxemic respiratory failure (HRF) who had received iNO after maximal conventional therapies. Methods: We retrospectively reviewed preterm neonates (<33 weeks of gestation with a birth weight <1,500 g) who had all received HFOV and then iNO from March 1, 2009 to April 1, 2014 at the Royal Alexandra Hospital. We collected demographic and clinical parameters, doses, duration and response to iNO, survival to neonatal intensive care unit (NICU) discharge, major complications, and neurodevelopmental outcome at 18-24 months of corrected age. Results: During the study period, 1,168 eligible preterm neonates were admitted; 155 (13%) had HRF treated with HFOV, of whom 47 (30%) received iNO. The baseline characteristics between the 24 survivors and 23 nonsurvivors were not different. Survivors had a greater decrease in oxygenation index than nonsurvivors (61 vs. 33%) after 6 h of iNO (p = 0.003). The causes of death were refractory hypoxemia (8), multi-organ failure (7), treatment withdrawal (6), and others (2). During the NICU stay, 23 survivors (96%) developed complications. At 18-24 months, 7 (29%) had significant disabilities. Conclusions: Of the VLBW neonates with severe HRF rescued by HFOV and iNO, many survived without neurodevelopmental disability at early childhood, despite multiple short-term complications. Further research is necessary to understand the clinical course and risk factors of adverse outcomes and to improve the management care of these critically ill neonates.

show abstract

“…However, with respect to the optimal timing, previous studies [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] differ greatly due to their design ( table 1 ). Some authors report the age at enrolment, while others prefer to record the age at randomization or therapy beginning; nevertheless, in the majority of studies iNO was started within the first 48 h of life [7,[9][10][11][12][13][14][15][16][17][18]20] , and it was started later only by Subhedar and Shaw [8] (4-5 days of life) and Ballard et al [19] (7-21 days of life). Unfortunately, no studies compared the effects of starting iNO at different ages in preterm infants; therefore, the optimal timing for starting iNO is still unknown.…”

Section: Optimal Age Dose and Duration Of Ino Therapymentioning

confidence: 99%

“…In conclusion, it appears that from a methodological point of view these studies may be put into 3 categories: the studies in which iNO was given as an early prophylaxis [12,18] , the studies in which iNO was given as an early rescue treatment [9,11,14,15,17,20] , and the studies in which iNO was given as a late treatment [8,19] . Unfortunately, the usefulness of this classification is limited by the large differences remaining between the studies in each category (e.g.…”

Section: Clinical Studies On Ino Treatment In Preterm Infantsmentioning

confidence: 99%

Inhaled Nitric Oxide for the Treatment of Preterm Infants with Respiratory Distress Syndrome

Dani¹,

Bertini²

2008

Neonatology

View full text Add to dashboard Cite

Many authors have hypothesized that inhaled nitric oxide (iNO) might acutely improve oxygenation in preterm neonates with infant respiratory distress syndrome (iRDS) and decrease the risk of bronchopulmonary dysplasia. The studies on the effects of iNO in preterm infants with iRDS have given contradictory results. We report their main methodological characteristics and the observed effects of iNO in preterm infants. Moreover, we discuss the infants’ age at the beginning of the study, the dose and duration of iNO therapy, its potential effect on neurodevelopment, its relationship with surfactant properties, and the need to identify patients who are likely to respond to this therapy. We advise caution against the widespread use of iNO in preterm infants with iRDS. At present, it appears to be premature to have specific recommendations regarding the indications for iNO therapy in this group of patients. The conclusion of current trials and the follow-up studies of recently completed trials will give further data to guide neonatologists’ decisions, and until then it is likely that clinicians will continue to make case-by-case decisions for the treatment of iNO in preterm infants with hypoxia that is unresponsive to other therapies. However, this decision should always be discussed with the parents.

show abstract

Inhaled nitric oxide in infants >1500 g and <34 weeks gestation with severe respiratory failure

Cited by 31 publications

References 29 publications

Use of Inhaled Nitric Oxide in Preterm Infants

Use of Inhaled Nitric Oxide in Preterm Infants

Outcome of Preterm Neonates with a Birth Weight <1,500 g with Severe Hypoxemic Respiratory Failure Rescued by Inhaled Nitric Oxide Therapy and High-Frequency Oscillatory Ventilation

Inhaled Nitric Oxide for the Treatment of Preterm Infants with Respiratory Distress Syndrome

Contact Info

Product

Resources

About