Document Detail


Inhaled nitric oxide in preterm infants: a systematic review.
MedLine Citation:
PMID:  21220391     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
CONTEXT: Studies of the efficacy of inhaled nitric oxide (iNO) to prevent or treat respiratory failure in preterm infants have had variable and contradictory findings.
OBJECTIVES: To systematically review the evidence on the use of iNO in infants born at ≤ 34 weeks' gestation who receive respiratory support.
METHODS: Medline, Embase, the Cochrane Central Register of Controlled Studies, PsycInfo, ClinicalTrials.gov, and proceedings of the 2009 and 2010 Pediatric Academic Societies meetings were searched in June 2010. Additional studies from reference lists of eligible articles, relevant reviews, and technical experts were considered. Two investigators independently screened search results and abstracted data from eligible articles. We focus here on mortality, bronchopulmonary dysplasia (BPD), the composite outcome of death or BPD, and neurodevelopmental impairment.
RESULTS: Fourteen randomized controlled trials, 7 follow-up studies, and 1 observational study were eligible for inclusion. Mortality rates in the NICU did not differ for infants treated with iNO compared with controls (risk ratio [RR]: 0.97 [95% confidence interval (CI): 0.82-1.15]). BPD at 36 weeks for iNO and control groups also did not differ for survivors (RR: 0.93 [95% CI: 0.86-1.003]). A small difference was found in favor of iNO in the composite outcome of death or BPD (RR: 0.93 [95% CI: 0.87-0.99]). There was no evidence to suggest a difference in the incidence of cerebral palsy (RR: 1.36 [95% CI: 0.88-2.10]), neurodevelopmental impairment (RR: 0.91 [95% CI: 0.77-1.12]), or cognitive impairment (RR: 0.72 [95% CI: 0.35-1.45]).
CONCLUSIONS: There was a 7% reduction in the risk of the composite outcome of death or BPD at 36 weeks for infants treated with iNO compared with controls but no reduction in death alone or BPD. There is currently no evidence to support the use of iNO in preterm infants with respiratory failure outside the context of rigorously conducted randomized clinical trials.
Authors:
Pamela K Donohue; Maureen M Gilmore; Elizabeth Cristofalo; Renee F Wilson; Jonathan Z Weiner; Brandyn D Lau; Karen A Robinson; Marilee C Allen
Publication Detail:
Type:  Journal Article; Research Support, U.S. Gov't, P.H.S.; Review     Date:  2011-01-10
Journal Detail:
Title:  Pediatrics     Volume:  127     ISSN:  1098-4275     ISO Abbreviation:  Pediatrics     Publication Date:  2011 Feb 
Date Detail:
Created Date:  2011-02-02     Completed Date:  2011-03-21     Revised Date:  2011-08-19    
Medline Journal Info:
Nlm Unique ID:  0376422     Medline TA:  Pediatrics     Country:  United States    
Other Details:
Languages:  eng     Pagination:  e414-22     Citation Subset:  AIM; IM    
Affiliation:
Department of Pediatrics, Johns Hopkins School of Medicine, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA. pdonohue@jhmi.edu
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MeSH Terms
Descriptor/Qualifier:
Administration, Inhalation
Bronchopulmonary Dysplasia / epidemiology*,  prevention & control*
Humans
Infant, Newborn
Infant, Premature
Infant, Premature, Diseases / epidemiology,  prevention & control
Nitric Oxide / administration & dosage*,  adverse effects
Randomized Controlled Trials as Topic / methods
Respiratory Distress Syndrome, Newborn / epidemiology,  prevention & control
Chemical
Reg. No./Substance:
10102-43-9/Nitric Oxide
Comments/Corrections
Comment In:
Pediatrics. 2011 Jul;128(1):e255-6; author reply e256-7   [PMID:  21725058 ]

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