Document Detail


Inhaled nitric oxide for preterm infants: a systematic review.
MedLine Citation:
PMID:  17974747     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: Our goal was to determine whether, for preterm newborn infants with respiratory disease, inhaled nitric oxide reduced the rates of death, bronchopulmonary dysplasia, intracranial hemorrhage, or neurodevelopmental disability. METHODS: We searched Medline, Embase, Healthstar, and the Cochrane Central Register of Controlled Trials using the search terms "nitric oxide," "clinical trial," and "newborn" and covering 1985-2006. We also searched abstracts of the Pediatric Academic Societies. RESULTS: Eleven randomized, controlled trials of inhaled nitric oxide therapy for preterm infants were found. The trials were grouped into 3 categories according to the entry criteria, that is, entry in the first 3 days of life on the basis of oxygenation criteria (early rescue), enrollment after 3 days on the basis of elevated risk of bronchopulmonary dysplasia, and routine use for intubated preterm infants. Early rescue treatment based on oxygenation criteria did not seem to affect mortality or bronchopulmonary dysplasia rates. Routine use for intubated preterm infants showed a barely significant reduction in the incidence of the combined outcome of death or bronchopulmonary dysplasia (relative risk [RR]: 0.91 [95% confidence limits (CLs): 0.84, 0.99]). Later treatment based on the risk of bronchopulmonary dysplasia showed no significant effect on this outcome. Early rescue treatment showed a trend toward increased incidence of severe intracranial hemorrhage, whereas routine use for intubated preterm infants seemed to show a reduction in the incidence of either severe intracranial hemorrhage or periventricular leukomalacia (RR: 0.70 [95% CLs: 0.53, 0.91]). CONCLUSIONS: Inhaled nitric oxide as rescue therapy for very ill preterm infants undergoing ventilation does not seem to be effective and may increase severe intracranial hemorrhage. Later use of inhaled nitric oxide to prevent bronchopulmonary dysplasia does not seem to be effective. Early routine use of inhaled nitric oxide for mildly sick, preterm infants seems to decrease the risk of serious brain injury and may improve rates of survival without bronchopulmonary dysplasia.
Authors:
Keith J Barrington; Neil N Finer
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Pediatrics     Volume:  120     ISSN:  1098-4275     ISO Abbreviation:  Pediatrics     Publication Date:  2007 Nov 
Date Detail:
Created Date:  2007-11-02     Completed Date:  2007-12-07     Revised Date:  2008-08-11    
Medline Journal Info:
Nlm Unique ID:  0376422     Medline TA:  Pediatrics     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1088-99     Citation Subset:  AIM; IM    
Affiliation:
Department of Pediatrics, McGill University, Royal Victoria Hospital, 687 Pine Ave W, Montreal, Quebec, Canada H3A 1A1. keith.barrington@mcgill.ca
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MeSH Terms
Descriptor/Qualifier:
Administration, Inhalation
Humans
Infant, Newborn
Infant, Premature* / physiology
Infant, Premature, Diseases / drug therapy*,  epidemiology
Nitric Oxide / administration & dosage*,  adverse effects*
Randomized Controlled Trials as Topic / methods
Chemical
Reg. No./Substance:
10102-43-9/Nitric Oxide
Comments/Corrections
Comment In:
Pediatrics. 2008 Jun;121(6):1287-8; author reply 1288-9   [PMID:  18519502 ]
Erratum In:
Pediatrics. 2008 Feb;121(2):451

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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