Abstract：Objective To investigate the safety and efficacy of low-concentration inhaled nitric oxide (NO) in the treatment of hypoxic respiratory failure (HRF) among premature infants. Methods Sixty premature infants (gestational age ≤34 weeks) with HRF were randomized into NO and control groups between 2012 and 2013, with 30 cases in each group. Both groups received nasal continuous positive airway pressure (nCPAP) or mechanical ventilation. NO inhalation was continued for at least 7 days or until weaning in the NO group. The general conditions, blood gas results, complications, and clinical outcomes of the two groups were analyzed. Results The NO group showed significantly more improvement in blood gas results than the control group after 12 hours of treatment (PP>0.05). There were no significant differences in total time of assisted ventilation and duration of oxygen therapy between the two groups (P>0.05). The incidence of bronchopulmonary dysplasia (BPD), patent ductus arteriosus, necrotizing enterocolitis, retinopathy of prematurity, and pneumothorax in infants showed no significant differences between the NO and control groups (P>0.05), but the incidence of IVH and mortality were significantly lower in the NO group than in the control group (7% vs 17%, PPConclusions NO inhalation may improve oxygenation status and reduce the mortality in premature infants with HRF, but it cannot reduce the incidence of BPD and the total time of mechanical ventilation or nCPAP and duration of oxygen therapy. NO therapy may have a brain-protective effect for premature infants with HRF and does not increase clinical complications.
WEI Qiu-Fen,PAN Xin-Nian,LI Yan et al. Efficacy of inhaled nitric oxide in premature infants with hypoxic respiratory failure[J]. CJCP, 2014, 16(8): 805-809.
Kinsella JP, Ivy DD, Abman SH. Inhaled nitric oxide improves gas exchange and lowers pulmonary vascular resistance in severe experimental hyaline membrane disease[J]. Pediatr Res 1994, 36: 402-408.
[7]
Hamon I, Fresson J, Nicolas MB, et al. Early inhaled nitric oxide improves oxidative balance in very preterm infants[J]. Pediatr Res, 2005, 57(5 Pt 1): 637-643.
[8]
Bland RD, Albertine RH, Carlton DP, et al. Inhaled nitric oxide effects on lung structure and function in chronically ventilated preterm lambs[J]. Am J Respir Crit Care Med, 2005, 172(7): 899-906.
[9]
Henderson-Smart DJ, Wilkinson A, Raynes-Greenow CH. Mechanical ventilation for newborn infants with respiratory failure due to pulmonary disease[J]. Cochrane Database Syst Rev, 2013(3): CD002770.
[10]
Dani C, Pratesi S. Nitric oxide for the treatment of preterm infants with respiratory distress syndrome[J]. Expert Opin Pharmacother, 2013, 14(1): 97-103.
[11]
Golombek SG, Young JN. Efficacy of inhaled nitric oxide for hypoxic respiratory failure in term and late preterm infants by baseline severity of illness: a polled analysis of three clinical trials[J]. Clin Ther, 2010, 32(5): 939-948.
[12]
Field D, Elbourne D, Hardy P, et al. Neonatal ventilation with inhaled nitric oxide vs ventilatory support without inhaled nitric oxide for infants with severe respiratory failure born at or near term: the INNOVO multicenter randomized controlled trial[J]. Neonatology, 2007, 91(2): 73-82.
[13]
Aikio O, Metsola J, Vuolteenaho R, et al. Transient defect in nitric oxide generation after rupture of fetal membrane and responsiveness to inhaled nitric oxide in very preterm infants with hypoxic respiratory failure[J]. J Pediatr, 2012, 161(3): 397- 403.
[14]
Posencheg MA, Gow AJ, Truog WE, et al. Inhaled nitric oxide in premature infants: effect on tracheal aspirate and plasma nitric oxide metabolite[J]. J Perinatol, 2010, 30(4): 275-280.
[15]
Zeitlin J, Draper ES, Kollee L, et al. Differences in rates and short-term outcome of live births before 32 weeks of gestation in Europe in 2003: results from the MOSAIC cohort[J]. Pediatrics 2008, 121: e936-e944.
