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Inhaled Nitric Oxide in Preterm Infants: An Individual-Patient Data Meta-analysis of Randomized Trials

2011; American Academy of Pediatrics; Volume: 128; Issue: 4 Linguagem: Inglês

10.1542/peds.2010-2725

1098-4275

Lisa Askie, Roberta A. Ballard, Gary Cutter, Carlo Dani, Diana Elbourne, David Field, Jean‐Michel Hascoët, Anna Maria Hibbs, John P. Kinsella, Jean‐Christophe Mercier, Wade Rich, Michael D. Schreiber, Pimol Wongsiridej, N. Subhedar, Krisa P. Van Meurs, Merryn Voysey, Keith J. Barrington, Richard A. Ehrenkranz, Neil N. Finer,

Infant Development and Preterm Care

Inhaled nitric oxide (iNO) is an effective therapy for pulmonary hypertension and hypoxic respiratory failure in term infants. Fourteen randomized controlled trials (n = 3430 infants) have been conducted on preterm infants at risk for chronic lung disease (CLD). The study results seem contradictory.Individual-patient data meta-analysis included randomized controlled trials of preterm infants ( 5 vs ≤ 5 ppm there was evidence of improved outcome (interaction P = .02); however, these differences were not observed at other levels of exposure to iNO. This result was driven primarily by 1 trial, which also differed according to overall dose, duration, timing, and indication for treatment; a significant reduction in death or CLD (RR: 0.85 [95% CI: 0.74-0.98]) was found.Routine use of iNO for treatment of respiratory failure in preterm infants cannot be recommended. The use of a higher starting dose might be associated with improved outcome, but because there were differences in the designs of these trials, it requires further examination.