Publication:
Inhaled nitric oxide in preterm infants: An individual-patient data meta-analysis of randomized trials

Issued Date

2011-10-01

Resource Type

Review

ISSN

10984275
00314005

DOI

10.1542/peds.2010-2725

Other identifier(s)

2-s2.0-80053519757

Rights

Mahidol University

Rights Holder(s)

SCOPUS

Bibliographic Citation

Pediatrics. Vol.128, No.4 (2011), 729-739

Suggested Citation

Lisa M. Askie, Roberta A. Ballard, Gary R. Cutter, Carlo Dani, Diana Elbourne, David Field, Jean Michel Hascoet, Anna Maria Hibbs, John P. Kinsella, Jean Christophe Mercier, Wade Rich, Michael D. Schreiber, Pimol Wongsiridej, Nim V. Subhedar, Krisa P. Van Meurs, Merryn Voysey, Keith Barrington, Richard A. Ehrenkranz, Neil N. Finer Inhaled nitric oxide in preterm infants: An individual-patient data meta-analysis of randomized trials. Pediatrics. Vol.128, No.4 (2011), 729-739. doi:10.1542/peds.2010-2725 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/12310

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Title

Inhaled nitric oxide in preterm infants: An individual-patient data meta-analysis of randomized trials

Author(s)

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

Other Contributor(s)

The University of Sydney
 UCSF School of Medicine
 University of Alabama at Birmingham
 Azienda Ospedaliera Careggi
 London School of Hygiene & Tropical Medicine
 University of Leicester
 Maternite Regionale de Nancy
 Rainbow Babies and Children's Hosp.
 University of Colorado School of Medicine
 Universite Paris 7- Denis Diderot
 University of California, San Diego
 University of Chicago
 Mahidol University
 Liverpool Women's Hospital
 Stanford University School of Medicine
 Centre Hospitalier de L'Universite de Montreal
 Yale University School of Medicine

Abstract

BACKGROUND: 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. DESIGN/METHODS: Individual-patient data meta-analysis included randomized controlled trials of preterm infants ( < 37 weeks' gestation). Outcomes were adjusted for trial differences and correlation between siblings. RESULTS: Data from 3298 infants in 12 trials (96%) were analyzed. There was no statistically significant effect of iNO on death or CLD (59% vs 61%: relative risk [RR]: 0.96 [95% confidence interval (CI): 0.92-1.01] ; P=.11) or severe neurologic events on imaging (25% vs 23%: RR: 1.12 [95% CI: 0.98-1.28]; P = .09). There were no statistically significant differences in iNO effect according to any of the patient-level characteristics tested. In trials that used a starting iNO dose of > 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. CONCLUSIONS: 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. Copyright © 2011 by the American Academy of Pediatrics.

Keyword(s)

Medicine

Availability

URI

https://repository.li.mahidol.ac.th/handle/20.500.14594/12310

Collections

Scopus 2011-2015