Lisa M. AskieRoberta A. BallardGary R. CutterCarlo DaniDiana ElbourneDavid FieldJean Michel HascoetAnna Maria HibbsJohn P. KinsellaJean Christophe MercierWade RichMichael D. SchreiberPimol WongsiridejNim V. SubhedarKrisa P. Van MeursMerryn VoyseyKeith BarringtonRichard A. EhrenkranzNeil N. FinerThe University of SydneyUCSF School of MedicineUniversity of Alabama at BirminghamAzienda Ospedaliera CareggiLondon School of Hygiene &amp; Tropical MedicineUniversity of LeicesterMaternite Regionale de NancyRainbow Babies and Children's Hosp.University of Colorado School of MedicineUniversite Paris 7- Denis DiderotUniversity of California, San DiegoUniversity of ChicagoMahidol UniversityLiverpool Women's HospitalStanford University School of MedicineCentre Hospitalier de L'Universite de MontrealYale University School of Medicine2018-05-032018-05-032011-10-01Pediatrics. Vol.128, No.4 (2011), 729-73910984275003140052-s2.0-80053519757https://repository.li.mahidol.ac.th/handle/20.500.14594/12310BACKGROUND: 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.Mahidol UniversityMedicineReviewSCOPUS10.1542/peds.2010-2725