title: Early inhaled nitric oxide improves oxidative balance in very preterm infants.
abstract: Inhaled nitric oxide (iNO) improves oxygenation in premature infants, but concern has been raised about its potential oxidative toxicity. We designed this study to assess the oxidative balance in premature infants who were exposed to low dose iNO and the relationship with their clinical outcome on day 28 of life. A total of 274 infants who were <32 wk gestation were randomized at birth to receive 5 ppm of iNO if they presented with hypoxemic respiratory failure. Nonhypoxemic infants were studied as the reference group. Blood samples were withdrawn 24 h apart, within the first 4 d of life, to assess malondialdehyde (MDA) concentration as oxidative stress marker and total plasmatic glutathione (GSH), intraerythrocyte GSH peroxidase, and GSH reductase activities as antioxidant defenses. After 24 h, the rise in MDA was blunted in the iNO group compared with controls and was close to the reference infants. Conversely, GSH was more stable in the iNO group, when there was no difference for the GSH peroxidase and GSH reductase activities. On day 28, Oxygen dependence was linked with a higher increase in MDA as was the risk for death, whereas intraventricular hemorrhage was associated with a higher initial drop in GSH. Early low-dose iNO in hypoxemic preterm infants improves oxidative balance and seems to be clinically beneficial up to day 28 of life.
authors.affiliation: Neonatology Division, Maternite Regionale Universitaire de Nancy, Nancy 54045, France. i.hamon@maternite.chu-nancy.fr
authors.forename: Isabelle
authors.initials: I
authors.lastname: Hamon
authors.forename: Jeanne
authors.initials: J
authors.lastname: Fresson
authors.forename: Marie-Benedicte
authors.initials: MB
authors.lastname: Nicolas
authors.forename: Marie-Christine
authors.initials: MC
authors.lastname: Buchweiller
authors.forename: Patricia
authors.initials: P
authors.lastname: Franck
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Hascoet
mesh_terms: D000280:Administration, Inhalation; D000975:Antioxidants / Q000378:metabolism; D004912:Erythrocytes / Q000166:cytology / Q000378:metabolism; D005260:Female; D005865:Gestational Age; D005978:Glutathione / Q000097:blood; D005979:Glutathione Peroxidase / Q000097:blood; D005980:Glutathione Reductase / Q000097:blood; D006801:Humans; D000860:Hypoxia; D007231:Infant, Newborn; D007234:Infant, Premature; D008297:Male; D008315:Malondialdehyde / Q000097:blood; D009569:Nitric Oxide / Q000008:administration & dosage / Q000494:pharmacology*; D018384:Oxidative Stress; D010100:Oxygen / Q000378:metabolism*; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000975:Antioxidants; D009569:Nitric Oxide; D008315:Malondialdehyde; D005979:Glutathione Peroxidase; D005980:Glutathione Reductase; D005978:Glutathione; D010100:Oxygen