Inhaled nitric oxide in premature infants: effect on tracheal aspirate and plasma nitric oxide metabolites.
OBJECTIVE
Inhaled nitric oxide (iNO) is a potential new therapy for prevention of bronchopulmonary dysplasia and brain injury in premature infants. This study examined dose-related effects of iNO on NO metabolites as evidence of NO delivery.


METHODS
A subset of 102 premature infants in the NO CLD trial, receiving 24 days of iNO (20 p.p.m. decreasing to 2 p.p.m.) or placebo, were analyzed. Tracheal aspirate (TA) and plasma samples collected at enrollment and at intervals during study gas were analyzed for NO metabolites.


RESULTS
iNO treatment increased NO metabolites in TA at 20 and 10 p.p.m. (1.7- to 2.3-fold vs control) and in plasma at 20, 10, and 5 p.p.m. (1.6- to 2.3-fold). In post hoc analysis, treated infants with lower metabolite levels at entry had an improved clinical outcome.


CONCLUSIONS
iNO causes dose-related increases in NO metabolites in the circulation as well as lung fluid, as evidenced by TA analysis, showing NO delivery to these compartments.
Posencheg
M A
MA
Department of Pediatrics, University of Pennsylvania School of Medicine and The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA. michael.posencheg@uphs.upenn.edu
Gow
A J
AJ
Truog
W E
WE
Ballard
R A
RA
Cnaan
A
A
Golombek
S G
SG
Ballard
P L
PL
D001997:Bronchopulmonary Dysplasia / Q000517:prevention & control; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature / Q000097:blood / Q000378:metabolism*; D009566:Nitrates / Q000097:blood; D009569:Nitric Oxide / Q000378:metabolism* / Q000627:therapeutic use*; D009573:Nitrites / Q000097:blood*; D012138:Respiratory Therapy / Q000379:methods*; D014132:Trachea
D009566:Nitrates; D009573:Nitrites; D009569:Nitric Oxide