title: NIH Consensus Development Conference statement: inhaled nitric-oxide therapy for premature infants.
abstract: Premature birth is a major public health problem in the United States and internationally. Infants born at or before 32 weeks' gestation (2% of all births in the United States in 2007) are at extremely high risk for death in the neonatal period or for pulmonary, visual, and neurodevelopmental morbidities with lifelong consequences including bronchopulmonary dysplasia, retinopathy of prematurity, and brain injury. Risks for adverse outcomes increase with decreasing gestational age. The economic costs to care for these infants are also substantial (estimated at $26 billion in 2005 in the United States). It is clear that the need for strategies to improve outcomes for this high-risk population is great, and this need has prompted testing of new therapies with the potential to decrease pulmonary and other complications of prematurity. Inhaled nitric oxide (iNO) emerged as one such therapy. To provide health care professionals, families, and the general public with a responsible assessment of currently available data regarding the benefits and risks of iNO in premature infants, the Eunice Kennedy Shriver National Institute of Child Health and Human Development, the National Heart, Lung, and Blood Institute, and the Office of Medical Applications of Research of the National Institutes of Health convened a consensus-development conference. Findings from a substantial body of experimental work in developing animals and other model systems suggest that nitric oxide may enhance lung growth and reduce lung inflammation independently of its effects on blood vessel resistance. Although this work demonstrates biological plausibility and the results of randomized controlled trials in term and near-term infants were positive, combined evidence from the 14 randomized controlled trials of iNO treatment in premature infants of ≤ 34 weeks' gestation shows equivocal effects on pulmonary outcomes, survival, and neurodevelopmental outcomes.
authors.affiliation: Division of Newborn Medicine, Department of Pediatrics, Washington University School of Medicine, St Louis, Missouri 63110, USA. cole@kids.wustl.edu
authors.forename: F Sessions
authors.initials: FS
authors.lastname: Cole
authors.forename: Claudia
authors.initials: C
authors.lastname: Alleyne
authors.forename: John D E
authors.initials: JD
authors.lastname: Barks
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Boyle
authors.forename: John L
authors.initials: JL
authors.lastname: Carroll
authors.forename: Deborah
authors.initials: D
authors.lastname: Dokken
authors.forename: William H
authors.initials: WH
authors.lastname: Edwards
authors.forename: Michael
authors.initials: M
authors.lastname: Georgieff
authors.forename: Katherine
authors.initials: K
authors.lastname: Gregory
authors.forename: Michael V
authors.initials: MV
authors.lastname: Johnston
authors.forename: Michael
authors.initials: M
authors.lastname: Kramer
authors.forename: Christine
authors.initials: C
authors.lastname: Mitchell
authors.forename: Josef
authors.initials: J
authors.lastname: Neu
authors.forename: DeWayne M
authors.initials: DM
authors.lastname: Pursley
authors.forename: Walter M
authors.initials: WM
authors.lastname: Robinson
authors.forename: David H
authors.initials: DH
authors.lastname: Rowitch
mesh_terms: D000280:Administration, Inhalation; D000367:Age Factors; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007234:Infant, Premature; D009569:Nitric Oxide / Q000008:administration & dosage*; D016032:Randomized Controlled Trials as Topic / Q000379:methods; D012127:Respiratory Distress Syndrome, Newborn / Q000188:drug therapy / Q000453:epidemiology; D014481:United States / Q000453:epidemiology
chemical_list: D009569:Nitric Oxide