title: Effects of early inhaled nitric oxide therapy and vitamin A supplementation on the risk for bronchopulmonary dysplasia in premature newborns with respiratory failure.
abstract: OBJECTIVE
  To assess whether the combination of early inhaled nitric oxide (iNO) therapy and vitamin A supplementation lowers the incidence of bronchopulmonary dysplasia (BPD) in premature newborns with respiratory failure.
  
  
  METHODS
  A total of 793 mechanically ventilated infants (birth weight 500-1250 g) were randomized (after stratification by birth weight) to receive placebo or iNO (5 ppm) for 21 days or until extubation (500-749, 750-999, or 1000-1250 g). A total of 398 newborns received iNO, and of these, 118 (30%) received vitamin A according to their enrollment center. We compared patients who received iNO + vitamin A with those who received iNO alone. The primary outcome was a composite of death or BPD at 36 weeks postconceptual age.
  
  
  RESULTS
  BPD was reduced in infants who received iNO + vitamin A for the 750-999 g birth weight group compared with iNO alone (P = .01). This group also showed a reduction in the combined outcome of BPD + death compared with iNO alone (P = .01). The use of vitamin A did not change the risk for BPD in the placebo group. Overall, the use of vitamin A was low (229 of 793 patients, or 29%). Combined therapy improved Bayley Scales of Infant Development II Mental and Psychomotor Developmental Index scores at 1 year compared with infants treated solely with iNO for the 500-749 g birth weight group.
  
  
  CONCLUSIONS
  In this retrospective analysis of the nonrandomized use of vitamin A, combined iNO + vitamin A therapy in preterm infants with birth weight 750-999 g reduced the incidence of BPD and BPD + death and improved neurocognitive outcomes at 1 year in the 500-749 g birth weight group.
authors.affiliation: Division of Neonatology, Department of Pediatrics, Weill Cornell Medical College, New York, NY. Electronic address: Mog9018@med.cornell.edu.
authors.forename: Monika M
authors.initials: MM
authors.lastname: Gadhia
authors.affiliation: Department of Biostatistics, University of Alabama, Birmingham, AL.
authors.forename: Gary R
authors.initials: GR
authors.lastname: Cutter
authors.affiliation: Pediatric Heart Lung Center, University of Colorado School of Medicine, Aurora, CO; Section of Pulmonary Medicine, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO.
authors.forename: Steven H
authors.initials: SH
authors.lastname: Abman
authors.affiliation: Pediatric Heart Lung Center, University of Colorado School of Medicine, Aurora, CO; Section of Neonatology, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO.
authors.forename: John P
authors.initials: JP
authors.lastname: Kinsella
mesh_terms: D000280:Administration, Inhalation; D001997:Bronchopulmonary Dysplasia / Q000209:etiology* / Q000517:prevention & control*; D019587:Dietary Supplements; D061345:Early Medical Intervention; D005260:Female; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D007234:Infant, Premature; D008297:Male; D009569:Nitric Oxide / Q000008:administration & dosage*; D012131:Respiratory Insufficiency / Q000150:complications*; D012189:Retrospective Studies; D012306:Risk; D016037:Single-Blind Method; D014801:Vitamin A / Q000627:therapeutic use*; D014815:Vitamins / Q000627:therapeutic use*
chemical_list: D014815:Vitamins; D014801:Vitamin A; D009569:Nitric Oxide