title: Establishing normative nasal nitric oxide values in infants.
abstract: BACKGROUND
  Primary ciliary dyskinesia (PCD), a disease of impaired respiratory cilia motility, is often difficult to diagnose. Recent studies show low nasal nitric oxide (nNO) is closely linked to PCD, allowing the use of nNO measurement for PCD assessments. Nasal NO cutoff values for PCD are stratified by age, given nNO levels normally increase with age. However, normative values for nNO have not been established for infants less than 1 year old. In this study, we aim to establish normative values for nNO in infants and determine their utility in guiding infant PCD assessment.
  
  
  RESULTS
  We obtained 42 nNO values from infants less than 1 year old without a history of PCD or recurrent sinopulmonary disease. Using regression analysis, we estimated the mean age-adjusted nNO values and established a 95% prediction interval (PI) for normal nNO. Using these findings, we were able to show 14 of 15 infant PCD patients had abnormally low nNO with values below the 95% PI.
  
  
  CONCLUSIONS
  In this study we determined a regression model that best fits normative nNO values for infants less than 1 year old. This model identified the majority of PCD infants as having abnormally low nNO. These findings suggest nNO measurement can help guide PCD assessment in infants, and perhaps other pulmonary diseases with a link to low nNO. With early assessments, earlier clinical intervention may be possible to slow disease progression and help reduce pulmonary morbidity.
authors.affiliation: Division of Pediatric Anesthesiology, Department of Anesthesiology, University of Pittsburgh School of Medicine, 4401 Penn Ave, Pittsburgh, PA, 15224, USA. Electronic address: adamsp@upmc.edu.
authors.forename: Phillip S
authors.initials: PS
authors.lastname: Adams
authors.affiliation: Office of Biostatistics Research, National Heart, Lung and Blood Institute, 6701 Rockledge Dr MSC 7913, Bethesda, MD, 20892, USA. Electronic address: tianx@nhlbi.nih.gov.
authors.forename: Xin
authors.initials: X
authors.lastname: Tian
authors.affiliation: Department of Developmental Biology, University of Pittsburgh School of Medicine, 4401 Penn Ave, 8120 Rangos Research Center, Pittsburgh, PA, 15201, USA. Electronic address: maz7@pitt.edu.
authors.forename: Maliha
authors.initials: M
authors.lastname: Zahid
authors.affiliation: Department of Developmental Biology, University of Pittsburgh School of Medicine, 4401 Penn Ave, 8120 Rangos Research Center, Pittsburgh, PA, 15201, USA. Electronic address: omk4@pitt.edu.
authors.forename: Omar
authors.initials: O
authors.lastname: Khalifa
authors.affiliation: Division of Cardiology, Department of Pediatrics, Children's National Medical Center, 111 Michigan Ave NW #200, Washington, DC, 20310, USA. Electronic address: lleather@childrensnational.org.
authors.forename: Linda
authors.initials: L
authors.lastname: Leatherbury
authors.affiliation: Department of Developmental Biology, University of Pittsburgh School of Medicine, 4401 Penn Ave, 8120 Rangos Research Center, Pittsburgh, PA, 15201, USA. Electronic address: cel36@pitt.edu.
authors.forename: Cecilia W
authors.initials: CW
authors.lastname: Lo
mesh_terms: D000375:Aging / Q000378:metabolism; D001944:Breath Tests / Q000379:methods; D005240:Feasibility Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007619:Kartagener Syndrome / Q000175:diagnosis*; D009296:Nasal Cavity; D009569:Nitric Oxide / Q000378:metabolism*; D012016:Reference Values
chemical_list: D009569:Nitric Oxide
keywords: Control values; Infant; Nasal nitric oxide; Primary ciliary dyskinesia; Stratification method