Preemie Breathing Treatment Ineffective

Inhaled nitric oxide use for preterm babies does not improve likelihood of survival

March 15, 2012 / Author:  / Reviewed by: Joseph V. Madia, MD

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(dailyRx News) Preemies often struggle with breathing problems, so some hospitals give them nitric oxide to help with breathing. But recent evidence shows this gas treatment may not be any help.

Inhaled nitric oxide is an FDA-approved gas used to open up the lungs in babies born on time or slightly early who are suffering from hypoxic respiratory failure.

Some doctors believe the nitric oxide may help prevent common problems associated with being born earlier than 34 weeks.

"Regular prenatal care is the best defense against prematurity."

The National Institutes of Health and the Agency for Healthcare Research and Quality, however, recently determined that the evidence does not show any benefit from using inhaled nitric oxide in preemies who need help with breathing. So a recent study was conducted to determine whether the nitric oxide benefitted premature babies or not.

A group of researchers from the Ohio Perinatal Research Network joined forces with the faculty of Nationwide Children's Hospital for the study, led by Dr. Michael Stenger, M.D., a neonatologist at Nationwide Children's.

They used data from the Child Health Corporation of America's Pediatric Health Information Database to look at the cases of 22,699 preemies born before 34 weeks and sent to the neonatal intensive care unit (NICU) in 37 children's hospitals throughout the U.S. from 2007 through 2010.

They found that the practice and results of using inhaled nitric oxide were inconsistent, even after taking into account the demographics of the children and the medical conditions they had.

Hospitals varied in terms of when they began using the nitric oxide treatment and how long they used it, though hospitals that used it for more babies also used it for a longer period of time.

A total of 1,644 infants were treated with inhaled nitric oxide for an average of 13 days, but the range of treatment days varied from 1 to 31.

They found that hospital in the Northeastern U.S. used nitric oxide less frequently. NICUs who had higher numbers of babies also tended to use less nitric oxide and had lower rates of deaths among all the preemies admitted.

Babies who did receive nitric oxide did not show a greater likelihood of surviving, which led the researchers to conclude the treatment was possibly being used in babies already at high risk of mortality.

"Despite years of data unable to support its off-label use, iNO treatment in preterm infants remains common in U.S. children's hospital NICUs," Stenger said. "Overall, we found that there is a pervasive lack of standardization in iNO use across NICUs."

Stenger said the use of inhaled nitric oxide may decline if more hospital follow the guidelines by the NIH.

Although this study did not appear to show any benefits for preemies when they receive inhaled nitric oxide, the observational nature of the study means it is not possible to determine for certain whether the babies did not have any positive effects from the treatment.

The data did show, however, that the rates of death among premature newborns did not get better when the nitric oxide was used.

The study appeared in the April issue of the journal Pediatrics and was funded by grants from the Agency for Healthcare Research and Quality and from the National Center for Research Resources. The authors declared no conflicts of interest.

Reviewed by: 
Review Date: 
March 14, 2012
Last Updated:
March 15, 2012