Am J Perinatol 2009; 26(4): 317-322
DOI: 10.1055/s-0028-1104743
© Thieme Medical Publishers

Inhaled Nitric Oxide for Preterm Premature Rupture of Membranes, Oligohydramnios, and Pulmonary Hypoplasia

Valerie Y. Chock1 , Krisa P. Van Meurs1 , Susan R. Hintz1 , Richard A. Ehrenkranz2 , James A. Lemons3 , Douglas E. Kendrick4 , David K. Stevenson1 for the NICHD Neonatal Research Network
  • 1Division of Neonatology, Stanford University, Stanford, California
  • 2Yale University, New Haven, Connecticut
  • 3Indiana University, Indianapolis, Indiana
  • 4Research Triangle Institute, Research Triangle Park, North Carolina
Further Information

Publication History

Publication Date:
09 December 2008 (online)

ABSTRACT

We sought to determine if inhaled nitric oxide (iNO) administered to preterm infants with premature rupture of membranes (PPROM), oligohydramnios, and pulmonary hypoplasia improved oxygenation, survival, or other clinical outcomes. Data were analyzed from infants with suspected pulmonary hypoplasia, oligohydramnios, and PPROM enrolled in the National Institute of Child Health and Development Neonatal Research Network Preemie Inhaled Nitric Oxide (PiNO) trial, where patients were randomized to receive placebo (oxygen) or iNO at 5 to 10 ppm. Outcome variables assessed were PaO2 response, mortality, bronchopulmonary dysplasia (BPD), and severe intraventricular hemorrhage (IVH) or periventricular leukomalacia (PVL). Twelve of 449 infants in the PiNO trial met criteria. Six infants received iNO and six received placebo. The iNO group had a mean increase in PaO2 of 39 ± 50 mm Hg versus a mean decrease of 11 ± 15 mm Hg in the control group. Mortality was 33% versus 67%, BPD (2/5) 40% versus (2/2) 100%, and severe IVH or PVL (1/5) 20% versus (1/2) 50% in the iNO and control groups, respectively. None of these changes were statistically significant. Review of a limited number of cases from a large multicenter trial suggests that iNO use in the setting of PPROM, oligohydramnios, and suspected pulmonary hypoplasia improves oxygenation and may decrease the rate of BPD and death without increasing severe IVH or PVL. However, the small sample size precludes definitive conclusions. Further studies are required to determine if iNO is of benefit in this specific patient population.

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Valerie Y ChockM.D. 

Division of Neonatal and Developmental Medicine, Stanford University School of Medicine

750 Welch Road, Suite 315, Palo Alto, CA 94304

Email: vchock@stanford.edu

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