Nitric oxide for the treatment of preterm infants with respiratory distress syndrome.

Careggi University Hospital of Florence, Department of Surgical and Medical Critical Care, Section of Neonatology, Viale Morgagni, 85, 50134 Florence, Italy. cdani@unifi.It

Expert opinion on pharmacotherapy 2013 Jan

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Inhaled Nitric oxide (iNO) has been proposed as effective treatment for improving oxygenation in preterm infants with respiratory distress syndrome (RDS), and for preventing the development of bronchopulmonary dysplasia (BPD). This drug evaluation mainly reviews the results of clinical studies on the effects of iNO in preterm infants with RDS which have provided contradictory results probably due to their different designs. Three recent meta-analyses of these studies have concluded that iNO therapy is not effective in decreasing the risk of death and BPD and cannot be recommended as routine treatment. The same meta-analyses suggest that some strategy of iNO treatment and some subgroups of patients, such as infants with persistent pulmonary hypertension of the newborn (PPHN), should be further studied. At present, the available evidence does not support the use of iNO in preterm infants with RDS, and iNO therapy cannot be recommended for the routine treatment of respiratory failure in premature neonates. In the future, further studies in selected populations using adequate doses and investigating the effectiveness of other drugs, such as sildenafil, might affect the use and diffusion of iNO.

Citation

Carlo Dani, Simone Pratesi. Nitric oxide for the treatment of preterm infants with respiratory distress syndrome. Expert opinion on pharmacotherapy. 2013 Jan;14(1):97-103