Study | Participants | Intervention | Primary outcome |
---|---|---|---|
Ballard 2006 | 582 infants <1250 g and <32 wks on assisted ventilation at 7-21 days (or, if <800 g, on CPAP) | Inhaled NO at 20 ppm initial dose for 48 to 96 hours, then dose subsequently decreased to 10, 5, and 2 ppm at weekly intervals, with a minimum treatment duration of 24 days | Survival without BPD at 36 wks postmenstrual age |
Dani 2006 | 40 infants <30 wks ventilated with severe RDS: FiO2 >0.5 and arterial-alveolar oxygen ratio < 0.15 despite surfactant treatment | Inhaled NO at 10 ppm for 4 hours followed by 6 ppm. Weaning (decrease by 2 ppm every 3 hrs) started at 72 hrs or when the infant was extubated or when the FiO2 <0.3 with a mean airway pressure <8 cmH2O | Death or BPD (oxygen requirement at 36 weeks postconceptional age) in survivors |
Hascoet 2005 | 860 infants <32 wk enrolled at birth; n = 145 infants were eligible for study gas as had hypoxic respiratory failure (defined as need for mechanical ventilation, FiO2>0.40 and arterio-alveolar O2 ratio <0.22) at 6-48 hrs age | Inhaled NO was administered starting at 5 ppm, with adjustments allowed depending on response up to a maximum of 10 ppm. Subjects were allowed to receive (unblinded) iNO in either group if they developed refractory hypoxemia. | Intact survival at 28 days (defined as alive without need for oxygen supplementation or IVH >grade 1 or refractory hypoxaemia (need for 100% oxygen with PaO2<50 mmHg) and PCO2 <50 mmHg) |
INNOVO 2005 | 108 preterm infants (<34 wks) less than 28 days of age with severe respiratory failure requiring ventilator support and have had surfactant when appropriate | Inhaled NO usually at 5 ppm, up to 40 ppm based on response criteria (satisfactory response: increase in PaO2 >22.5 mmHg after 15 minutes iNO) | 1) Death or severe disability at 1 year corrected age; and 2) Death before discharge or continued oxygen need at 36 wks pma and/or at expected date of delivery |
Kinsella 1999 | 80 preterm infants (</= 34 weeks) aged 7 days or less, with a/A ratio <0.1 on two sequential arterial blood measurements despite mechanical ventilation and surfactant treatment | Inhaled NO at 5 ppm for 7 days after which periods of no study gas were tried; threshold criteria for gas re-start was an increase of >/=15% in OI; maximum treatment duration was 14 days | Survival to discharge |
Kinsella 2006 | 793 preterm infants < 34 wks, with respiratory failure needing assisted ventilation in first 48 hours of life | Inhaled NO at 5 ppm for 21 days or until extubation | Death or BPD (need for supplemental oxygen or mechanical ventilation at 36 wks pma and abnormal CXR) |
Schreiber 2003 | 207 infants < 34 wks and < 2000 g birth weight, < 72 hours of age, and intubated/ventilated for RDS, having had exogenous surfactant | Inhaled NO starting at 10 ppm for 12-24 hrs, then 5 ppm for 6 days, then weaned by 1 ppm every 6 hrs if PaO2 did not decrease by more than 15% until extubation; 2 × 2 factorial trial of iNO vs control gas and HFOV vs CMV | Death or CLD (supplemental oxygen and CXR showing persistent parenchymal lung disease at 36 weeks pma) among surviving infants |
Srisuparp 2002 | 34 infants < 2000 g, ventilated after surfactant with an arterial catheter and less than 72 hours of age + satisfying severity of illness criterion: OI >4 if birthweight<1000 g; >6 if 1001-1250 g; >8 if 1251-1500 g; >10 if 1501-1750 g; and >12 if 1751-2000 g birthweight | Inhaled NO at 20 ppm for 6-12 hrs, then reduced to 10 ppm, and weaned to 5 ppm in the next 12 hrs; weaning tolerated if PaO2did not decrease by more than 15%; once 5 ppm achieved, weaning was attempted at 1 ppm a time as tolerated until gas discontinued; maximum duration allowed was 7 days | Severe intraventricular hemorrhage (grade 3 or 4) |
Subhedar 1997 | 42 preterm infants, < 32 wks, assessed at 96 hrs age for: mechanical ventilation since birth, had received surfactant, and high risk of developing CLD using a modified prediction score | Inhaled Nitric Oxide at 20 ppm for 2 hrs then weaned according to response criteria (positive response: decrease in OI by >=25% or reduction in FiO2 of >=0.10) by 5 ppm increments every 15 mins until 5 ppm level for further 72 hrs, then weaned off; 2 × 2 factorial trial of iNO vs control and IV dexamethasone vs control | Death before discharge or CLD (oxygen dependency for at least 28 days and beyond 36 wks pma with abnormal CXR) |
Van Meurs 2005 | 420 preterm infants, < 34 weeks, 401-1500 g birthweight, assisted ventilation, OI >=10 on two consecutive blood gases 30 min -12 hrs apart at least 4 hrs after surfactant | Inhaled Nitric Oxide initially at 5-10 ppm; weaning commenced 10-14 hrs after initiation according to response criteria (change in PaO2); at 30 min intervals; maximum duration was 336 hours | Death or BPD at 36 wks in survivors |
EUNO 2008 | 800 preterm infants <29 wks, birthweight >=500 g requiring either surfactant or CPAP >4 cmH2O with FiO2 >0.3 to maintain SpO2 ≥ 85% | Inhaled NO 5 ppm for minimum 7 to maximum of 21 days if still requiring respiratory support (including CPAP use) | Survival without BPD at 36 wks post conceptional age |