Research Article Short Term Effects of Inhaled Nitric Oxide on Preterm Infants
by Alla Kushnir1,2*, Mona Moshet3, Nisha Agasthya4, Krystal Hunter5, Sabahat Javaid6, Gary Stahl1
1Cooper Medical School of Rowan University, Camden, NJ, USA
2Department of Pediatrics, Division of Neonatology, Cooper University Hospital, Camden, NJ, USA
3Department of Emergency Medicine, Christiana Care, Newark, DE, USA
4Department of Pediatrics, Division of Pediatric Critical Care, Nemours Children’s Hospital, Orlando, FL, USA
5Research Institute, Cooper University Hospital, Camden, NJ, USA
6The Hospital for Sick Children, Toronto, Ontario, Canada
*Corresponding author: Alla Kushnir, Department of Pediatrics, Division of Neonatology, Children's Regional Hospital, Cooper University Health Care, Camden, New Jersey, USA
Received Date: 21 June 2025
Accepted Date: 28 June 2025
Published Date: 30 June 2025
Citation: Kushnir A, Moshet M, Agasthya N, Hunter K, Javaid S, et al. (2025) Short Term Effects of Inhaled Nitric Oxide on Preterm Infants. Arch Pediatr 10: 325. https://doi.org/10.29011/2575-825X.100325
Abstract
Objective: Inhaled Nitric Oxide (iNO) is effective in hypoxemic respiratory failure (HRF) from persistent pulmonary hypertension (PPHN) in term neonates, however, there is controversy regarding its benefits in preterm infants. We hypothesize that iNO has short term benefits in infants < 34 weeks gestational age (GA). Study Design: Retrospective cohort analyzed infants < 34 week GA and birth weight of <1500 grams admitted to the NICU from 1/2010 to 6/2022, who required iNO. Setting: The study took place in a level IIIC NICU in an urban area in NJ, USA. Patients: All neonates < 34 weeks gestation and < 1500 grams admitted to the NICU, were mechanically ventilated and received iNO therapy (iNO; iNOmax®, Mallinckrodt Pharmaceuticals, Bridgewater, NJ, USA) were included. Interventions: All neonates were initiated on 20 parts per minute of iNO. Those with complex congenital anomalies were excluded. Main Outcome Measures: Ventilatory parameters, amount of fraction of inspired oxygen (FiO2), and Oxygenation Index (OI) were collected prior to, at initiation, and for 24 hours after initiation of iNO. Results: There was a total of 98 newborns included in this IRB approved cohort study, with mean GA 25.7 (± 2.9 weeks). There was a decrease in FiO2 (p<0.001) and oxygen saturation (p=0.007) after 24 hours of iNO. There was an improvement in OI throughout the first 24 hours of iNO use (p<0.001). There was no change in the Mean Airway Pressure (MAP) (p= 0.768). Conclusion: Among preterm infants with HRF, iNO use improved oxygen saturation, FiO2 and OI over 24 hours.
Key Messages
- What is already known on this topic – iNO is a standard of care for persistent pulmonary hypertension and hypoxic failure in term neonates, however, its use in preterm infants continues to be controversial.
- What this study adds – we showed that iNO has short term benefits in infants < 34 weeks gestational age (GA) with hypoxic respiratory failure.
- How this study might affect research, practice or policy – this research will add to the literature on the use of iNO in preterm neonates and will provide specific data on improvement in variables such as oxygenation and mean airway pressure.
Keywords: iNO; Preterm Neonates; Hypoxemic Failure
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