Benefits of nitric oxide vary in preemies, Stanford/Packard researchers say

STANFORD, Calif. - Doctors have been trying for many years to improve the survival rate of very premature infants, whose immature lungs are often not up to the task of living outside the womb. Inhaled nitric oxide has shown some success in treating full-term infants with life-threatening lung disease, and physicians have been eager to learn if this treatment would help premature infants as well.

Now a new study led by researchers at the Stanford University School of Medicine involving more than 400 tiny preemies has shown that, although nitric oxide did not improve the odds of survival or decrease the likelihood of long-term lung disease in the group overall, it may benefit a specific sub-group of newborns weighing more than 1,000 grams, or 2.2 pounds, at birth.

"This study suggests that the key to the effective use of inhaled nitric oxide may lie in choosing the right patients," said Krisa Van Meurs, MD, a neonatologist at Lucile Packard Children's Hospital at Stanford and professor of pediatrics at the School of Medicine. "Because of its effect on bleeding, it may not be useful in certain critically ill babies." Van Meurs is the lead author of the study, published in the July 7 issue of the New England Journal of Medicine.

Inhaled nitric oxide works by dilating blood vessels in the lungs to allow the more efficient delivery of oxygen and the elimination of carbon dioxide. It also helps to send blood to the most oxygenated areas of the lung and to decrease inflammatory responses that make the lungs less efficient. However, because research suggested it can also increase the already significant risk of brain hemorrhage in premature infants, physicians have been very cautious about its use, fearing the potential benefit may not be worth the risk in this group.

The current study is the first large multicenter trial testing the effects of inhaled nitric oxide in the very sickest and smallest premature infants. All 420 infants

Contact: Krista Conger
Stanford University Medical Center

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