Inhaled nitric oxide reduces lung disease in premature babies

osts for the more than 500,000 babies born prematurely in the U.S. totaled $26 billion, or $51,000 per infant.

The NOCLD clinical trial included 21 neonatal intensive care units throughout the country, enrolling infants with birth weights between 500 and 1250 grams, or about one to three pounds. Their median gestational age was 26 weeks (full-term babies are born at about 40 weeks gestational age). All the infants were receiving oxygen through ventilators and were at high risk of developing chronic lung disease, also known as bronchopulmonary dysplasia, because their lungs were immature and underdeveloped. In this condition, scarring and inflammation in lung tissue make breathing difficult, and the infant often requires prolonged mechanical ventilation and hospitalization.

Although treatment with nitric oxide, a substance naturally produced in the body, is already known to benefit full-term infants with pulmonary hypertension, its value for preterm infants was uncertain. "The mechanism by which nitric oxide affects the lungs is not fully understood," said Dr. Ballard, "but animal studies and pilot studies in infants previously suggested that nitric oxide restores normal growth and development in very immature lungs."

The trial was randomized and double-blinded, with 294 infants receiving inhaled nitric oxide and 288 receiving a placebo. The rate of survival without chronic lung disease at 36 weeks after the mother's last menstrual period was 43.9 percent in treated infants compared to 36.8 percent in the control group.

The effect was more pronounced for the infants entered earlier (between seven and 14 days): 49.1 percent in treated infants vs. 27.8 percent in controls. Lung disease was also less severe in treated infants at 40 and 44 weeks, with treated infants having shorter hospitalizations and less need for mechanical ventilation or oxygen therapy than the control infants.

The NOCLD team expects to provide defin

Contact: Joey Marie McCool
Children's Hospital of Philadelphia

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