Neurodevelopmental outcomes of premature infants with severe respiratory failure enrolled in a randomized controlled trial of inhaled nitric oxide

Abhik Das; W. Kenneth Poole; Susan R Hintz; KP van Meurs; Rebecca Perritt; W. Kenneth Poole; Abhik Das; DK Stevenson; RA Ehrenkranz; JA Lemons; Betty R Vohr; R Heyne; DO Childers; Myriam A Peralta-Carcelen; A Dusick; YR Johnson; B Morris; R Dillard; Yvonne E Vaucher; J Steichen; I Adams-Chapman; G Konduri; GJ Myers; M de Ungria; JE Tyson; Rosemary D. Higgins; for the NICHD Neonatal Research Network

Neurodevelopmental outcomes of premature infants with severe respiratory failure enrolled in a randomized controlled trial of inhaled nitric oxide

Hintz, SR., Van Meurs, KP., Perritt, R., Poole, W., Das, A., Stevenson, DK., Ehrenkranz, RA., Lemons, JA., Vohr, BR., Heyne, R., Childers, DO., Peralta-Carcelen, M., Dusick, A., Johnson, YR., Morris, B., Dillard, R., Vaucher, Y., Steichen, J., Adams-Chapman, I., ... NICHD Neonatal Research Network, U. (2007). Neurodevelopmental outcomes of premature infants with severe respiratory failure enrolled in a randomized controlled trial of inhaled nitric oxide. Journal of Pediatrics, 151(1), 16-22, e3. https://doi.org/10.1016/j.jpeds.2007.03.017

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Abstract

Objectives We hypothesized that inhaled nitric oxide (iNO) would not decrease death or neurodevelopmental impairment (NDI) in infants enrolled in the National Institute of Child Health and Human Development Preemie iNO Trial (PiNO) trial, nor improve neurodevelopmental outcomes in the follow-up group. Study design Infants <34 weeks of age, weighing <1500 g, with severe respiratory failure were enrolled in the multicenter, randomized, controlled trial. NDI at 18 to 22 months corrected age was defined as: moderate to severe cerebral palsy (CP; Mental Developmental Index or Psychomotor score Developmental Index <70), blindness, or deafness. Results Of 420 patients enrolled, 109 who received iNO (52%) and 98 who received placebo (47%) died. The follow-up rate in survivors was 90%. iNO did not reduce death or NDI (78% versus 73%; relative risk [RR], 1.07; 95% CI, 0.95-1.19), or NDI or Mental Developmental Index <70 in the follow-up group. Moderate-severe CP was slightly higher with iNO (RR, 2.41; 95% CI, 1.01-5.75), as was death or CP in infants weighing <1000 g (RR, 1.22; 95% CI, 1.05-1.43). Conclusions In this extremely ill cohort, iNO did not reduce death or NDI or improve neurodevelopmental outcomes. Routine iNO use in premature infants should be limited to research settings until further data are available.