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J Pediatr. 2014 Apr;164(4):744-8. doi: 10.1016/j.jpeds.2013.11.040. Epub 2013 Dec 31.

Effects of early inhaled nitric oxide therapy and vitamin A supplementation on the risk for bronchopulmonary dysplasia in premature newborns with respiratory failure.

Author information

1
Division of Neonatology, Department of Pediatrics, Weill Cornell Medical College, New York, NY. Electronic address: Mog9018@med.cornell.edu.
2
Department of Biostatistics, University of Alabama, Birmingham, AL.
3
Pediatric Heart Lung Center, University of Colorado School of Medicine, Aurora, CO; Section of Pulmonary Medicine, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO.
4
Pediatric Heart Lung Center, University of Colorado School of Medicine, Aurora, CO; Section of Neonatology, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO.

Abstract

OBJECTIVE:

To assess whether the combination of early inhaled nitric oxide (iNO) therapy and vitamin A supplementation lowers the incidence of bronchopulmonary dysplasia (BPD) in premature newborns with respiratory failure.

STUDY DESIGN:

A total of 793 mechanically ventilated infants (birth weight 500-1250 g) were randomized (after stratification by birth weight) to receive placebo or iNO (5 ppm) for 21 days or until extubation (500-749, 750-999, or 1000-1250 g). A total of 398 newborns received iNO, and of these, 118 (30%) received vitamin A according to their enrollment center. We compared patients who received iNO + vitamin A with those who received iNO alone. The primary outcome was a composite of death or BPD at 36 weeks postconceptual age.

RESULTS:

BPD was reduced in infants who received iNO + vitamin A for the 750-999 g birth weight group compared with iNO alone (P = .01). This group also showed a reduction in the combined outcome of BPD + death compared with iNO alone (P = .01). The use of vitamin A did not change the risk for BPD in the placebo group. Overall, the use of vitamin A was low (229 of 793 patients, or 29%). Combined therapy improved Bayley Scales of Infant Development II Mental and Psychomotor Developmental Index scores at 1 year compared with infants treated solely with iNO for the 500-749 g birth weight group.

CONCLUSIONS:

In this retrospective analysis of the nonrandomized use of vitamin A, combined iNO + vitamin A therapy in preterm infants with birth weight 750-999 g reduced the incidence of BPD and BPD + death and improved neurocognitive outcomes at 1 year in the 500-749 g birth weight group.

PMID:
24388327
PMCID:
PMC3962699
DOI:
10.1016/j.jpeds.2013.11.040
[Indexed for MEDLINE]
Free PMC Article

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