Nitric oxide saves preemies

A one-week treatment reduced the risk of lung disease and death in the premature by almost 25%

By Marcello Palmieri

A premature newborn with respiratory distress syndrome (RDS) begins life with an uphill battle. RDS is a breathing disorder in which the alveoli don't remain open in a newborn's lungs, making it extremely difficult to breathe. It's caused by the absence or lack of surfactant, a lipoprotein mixture that coats the alveoli and if left untreated can lead to organ damage, brain damage and even death due to the lack of oxygen.

A recent study published in the New England Journal of Medicine suggested that a one-week treatment of inhaled nitric oxide could reduce the risk of chronic lung disease and death in premature infants undergoing mechanical ventilation for RDS. A research team led by Dr Michael Schreiber, a neonatologist and associate professor of pediatrics at the University of Chicago Children's Hospital, knew that "inhaled nitric oxide could give neonatologists a simple and effective tool to help protect premature infants."

The concern was that it might increase the risk of bleeding into the ventricles and damage brain tissue near the ventricles, which are the main causes of long-term brain damage in premature infants. Using a randomized, double-blind, placebo control study, 105 infants were given a low-dose of nitric oxide, 10 parts per million (PPM) on the first day and 5PPM for the next six days. The placebo group consisted of 102 infants who were given inhaled oxygen for seven days. In the study, 64% of infants in the placebo group died compared to 49% of infants who received the inhaled nitric oxide. The research showed that the inhaled nitric oxide treatment reduced the risk of lung disease and death by nearly 25% and reduced the risk of severe bleeding into the brain and loss of brain tissue by almost 50%. Nitric oxide didn't cause bleeding into the ventricles or damage brain tissue; rather, it appeared to prevent the most severe brain injuries. Another benefit was that the infants given inhaled nitric oxide spent less time on the mechanical ventilator and left the hospital sooner. Dr Schreiber added that the optimal dose and length of treatment wasn't yet known and that more research was needed. He also noted that nitric oxide didn't rescue the sickest infants, though it was able to limit the amount of lung damage. Currently, there are three studies on nitric oxide being conducted. If these new studies confirm the benefits of inhaled nitric oxide, premature infants with RDS will get some much-needed help in their struggle to survive.