Inhaled nitric oxide as an adjunct to neonatal resuscitation in premature infants: a pilot, double blind, randomized controlled trial

Krishnamurthy Sekar, Edgardo Szyld, Michael McCoy, Anne Wlodaver, Douglas Dannaway, Ashley Helmbrecht, Julee Riley, Amy Manfredo, Michael Anderson, Satyan Lakshminrusimha, Shahab Noori

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1 Citation (Scopus)

Abstract

Background: Nitric oxide (NO) plays an important role in normal postnatal transition. Our aims were to determine whether adding inhaled NO (iNO) decreases supplemental oxygen exposure in preterm infants requiring positive pressure ventilation (PPV) during resuscitation and to study iNO effects on heart rate (HR), oxygen saturation (SpO2), and need for intubation during the first 20 min of life. Methods: This was a pilot, double-blind, randomized, placebo-controlled trial. Infants 25 0/7–31 6/7 weeks’ gestational age requiring PPV with supplemental oxygen during resuscitation were enrolled. PPV was initiated with either oxygen (FiO2–0.30) + iNO at 20 ppm (iNO group) or oxygen (FiO2–0.30) + nitrogen (placebo group). Oxygen was titrated targeting defined SpO2 per current guidelines. After 10 min, iNO/nitrogen was weaned stepwise per protocol and terminated at 17 min. Results: Twenty-eight infants were studied (14 per group). The mean gestational age in both groups was similar. Cumulative FiO2 and rate of exposure to high FiO2 (>0.60) were significantly lower in the iNO group. There were no differences in HR, SpO2, and need for intubation. Conclusions: Administration of iNO as an adjunct during neonatal resuscitation is feasible without side effects. It diminishes exposure to high levels of supplemental oxygen.

Original languageEnglish (US)
JournalPediatric research
DOIs
StateAccepted/In press - Jan 1 2019

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Premature Infants
Resuscitation
Nitric Oxide
Randomized Controlled Trials
Oxygen
Positive-Pressure Respiration
Intubation
Gestational Age
Nitrogen
Heart Rate
Placebos
Guidelines

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

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Inhaled nitric oxide as an adjunct to neonatal resuscitation in premature infants : a pilot, double blind, randomized controlled trial. / Sekar, Krishnamurthy; Szyld, Edgardo; McCoy, Michael; Wlodaver, Anne; Dannaway, Douglas; Helmbrecht, Ashley; Riley, Julee; Manfredo, Amy; Anderson, Michael; Lakshminrusimha, Satyan; Noori, Shahab.

In: Pediatric research, 01.01.2019.

Research output: Contribution to journalArticle

Sekar, Krishnamurthy ; Szyld, Edgardo ; McCoy, Michael ; Wlodaver, Anne ; Dannaway, Douglas ; Helmbrecht, Ashley ; Riley, Julee ; Manfredo, Amy ; Anderson, Michael ; Lakshminrusimha, Satyan ; Noori, Shahab. / Inhaled nitric oxide as an adjunct to neonatal resuscitation in premature infants : a pilot, double blind, randomized controlled trial. In: Pediatric research. 2019.
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T2 - a pilot, double blind, randomized controlled trial

AU - Sekar, Krishnamurthy

AU - Szyld, Edgardo

AU - McCoy, Michael

AU - Wlodaver, Anne

AU - Dannaway, Douglas

AU - Helmbrecht, Ashley

AU - Riley, Julee

AU - Manfredo, Amy

AU - Anderson, Michael

AU - Lakshminrusimha, Satyan

AU - Noori, Shahab

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N2 - Background: Nitric oxide (NO) plays an important role in normal postnatal transition. Our aims were to determine whether adding inhaled NO (iNO) decreases supplemental oxygen exposure in preterm infants requiring positive pressure ventilation (PPV) during resuscitation and to study iNO effects on heart rate (HR), oxygen saturation (SpO2), and need for intubation during the first 20 min of life. Methods: This was a pilot, double-blind, randomized, placebo-controlled trial. Infants 25 0/7–31 6/7 weeks’ gestational age requiring PPV with supplemental oxygen during resuscitation were enrolled. PPV was initiated with either oxygen (FiO2–0.30) + iNO at 20 ppm (iNO group) or oxygen (FiO2–0.30) + nitrogen (placebo group). Oxygen was titrated targeting defined SpO2 per current guidelines. After 10 min, iNO/nitrogen was weaned stepwise per protocol and terminated at 17 min. Results: Twenty-eight infants were studied (14 per group). The mean gestational age in both groups was similar. Cumulative FiO2 and rate of exposure to high FiO2 (>0.60) were significantly lower in the iNO group. There were no differences in HR, SpO2, and need for intubation. Conclusions: Administration of iNO as an adjunct during neonatal resuscitation is feasible without side effects. It diminishes exposure to high levels of supplemental oxygen.

AB - Background: Nitric oxide (NO) plays an important role in normal postnatal transition. Our aims were to determine whether adding inhaled NO (iNO) decreases supplemental oxygen exposure in preterm infants requiring positive pressure ventilation (PPV) during resuscitation and to study iNO effects on heart rate (HR), oxygen saturation (SpO2), and need for intubation during the first 20 min of life. Methods: This was a pilot, double-blind, randomized, placebo-controlled trial. Infants 25 0/7–31 6/7 weeks’ gestational age requiring PPV with supplemental oxygen during resuscitation were enrolled. PPV was initiated with either oxygen (FiO2–0.30) + iNO at 20 ppm (iNO group) or oxygen (FiO2–0.30) + nitrogen (placebo group). Oxygen was titrated targeting defined SpO2 per current guidelines. After 10 min, iNO/nitrogen was weaned stepwise per protocol and terminated at 17 min. Results: Twenty-eight infants were studied (14 per group). The mean gestational age in both groups was similar. Cumulative FiO2 and rate of exposure to high FiO2 (>0.60) were significantly lower in the iNO group. There were no differences in HR, SpO2, and need for intubation. Conclusions: Administration of iNO as an adjunct during neonatal resuscitation is feasible without side effects. It diminishes exposure to high levels of supplemental oxygen.

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