Safety and efficacy of nitric oxide in chronic lung disease

Background: Therapies for neonatal chronic lung disease (CLD) of prematurity have had limited success Aims: To determine whether inhaled nitric oxide (INO) administered to very low birthweight infants with developing CLD might improve oxygenation without adverse effects. Methods: Subjects were 10-30 days of age, birth weight < 1250 9, with developing or established CLD, and requiring mechanical ventilation with mean airway pressure greater than or equal to7 cm H2O and Flo(2) greater than or equal to0.40. We monitored changes in oxygenation and Flo(2) requirement during treatment with INO (initial dose 20 ppm). Tracheal aspirate samples obtained before, during, and after treatment were analysed for inter leukin 1beta (IL-1beta), IL-8, 8-epi-prostagiandin F-2alpha (8-epi-PGF(2alpha)), laminin, and endothelin 1 (ET-1) to assess authors' affiliations any potential effects of INO on markers of inflammation peroxidation, basement membrane injury, or vasoactivity. Results: Thirty three patients met entry criteria. Mean gestational age was 25 (SD 2) weeks; birth weight was 736 (190 9); age of study infants was 19 (6) days (range 9-29). Mean Flo(2) decreased from baseline (0.75) to 0.58 at 72 hours. Duration of therapy was seven days, Tracheal aspirate con, centrations of IL-1beta, IL-8, 8-epi-PGF(2alpha), ET-1, and laminin were unchanged between baseline and 48 USA; hours of INO, and 48 hours after discontinuation of INO. No new cases of, nor extension of, intraventricular haemorrhage occurred. Four infants died. Conclusion: INO (less than or equal to20 ppm) improved oxygenation in most infants with early CLD, without inducing changes in markers of inflammatory or oxidative injury.