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

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.

• Authors: Monika M Gadhia, Gary R Cutter, Steven H Abman, John P Kinsella
• Journal: The Journal of pediatrics (J Pediatr) Vol. 164 Issue 4 Pg. 744-8 (Apr 2014) ISSN: 1097-6833 [Electronic] United States
• PMID: 24388327 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, N.I.H., Extramural)
• Copyright: Copyright © 2014 Mosby, Inc. All rights reserved.

Chemical References

• Vitamins
• Vitamin A
• Nitric Oxide

Topics

• Administration, Inhalation
• Bronchopulmonary Dysplasia (etiology, prevention & control)
• Dietary Supplements
• Early Medical Intervention
• Female
• Humans
• Incidence
• Infant, Newborn
• Infant, Premature
• Male
• Nitric Oxide (administration & dosage)
• Respiratory Insufficiency (complications)
• Retrospective Studies
• Risk
• Single-Blind Method
• Vitamin A (therapeutic use)
• Vitamins (therapeutic use)