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. 2014 Nov;34(11):842-6.
doi: 10.1038/jp.2014.105. Epub 2014 Jun 5.

Inhaled nitric oxide usage in preterm infants in the NICHD Neonatal Research Network: inter-site variation and propensity evaluation

W E Truog  1 , L D Nelin  2 , A Das  3 , D E Kendrick  3 , E F Bell  4 , W A Carlo  5 , R D Higgins  6 , A R Laptook  7 , P J Sanchez  8 , S Shankaran  9 , B J Stoll  10 , K P Van Meurs  11 , M C Walsh  12 ; NICHD Neonatal Research Network
Affiliations

Inhaled nitric oxide usage in preterm infants in the NICHD Neonatal Research Network: inter-site variation and propensity evaluation

W E Truog et al. J Perinatol. 2014 Nov.

Abstract

Objective: The use of inhaled nitric oxide (iNO) in preterm infants remains controversial. In October 2010, a National Institutes of Health consensus development conference cautioned against use of iNO in preterm infants. This study aims (1) to determine the prevalence and variability in use of iNO in the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network (NICHD NRN) before and after the consensus conference and (2) separately, to examine associations between iNO use and severe bronchopulmonary dysplasia (BPD) or death.

Study design: The NICHD NRN Generic Database collects data including iNO use on very preterm infants. A total of 13 centers contributed data across the time period 2008 to 2011. Infants exposed or not to iNO were compared using logistic regression, which included factors related to risk as well as their likelihood of being exposed to iNO.

Result: A total of 4885 infants were assessed between 2008 and 2011; 128 (2.6%) received iNO before day 7, 140 (2.9%) between day 7 and 28, and 47 (1.0%) at >28 days. Center-specific iNO use during 2008 to 2010 ranged from 21.9 to 0.4%; 12 of 13 sites reduced usage and overall NRN iNO usage decreased from 4.6 to 1.6% (P<0.001) in 2011. The use of iNO started between day 7 and day 14 was more prevalent among younger infants with more severe courses in week 1 and associated with increased risk of severe BPD or death (odds ratio 2.24; 95% confidence interval 1.23 to 4.07).

Conclusion: The variability and total use of iNO decreased in 2011 compared with 2008 to 2010. iNO administration started at ⩾ day 7 was associated with more severe outcomes compared with infants without iNO exposure.

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Conflict of interest statement

Conflicts of Interest:

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Enrollment of GDB patients; of 6,337 patients born between 2008 and 2011 who qualified for the GDB 4,757 were utilized for propensity analysis based on the exclusion criteria shown.
Figure 2
Figure 2. iNO Initiation at ≥7 Days of Age (% of Patients in the Database by Site)
Use of iNO in the 13 NRN sites before (2008–2010) and after (2011) the NIH consensus development conference report. Each individual line represents one NRN site, and iNO use decreased from before to after the NIH consensus development conference report in 12 of the 13 centers. The solid short blue horizontal lines represent mean use of iNO before and after, and use was significantly less after than before the NIH consensus development conference report (p<0.001).
See this image and copyright information in PMC

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