Neonatology. 2012;102(4):251-3. doi: 10.1159/000338552. Epub 2012 Aug 15.
Inhaled nitric oxide (iNO) is effective in term infants with hypoxic respiratory failure. The pathophysiology of respiratory failure and the potential risks of iNO differ substantially in preterm infants, necessitating study in this population.
To determine the effect of treatment with iNO on death, bronchopulmonary dysplasia (BPD), intraventricular hemorrhage (IVH), and neurodevelopmental disability in preterm newborn infants with respiratory disease.
Standard methods of the Cochrane Neonatal Review Group were used. MEDLINE, EMBASE, Healthstar and the Cochrane Central Register of Controlled Trials (The Cochrane Library) were searched covering the years from 1985 to 2010. In addition, the abstracts of the Pediatric Academic Societies were also searched.
Randomized and quasi-randomized studies in preterm infants with respiratory disease that compared the effects of iNO gas to control, with or without placebo were eligible.
Standard methods of the Cochrane Neonatal Review Group were used.
Fourteen randomized controlled trials of iNO therapy in preterm infants were found. The trials have been grouped post hoc into three categories depending on entry criteria: entry in the first 3 days of life based on oxygenation criteria, routine use in preterm babies with pulmonary disease, and later enrolment based on an increased risk of BPD. No overall analyses were performed. Nine trials of early rescue treatment of infants based on oxygenation criteria demonstrated no significant effect of iNO on mortality or BPD. Three studies with routine use of iNO in infants with pulmonary disease also demonstrated no significant reduction in death or BPD [typical RR 0.93 (95% CI 0.86-1.01)] although this small effect approached significance. Later treatment with iNO based on the risk of BPD (two trials) demonstrated no significant benefit for this outcome in analyses which are possible using summary data. There is no clear effect of iNO on the frequency of all grades of IVH or of severe IVH. Early rescue treatment was associated with a non-significant 20% increase in severe IVH. No effect on the incidence of neurodevelopmental impairment was found.
吸入一氧化氮（iNO）可有效治疗患有低氧性呼吸衰竭的足月婴儿。然而，在早产儿中，呼吸衰竭的病理生理学和 iNO 的潜在风险有很大的不同，因此需要在这一人群中进行研究。
确定 iNO 治疗对患有呼吸疾病的早产儿的死亡率、支气管肺发育不良（BPD）、脑室内出血（IVH）和神经发育障碍的影响。
使用 Cochrane 新生儿评价组的标准方法。检索了 MEDLINE、EMBASE、Healthstar 和 Cochrane 对照试验中心注册库（Cochrane 图书馆），检索年限为 1985 年至 2010 年。此外，还检索了儿科学术协会的摘要。
随机和半随机对照试验，纳入患有呼吸疾病的早产儿，比较 iNO 气体与对照治疗的效果，包括有或没有安慰剂的治疗。
使用 Cochrane 新生儿评价组的标准方法。
共发现 14 项关于 iNO 治疗早产儿的随机对照试验。这些试验被分为三类，取决于纳入标准：根据氧合标准在生命的前 3 天内纳入、常规用于患有肺部疾病的早产儿、以及基于发生 BPD 的风险较高而后期纳入。没有进行总体分析。9 项基于氧合标准的早期抢救治疗婴儿的试验表明，iNO 对死亡率或 BPD 没有显著影响。3 项常规使用 iNO 治疗肺部疾病的婴儿的研究也没有显著降低死亡率或 BPD[典型 RR0.93（95%CI0.86-1.01)]，尽管这一较小的效果接近显著。基于 BPD 风险的后期 iNO 治疗（两项试验），在可以使用汇总数据进行的分析中，对这一结果没有显著的益处。iNO 对所有严重程度的 IVH 或严重 IVH 的发生率没有明显影响。早期抢救治疗与严重 IVH 发生率增加 20%相关，但无统计学意义。对神经发育障碍的发生率也没有发现影响。
