Vieira Frederico, Makoni Marjorie, Szyld Edgardo, Sekar Krishnamurthy
Neonatal Perinatal Section, Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States.
Front Pediatr. 2021 Mar 31;9:631765. doi: 10.3389/fped.2021.631765. eCollection 2021.
Inhaled nitric oxide (iNO) use in premature newborns remains controversial among clinicians. In 2014, the American Academy of Pediatrics, Committee on Fetus and Newborn released a statement that the available data do not support routine iNO use in pre-term newborns. Despite the absence of significant benefits, 2016 California data showed that clinicians continue to utilize iNO in pre-term infants. With studies as recent as January 2017, the Cochrane review confirmed no major advantages of iNO in pre-term newborns. Still, it recognized that a subset of pre-term infants with pulmonary hypertension (PHTN) had not been separately investigated. Furthermore, recent non-randomized controlled trials have suggested that iNO may benefit specific subgroups of pre-term newborns, especially those with PHTN, prolonged rupture of membranes, and antenatal steroid exposure. Those pre-term infants who showed a clinical response to iNO had increased survival without disability. These findings underscore the need for future studies in pre-term newborns with hypoxemic respiratory failure and PHTN. This review will discuss the rationale for using iNO, controversies regarding the diagnosis of PHTN, and additional novel approaches of iNO treatment in perinatal asphyxia and neonatal resuscitation in the pre-term population < 34 weeks gestation.
吸入一氧化氮（iNO）在早产新生儿中的应用在临床医生中仍存在争议。2014年，美国儿科学会胎儿与新生儿委员会发表声明称，现有数据不支持在早产新生儿中常规使用iNO。尽管没有显著益处，但2016年加利福尼亚的数据显示，临床医生仍继续在早产儿中使用iNO。截至2017年1月的研究中，Cochrane综述证实iNO在早产新生儿中没有主要优势。不过，该综述认识到，一部分患有肺动脉高压（PHTN）的早产儿尚未得到单独研究。此外，最近的非随机对照试验表明，iNO可能对特定亚组的早产新生儿有益，尤其是那些患有PHTN、胎膜早破和产前接触过类固醇的新生儿。那些对iNO有临床反应的早产儿存活且无残疾的几率有所增加。这些发现强调了未来对患有低氧性呼吸衰竭和PHTN的早产新生儿进行研究的必要性。本综述将讨论使用iNO的理论依据、关于PHTN诊断的争议，以及iNO在孕周小于34周的早产人群围产期窒息和新生儿复苏中的其他新治疗方法。
