NIH Consensus Development Conference Statement: Inhaled Nitric-Oxide Therapy for Premature Infants-Reference-Cited by-同舟云学术

NIH Consensus Development Conference Statement: Inhaled Nitric-Oxide Therapy for Premature Infants

Published:2011-02-01 Issue:2 Volume:127 Page:363-369
ISSN:0031-4005
Container-title:Pediatrics
language:en
Short-container-title:

Author:

Cole F. Sessions¹,Alleyne Claudia²,Barks John D. E.³⁴,Boyle Robert J.⁵,Carroll John L.⁶⁷,Dokken Deborah⁸,Edwards William H.⁹¹⁰,Georgieff Michael¹¹,Gregory Katherine¹²¹³,Johnston Michael V.¹⁴¹⁵,Kramer Michael¹⁶¹⁷,Mitchell Christine¹⁸¹⁹,Neu Josef²⁰,Pursley DeWayne M.²¹²²²³,Robinson Walter M.²⁴²⁵,Rowitch David H.²⁶

Affiliation:

1. Division of Newborn Medicine, Department of Pediatrics, Washington University School of Medicine, St Louis, Missouri;

2. Neonatal Intensive Care Unit, Kaiser Permanente Anaheim Medical Center, Anaheim, California;

3. Department of Pediatrics and Communicable Diseases, University of Michigan Medical School, Ann Arbor, Michigan;

4. Division of Neonatal-Perinatal Medicine, C. S. Mott Children's Hospital, University of Michigan Health System, Ann Arbor, Michigan;

5. Center for Biomedical Ethics, Division of Neonatology, Department of Pediatrics, University of Virginia Medical Center, Charlottesville, Virginia;

6. Department of Pediatrics, College of Medicine, University of Arkansas for Medical Sciences, and

7. Pediatric Pulmonary Division, Arkansas Children's Hospital, Little Rock, Arkansas;

8. Family Health Care Advocate, Consultant in Family-Centered Care, Chevy Chase, Maryland;

9. Department of Pediatrics, Children's Hospital at Dartmouth, Hanover, New Hampshire;

10. Vermont Oxford Network, Lebanon, New Hampshire;

11. Division of Neonatology, Departments of Pediatrics and Child Psychology, Center for Neurobehavioral Development, University of Minnesota School of Medicine, Minneapolis, Minnesota;

12. Department of Nursing, William F. Connell School of Nursing, Boston College, and

13. Brigham and Women's Hospital, Chestnut Hill, Massachusetts;

14. Department of Pediatric Neurology, Kennedy Krieger Institute; and

15. Departments of Neurology, Pediatrics, and Physical Medicine and Rehabilitation, Johns Hopkins University, School of Medicine, Baltimore, Maryland;

16. Institute of Human Development, Child and Youth Health, Canadian Institutes of Health Research, Ottawa, Ontario, Canada;

17. Departments of Pediatrics and Epidemiology, Biostatistics, and Occupational Health, McGill University Faculty of Medicine, Montreal Children's Hospital, Montreal, Quebec, Canada;

18. Clinical Ethics, Division of Medical Ethics, Harvard Medical School, Boston, Massachusetts;

19. Office of Ethics, Children's Hospital Boston, Boston, Massachusetts;

20. Division of Neonatology, Department of Pediatrics, College of Medicine, University of Florida, Gainesville, Florida;

21. Section on Perinatal Pediatrics, American Academy of Pediatrics, Elk Grove Village, Illinois;

22. Department of Pediatrics, Harvard Medical School, Boston, Massachusetts;

23. Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts;

24. Center for Applied Ethics, Education Development Center, Inc, Washington, DC;

25. Division of Pediatric Allergy, Immunology, and Pulmonary Medicine, Department of Pediatrics, Center for Biomedical Ethics and Society, Vanderbilt University School of Medicine, Nashville, Tennessee; and

26. Department of Pediatrics, Howard Hughes Medical Institute, University of California, San Francisco, California

Abstract

Premature birth is a major public health problem in the United States and internationally. Infants born at or before 32 weeks' gestation (2% of all births in the United States in 2007) are at extremely high risk for death in the neonatal period or for pulmonary, visual, and neurodevelopmental morbidities with lifelong consequences including bronchopulmonary dysplasia, retinopathy of prematurity, and brain injury. Risks for adverse outcomes increase with decreasing gestational age. The economic costs to care for these infants are also substantial (estimated at $26 billion in 2005 in the United States). It is clear that the need for strategies to improve outcomes for this high-risk population is great, and this need has prompted testing of new therapies with the potential to decrease pulmonary and other complications of prematurity. Inhaled nitric oxide (iNO) emerged as one such therapy. To provide health care professionals, families, and the general public with a responsible assessment of currently available data regarding the benefits and risks of iNO in premature infants, the Eunice Kennedy Shriver National Institute of Child Health and Human Development, the National Heart, Lung, and Blood Institute, and the Office of Medical Applications of Research of the National Institutes of Health convened a consensus-development conference. Findings from a substantial body of experimental work in developing animals and other model systems suggest that nitric oxide may enhance lung growth and reduce lung inflammation independently of its effects on blood vessel resistance. Although this work demonstrates biological plausibility and the results of randomized controlled trials in term and near-term infants were positive, combined evidence from the 14 randomized controlled trials of iNO treatment in premature infants of ≤34 weeks' gestation shows equivocal effects on pulmonary outcomes, survival, and neurodevelopmental outcomes.

Publisher

American Academy of Pediatrics (AAP)

Subject

Pediatrics, Perinatology, and Child Health

Link

https://publications.aap.org/pediatrics/article-pdf/127/2/363/1055548/zpe00211000363.pdf

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