Efficacy of inhaled nitric oxide in preterm infants ≤ 34 weeks: a systematic review and meta-analysis of randomized controlled trials

• Published in: Frontiers in pharmacology 2024-01, Vol.14, p.1268795
• Main Authors: Feng, Zhoushan, Wu, Xiaohong, Xu, Xiaona, Cui, Qiliang, Wu, Fan
• Format: Article
• Language: English
• Subjects: bronchopulmonary dysplasia; meta analysis; mortality; nitric oxide; Pharmacology; premature infant
• ISSN: 1663-9812; 1663-9812
• DOI: 10.3389/fphar.2023.1268795

The effect of inhaled nitric oxide (iNO) in neonates >34 weeks on improving respiration is well documented. However, the efficacy of iNO in preterm infants ≤34 weeks remains controversial. The main purpose of this review is to assess the effectiveness and safety of iNO treatment in preterm infants ≤34 weeks. We systematically searched PubMed, Embase and Cochrane Libraries from their inception to 1 June 2023. We also reviewed the reference lists of retrieved studies. Our study involved randomized controlled trials on preterm infants ≤34 weeks, especially those receiving iNO treatment, and mainly assessed outcomes such as bronchopulmonary dysplasia (BPD) and mortality. Two authors independently reviewed these trials, extracted data, and evaluated study biases. Disagreements were resolved by consensus. We used the GRADE method to assess evidence quality. Our research included a total of 17 studies involving 4,080 neonates and 7 follow-up studies. The synthesis of results showed that in neonates, iNO treatment reduced the incidence of BPD (RR: 0.92; 95% CI: 0.86-0.98). It also decreased the composite outcome of death or BPD (RR: 0.94; 95% CI: 0.90-0.98), without increasing the risk of short-term (such as intraventricular hemorrhage, periventricular leukomalacia) and long-term neurological outcomes (including Bayley mental developmental index