NIH Consensus Development Conference statement on inhaled nitric oxide therapy for premature infants.
|Cole FS, Alleyne C, Barks JD, Boyle RJ, Carroll JL, Dokken D, Edwards WH, Georgieff M, Gregory K, Johnston MV, Kramer M, Mitchell C, Neu J, Pursley DM, Robinson W, Rowitch DH. NIH consensus development conference: inhaled nitric oxide therapy for premature infants. NIH Consens State Sci Statements 2010 Oct 29;27(5):1-34. PubMed|
National Guideline Clearinghouse NIH Consensus Development Conference statement on inhaled nitric oxide therapy for premature infants.
NIH Consens State Sci Statements. 2010 Oct 29;27(5). [Epub ahead of print]
NIH Consensus Development Conference: Inhaled Nitric Oxide Therapy for Premature Infants.
Cole FS, Alleyne C, Barks JD, Boyle RJ, Carroll JL, Dokken D, Edwards WH, Georgieff M, Gregory K, Johnston MV, Kramer M, Mitchell C, Neu J, Pursley DM, Robinson W, Rowitch DH.
OBJECTIVE:To provide health care providers, patients, and the general public with a responsible assessment of currently available data on the use of inhaled nitric oxide in premature infants.
PARTICIPANTS:A non-Department of Health and Human Services, nonadvocate 16-member panel representing the fields of biostatistics, child psychology, clinical trials, ethics, family-centered care, neonatology, neurodevelopmental follow-up, nursing, pediatric epidemiology, neurobehavior, neurological surgery, neurology, and pulmonology, perinatology, and research methodology. In addition, 18 experts from pertinent fields presented data to the panel and conference audience.
EVIDENCE:Presentations by experts and a systematic review of the literature prepared by the Johns Hopkins University Evidence-based Practice Center, through the Agency for Healthcare Research and Quality. Scientific evidence was given precedence over anecdotal experience.
CONFERENCE PROCESS:The panel drafted its statement based on scientific evidence presented in open forum and on published scientific literature. The draft statement was presented on the final day of the conference and circulated to the audience for comment. The panel released a revised statement later that day at http://consensus.nih.gov. This statement is a report of the panel and is not a policy statement of the NIH or the Federal Government.
CONCLUSIONS:(1) Taken as a whole, the available evidence does not support use of inhaled nitric oxide (iNO) in early routine, early rescue, or later rescue regimens in the care of infants less than 34 weeks gestation who require respiratory support. (2) There are rare clinical situations, including pulmonary hypertension or hypoplasia, that have been inadequately studied in which iNO may have benefit in infants less than 34 weeks gestation. In such situations, clinicians should communicate with families regarding the current evidence on its risks and benefits as well as remaining uncertainties. (3) Basic research and animal studies have contributed to important understandings ofiNO benefits on lung development and function in infants at high risk of bronchopulmonary dysplasia (BPD). These promising results have only partly been realized in clinical trials of iNO treatment in premature infants. Future research should seek to understand this gap. (4) Predefined subgroup and post hoc analyses of previous trials showing potential benefit of iNO have generated hypotheses for future research for clinical trials. Prior strategies shown to be ineffective are discouraged unless new evidence emerges. The positive results of one multicenter trial, which was categorized by later timing, higher dose, and longer duration of treatment, require confirmation. Future trials should attempt to quantify the individual effects of each of these treatment-related variables (timing, dose, and duration), ideally by randomizing them separately. (5) Based on assessment of available data, hospitals, clinicians, and the pharmaceutical industry should avoid marketing iNO for premature infants less than 34 weeks gestation.
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