Nitric oxide aids some premature babies – studies

By Gene Emery

BOSTON (Reuters) – Although nitric oxide can halve the risk
of developmental problems in premature babies with undeveloped
lungs, the gas could be harmful to newborns who are too small
and too ill, according to two studies published on Thursday in
the New England Journal of Medicine.

The findings mean doctors should avoid using the treatment
during the first week of life in premature babies who are
seriously ill and weigh less than 1,000 grams (2.2 pounds),
Richard Martin and Michelle Walsh wrote in an editorial in the
same publication where the studies appear.

“Short-term use of inhaled nitric oxide cannot be
considered an effective rescue therapy for very preterm infants
with profound respiratory failure,” said Martin and Walsh, both
of Rainbow Babies and Children’s Hospital in Cleveland.

The good news for slightly larger, healthier premature
infants is that the gas makes the lungs mature rapidly, cutting
the risk of developmental problems in half. That could help
about half of the 60,000 premature infants born each year with
dangerously underdeveloped lungs.

“Babies born at two pounds (0.97 kg) have only a 50 percent
chance at 2 years of age of being considered totally normal,”
said pediatrician Michael Schreiber of the University of
Chicago, whose team tracked 138 children.

They found that by the second birthday, 24 percent of the
children given nitric oxide had problems such as blindness,
hearing loss and cerebral palsy, against 46 percent for those
2-year-olds who did not receive the gas.

“Not only does nitric oxide extend life in a large group of
premature infants, it also improves the quality of life for the
children and their parents,” Schreiber said.

But findings in the second study qualified that conclusion.

The research team led by Krisa Van Meurs of the Stanford
University School of Medicine found that the 210 premature
babies with severe respiratory failure who got nitric oxide
were just as likely to die or suffer lung damage as the 210 who
were given a placebo.

The study, however, focused on babies who tended to be
smaller and sicker than the ones in the Schreiber research.

The Van Meurs team also found that infants weighing over
1000 grams (35 ounces) benefited from nitric oxide, but those
weighing less were more likely to die or develop severe brain
bleeding than those who got standard care.

The Schreiber study was paid for in part by INO
Therapeutics, which makes the nitric oxide treatment. INO is a
division of Germany’s Linde AG . The Van Meurs study was
financed largely by the National Institute of Child Health and
Human Development.