of 12 RCT trials evaluating the ability of inhaled nitric oxide in newborns
with hypoxic respiratory failure to improve oxygenation, reduce mortality,
and need for ECMO.1
respiratory failure most likely due to either primary or secondary pulmonary
hypertension excluding congenital heart defects/shunting.
study looked at infants specifically with congenital diaphragmatic hernias
and was evaluated separately.
different types of outcomes were explored; however, not every study
measured each outcome specifically. Main outcomes were death, requirement
for ECMO, changes in oxygenation and oxygen index, and neurodevelopmental
size ranged from n=17 to n=235 with eligibility criteria described as
for hypoxemic respiratory failure was not the same in each study; however
on the above endpoints, the test for heterogeneity was not significant,
providing some reassurance that this did not have an effect on results.
addition, there were different modes of intervention among studies such
as type of mechanical ventilation, surfactant, cross-over to the intervention
article was valid in that it appeared to be an exhaustive search, methodology
among studies varied greatly-therefore not all studies were included
in each outcome. When similar studies were evaluated, reproducibility
of results occurred.
- Inhaled nitric oxide reduces the requirement for ECMO as demonstrated
by a meta-analysis of eight RCTs: RR 0.63 (95%CI 0.54, 0.75); ARR 0.19
(CI 0.12, 0.26); NNT= 6.
- Oxygenation Index decreased at 30 to 60 minutes after treatment demonstrated
by a meta-analysis of six RCTs: weighted mean difference ; -9.59 (CI
- PaO2 increased 30 to 60 minutes after treatment, as demonstrated
in a meta-analysis of six studies: weighted mean difference 45.5 mmHg
(CI 34.7, 56.3).
- Neurodevelopmental outcomes measured at 18 to 24 months were not
significantly different between newborns who received inhaled nitric
versus those that did not: RR 1.14 (CI 0.74, 1.77).