Tanaka Y et al. (2007) Inhaled nitric oxide therapy decreases the risk of cerebral palsy in preterm infants with persistent pulmonary hypertension of the newborn. Pediatrics 119: 1159–1164

Preterm infants with persistent pulmonary hypertension of the newborn (PPHN) are at high risk of serious neurodevelopmental complications resulting from hypoxemic respiratory failure. The benefits of treating hypoxemia with inhaled nitric oxide therapy (iNO) are uncertain, but the results of a recent historical study by Tanaka et al. show that the risk of cerebral palsy in preterm infants with PPHN is lower in those treated with iNO than in those treated with 100% oxygen.

The study included long-term follow-up data for 31 preterm infants with hypoxemic respiratory failure resulting from PPHN who were treated with iNO (n = 16) or 100% oxygen (n = 15). After 3 years, the mortality rate did not differ between the treatment groups, but the incidence of cerebral palsy in patients treated with iNO was 12.5%, compared with 46.7% in patients treated with 100% oxygen (P = 0.054). In multivariate logistic regression analyses adjusted for maternal fever during delivery, birth weight, Apgar score at 5 min, high-frequency oscillatory ventilation, or surfactant therapy, iNO therapy was associated with a decreased risk of cerebral palsy compared with 100% oxygen therapy in preterm infants with PPHN.

These results are not consistent with those of earlier studies, but Tanaka et al. note that the risk reduction could be limited to preterm infants whose respiratory failure was caused by PPHN and previous studies were not limited to this population. These findings could have important implications for treatment, but further studies involving large numbers of patients are needed.