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ORIGINAL RESEARCH article
Front. Pediatr.
Sec. Neonatology
Volume 13 - 2025 | doi: 10.3389/fped.2025.1525329
This article is part of the Research Topic Care of the extremely preterm infant View all 4 articles
Inhaled Nitric Oxide as an Independent Intervention to Lower the Risk of Bronchopulmonary Dysplasia in Preterm Infants (<33 Weeks) with Pulmonary Hypertension within the Initial 3 Days of Life
Provisionally accepted
Tasnim Azad *
Mingjie Wang *- Xiangya Hospital, Central South University, Changsha, China
Background: Bronchopulmonary dysplasia (BPD) is a significant health issue for preterm infants, especially those born early. Research on inhaled nitric oxide (iNO) for pulmonary hypertension (PH) is ongoing. Although iNO helps with oxygenation in respiratory failure, its impact on BPD incidence in preterm infants with PH during the early postnatal period is not clear.Objective: This study investigates the relation of early administration of iNO, alone and in combination with pulmonary surfactant (PS), on the incidence of BPD in preterm infants diagnosed with PH within the first three days of life.Methods: This retrospective cohort study included 56 preterm infants of gestational age <33 weeks with confirmed PH with hypoxemia. Comparative analysis of clinical outcomes, including the incidence of BPD, was performed between infants receiving iNO and/or therapy and those who did not.Multivariate logistic regression analysis was applied to identify independent predictors of BPD in this population.The incidence of BPD was significantly reduced in the iNO group (15%) in comparison to the non-iNO group (63.9%) (P= 0.012). Furthermore, infants in the iNO + PS group demonstrated enhanced outcomes for BPD when compared to those who only received PS or no treatment at all. Male gender and the lack of PS were identified as factors associated with an increased risk of BPD. A multivariate analysis confirmed that both iNO and PS served as independent protective factors, with odds ratios (OR) of 0.097 (95% CI: 0.014, 0.682; P = 0.019) for iNO and 0.125 (95% CI: 0.021, 0.728; P = 0.021) for PS.Early iNO use, particularly with PS, reduces BPD incidence in preterm infants with PH.Further studies are needed to confirm these findings and guide clinical practice.
Keywords: Bronchopulmonary Dysplasia, preterm infants, inhaled Nitric Oxide, pulmonary surfactant, pulmonary hypertension
Received: 09 Nov 2024; Accepted: 17 Feb 2025.
Copyright: © 2025 Azad and Wang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Tasnim Azad, Xiangya Hospital, Central South University, Changsha, China
Mingjie Wang, Xiangya Hospital, Central South University, Changsha, China
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