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Nitric Oxide Could Benefit Premature Babies

Allowing certain premature babies to inhale small amounts of nitric oxide could prevent a potentially fatal lung disease called bronchopulmonary dysplasia, according// to the results of two studies that were revealed on Wednesday. Many thousands of babies are born with this condition each year in the United States. As a result of this disease their lungs are too immature to mix inhaled air properly with blood to make oxygen available to the cells of the body. There has been limited progress in fighting this problem, which often leads to brain damage.

The two studies were published in this week’s New England Journal of Medicine. However they have mentioned that their findings were not conclusive enough to use nitric oxide as a recommend routine treatment and further tests were needed to ensure proper development of the child. Nitric oxide, a compound that plays a significant role in the heart and circulatory system, was delivered by different strategies by the researchets to these infants. In the study led by John Kinsella of the University of Colorado School of Medicine the gas was given soon after birth and it was found that this treatment appeared to be beneficial only to babies weighing at least 2.2 pounds. However their risk of lung problems was cut by half. No breathing benefit was shown for smaller babies on ventilators who received the gas although the risk of brain damage was halved in all babies who received the gas. Kinsella said, “We are optimistic that this therapy could prevent long-term developmental and neurological problems in many of these children.”

The 793 babies of the study, started to receive nitric oxide gas or a placebo when they were less than 48 hours old.

The second study was led by Roberta Ballard of Children’s Hospital of Philadelphia who gave 582 babies nitric oxide or a placebo only after the infants were at least seven days old.

In this study the researchers found that, after 36 weeks, 44 percent of the nitric oxide recipients were free of bronchopulmonary dysplasia versus 37 percent who got a placebo gas.

The Ballard team said, “As compared with infants who received placebo gas, infants who were treated with inhaled nitric oxide were hospitalized for fewer days, needed supplemental oxygen for a shorter period, and had less severe disease.”

According to Ballard the Kinsella team might not have seen significant improvement in some babies probably because they might have halted the treatment too soon. However as Ann Stark of Texas Children’s Hospital in Houston, said, ‘At a cost of about $3,000 per day, or as much as $12,000 for a month of therapy, nitric oxide for premature newborns is difficult to justify until benefit is proven.’ She recommended that the use of inhaled nitric oxide in this setting should be limited to clinical trials. Presently the U.S. Food and Drug Administration has approved the gas for full-term babies with breathing problems.

Its use in prematue infants is regarded with great interest for doctors because about one in three babies with weight less than 2.75 pounds at birth have the disease and need supplemental oxygen. Of those, about 10 percent have evidence of brain injury.
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