Nitric oxide found to help some premature babies

Gas therapy improved health of stronger infants, didn't benefit the smallest

July 07, 2005|By Rosie Mestel | Rosie Mestel,LOS ANGELES TIMES

Treating premature babies with nitric oxide gas improved their cognitive function at age 2 and lowered their risk of developing neurological complications such as cerebral palsy, according to a study published today in the New England Journal of Medicine.

But a separate study concurrently published in the journal reported that the therapy did not help survival in a group of smaller and sicker premature babies and might have worsened it in the sickest infants among that group.

Experts said that nitric oxide therapy, while promising for some premature infants, cannot be recommended generally until further research identifies which babies would benefit.

Each year, an estimated 60,000 U.S. babies are born so premature that they need assistance with breathing. Their lungs lack a critical substance known as a surfactant, which eases inflation of the lungs.

Although survival of babies as young as 24 weeks is possible because of treatment with oxygen, mechanical ventilators and animal surfactants, many premature babies still die. Others develop chronic lung disease and later complications such as blindness, deafness, cerebral palsy and cognitive delays.

In one of the studies, researchers led by Dr. Michael Schreiber, professor of pediatrics at the University of Chicago, gave either nitric oxide or a placebo to 207 premature infants born at less than 34 weeks gestation. All the infants were experiencing respiratory distress.

The scientists had reported in 2003 that the nitric oxide treatment increased the infants' survival rate and reduced rates of chronic lung disease and serious brain bleeding.

In their follow-up study today, Schreiber's group assessed 138 of those children at age 2.

They found that 16 percent of the 68 who had received nitric oxide had a significant delay in mental development, compared with 34 percent of the 70 babies in the placebo group.

Developmental delay was measured by a standard battery of tests that assess language, thinking and motor skills.

When the scientists pooled cognitive problems with other complications of prematurity such as cerebral palsy, blindness and hearing loss, they found that 24 percent of the nitric oxide group experienced such problems, compared with 46 percent of the placebo group.

In the second study, scientists tracked 420 premature infants with respiratory failure treated at 14 academic medical centers and 26 hospitals. Half of the babies received nitric oxide.

The overall figures in the study showed no significant improvement in death or lung disease rates in babies given nitric oxide vs. a placebo. In both cases, about half the infants died and two-thirds developed chronic lung disease.

But further analysis showed that larger babies in the study - those above 2.2 pounds at birth - had a higher survival rate and less chronic lung disease with nitric oxide treatments.

The Los Angeles Times is a Tribune Publishing newspaper.

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