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Viewpoint |

Inhaled Nitric Oxide Use in the Neonatal Intensive Care Unit Rising Costs and the Need for a New Research Paradigm

William A. Carey, MD1,2; Marc A. Ellsworth, MD1,2; Malinda N. Harris, MD2
[+] Author Affiliations
1Division of Neonatal Medicine, Mayo Clinic, Rochester, Minnesota
2Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota
JAMA Pediatr. 2016;170(7):639-640. doi:10.1001/jamapediatrics.2016.0228.
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This Viewpoint recommends that the research model for the Children’s Oncology Group be emulated to study the effects of inhaled nitric oxide in neonates to establish acceptable practice patterns and lower the economic burden on the US health care system.

For nearly 2 decades inhaled nitric oxide (iNO) has played an essential role in the management of severe hypoxic respiratory failure in term and late-preterm neonates. Selective vasodilation with iNO decreases ventilation-perfusion mismatch in the lung and thereby improves oxygenation in various forms of neonatal lung disease. Randomized clinical trials have demonstrated the safety and effectiveness of iNO as a treatment for persistent pulmonary hypertension of the newborn, with recipients less often requiring extracorporeal membrane oxygenation. Unfortunately, subgroup analyses in these studies have failed to demonstrate a benefit for neonates with congenital diaphragmatic hernia (CDH), congruent with that of an early clinical trial1 of iNO in this high-risk population.

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