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[Evidence of inhaled nitric oxide therapy for hypoxic respiratory failure in term and near-term infants].

OBJECTIVE
To study the evidence-based therapy of inhaled nitric oxide (iNO) for hypoxic respiratory failure (HRF) in term and near-term infants by analyzing the literature systematically.


METHODS
The literature related to the treatment of HRF with iNO was retrieved from the following: PubMed, EMBASE, OVID, Springer and Chinese Journals Full-Text Database (CNKI). The relevant literature on randomized controlled trials (RCTs) that met the criteria was statistically analyzed by the software of Review Manager 4.2, as recommended by Cochrane Collaboration.


RESULTS
A total of 162 articles were retrieved. Fifteen met the criteria and were selected for Meta analysis (4 single center and 11 multicenter randomized trials). Meta analysis showed that 30-60 minutes iNO therapy decreased the oxygenation index (P<0.05), increased PaO2 significantly, and reduced need of extracorporeal membrane oxygenation(ECMO) (P<0.05). However, for the neonates with HRF caused by congenital diaphragmatic hernia, iNO therapy did not result in a significant reduction in the oxygenation index and death rate. There was no significant difference in the occurrence of neurodevelopmental sequelae between the iNO and control groups.


CONCLUSIONS
The currently published evidence from RCTs supports the use of iNO in term and near-term infants with HRF but except for the HRF infants caused by diaphragmatic hernia. The effect of iNO therapy on long-term neurodevelopment needs to be further studied.