SynthesisPediatrics2011
Inhaled nitric oxide in preterm infants: an individual-patient data meta-analysis of randomized trials.
Synthesis in Pediatrics, 2011. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT03576885 (Treatment of Delayed Pulmonary Transition in Extremely Preterm Infants & Bronchopulmonary Dysplasia), which is not on this map. Cited by 56 papers, 5 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Treatment of Delayed Pulmonary Transition in Extremely Preterm Infants & Bronchopulmonary Dysplasia
Who cites it
56 citing papers in PubMed, 5 syntheses or guidelines pooled it, 147 citations in OpenAlex.
- Impact on mortality of inhaled nitric oxide in newborns ≤34 weeks with early hypoxemic respiratory failure: systematic review and meta-analysis.Pediatric research · 2026Pooled it
- Inhaled nitric oxide in preterm infants with respiratory disease: a systematic review and meta-analysis.European journal of medical research · 2025Pooled it
- Inhaled nitric oxide in premature infants for preventing bronchopulmonary dysplasia: a meta-analysis.BMC pediatrics · 2023Pooled it
- Pediatric Cardiac Intensive Care Society 2014 Consensus Statement: Pharmacotherapies in Cardiac Critical Care Pulmonary Hypertension.Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies · 2016Guideline
- Systematic review of methods for individual patient data meta- analysis with binary outcomes.BMC medical research methodology · 2014Pooled it
- Ancestry and genetic associations with bronchopulmonary dysplasia in preterm infants.American journal of physiology. Lung cellular and molecular physiology · 2018Trial
- Effect of Inhaled Nitric Oxide on Survival Without Bronchopulmonary Dysplasia in Preterm Infants: A Randomized Clinical Trial.JAMA pediatrics · 2017Trial
- Noninvasive inhaled nitric oxide does not prevent bronchopulmonary dysplasia in premature newborns.The Journal of pediatrics · 2014Trial
- Effects of early inhaled nitric oxide therapy and vitamin A supplementation on the risk for bronchopulmonary dysplasia in premature newborns with respiratory failure.The Journal of pediatrics · 2014Trial
- The role of prophylactic arginine supplementation for prevention of bronchopulmonary dysplasia in extremely preterm infants.Journal of perinatology : official journal of the California Perinatal Association · 2026Article
- Respiratory trajectory and risk of death or moderate-to-severe bronchopulmonary dysplasia in very preterm infants: a nine-year cohort study.Frontiers in pediatrics · 2026Article
- Inhaled nitric oxide therapy in preterm infants born before 34 weeks of gestation: a nationwide multicenter study.Italian journal of pediatrics · 2025Article
- Response to Inhaled Nitric Oxide and Mortality Among Very Preterm Neonates With Pulmonary Hypertension.JAMA network open · 2025Observational
- Strategies for the prevention of bronchopulmonary dysplasia.Frontiers in pediatrics · 2024Review
- Pulmonary vasodilator strategies in neonates with acute hypoxemic respiratory failure and pulmonary hypertension.Seminars in fetal & neonatal medicine · 2022Review
- Use of Inhaled Nitric Oxide in Preterm Infants: Is There Sufficient Evidence?Indian journal of pediatrics · 2022Review
- Evidence for the Management of Bronchopulmonary Dysplasia in Very Preterm Infants.Children (Basel, Switzerland) · 2021Review
- Nitric oxide and the brain. Part 2: Effects following neonatal brain injury-friend or foe?Pediatric research · 2021Review
- Early assessment of lung aeration using an ultrasound score as a biomarker of developing bronchopulmonary dysplasia: a prospective observational study.Journal of perinatology : official journal of the California Perinatal Association · 2021Observational
- A quality improvement project improving the value of iNO utilization in preterm and term infants.Journal of perinatology : official journal of the California Perinatal Association · 2021Article
Corrections and comments
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Authors and funding
20 authors at 15 institutions in 7 countries.
Funding
Abstract
backgroundInhaled nitric oxide (iNO) is an effective therapy for pulmonary hypertension and hypoxic respiratory failure in term infants. Fourteen randomized controlled trials (n = 3430 infants) have been conducted on preterm infants at risk for chronic lung disease (CLD). The study results seem contradictory. DESIGN/
methodsIndividual-patient data meta-analysis included randomized controlled trials of preterm infants (<37 weeks' gestation). Outcomes were adjusted for trial differences and correlation between siblings.
resultsData from 3298 infants in 12 trials (96%) were analyzed. There was no statistically significant effect of iNO on death or CLD (59% vs 61%: relative risk [RR]: 0.96 [95% confidence interval (CI): 0.92-1.01]; P = .11) or severe neurologic events on imaging (25% vs 23%: RR: 1.12 [95% CI: 0.98-1.28]; P = .09). There were no statistically significant differences in iNO effect according to any of the patient-level characteristics tested. In trials that used a starting iNO dose of >5 vs ≤ 5 ppm there was evidence of improved outcome (interaction P = .02); however, these differences were not observed at other levels of exposure to iNO. This result was driven primarily by 1 trial, which also differed according to overall dose, duration, timing, and indication for treatment; a significant reduction in death or CLD (RR: 0.85 [95% CI: 0.74-0.98]) was found.
conclusionsRoutine use of iNO for treatment of respiratory failure in preterm infants cannot be recommended. The use of a higher starting dose might be associated with improved outcome, but because there were differences in the designs of these trials, it requires further examination.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.