BMJ Paediatrics Open (Aug 2021)

Increase in the use of inhaled nitric oxide in neonatal intensive care units in England: a retrospective population study

  • Jonathan Cusack,
  • Matthew Babirecki,
  • Liza Harry,
  • Tim Wickham,
  • L M Wong,
  • Anita Mittal,
  • Sunita Seal,
  • Ahmed Hassan,
  • Karin Schwarz,
  • Graham Whincup,
  • Stephen Brearey,
  • Abdul Hasib,
  • Mehdi Garbash,
  • David Gibson,
  • Pauline Adiotomre,
  • Abby Deketelaere,
  • Ruth Shephard,
  • Mukta Jain,
  • Stanley Zengeya,
  • Cath Seagrave,
  • Hilary Dixon,
  • Narendra Aladangady,
  • Hassan Gaili,
  • M Lal,
  • Ambadkar,
  • Khalid Mannan,
  • Lawrence Miall,
  • J Kefas,
  • Jennifer Birch,
  • Gail Whitehead,
  • I Misra,
  • Imdad Ali,
  • Mark Dyke,
  • Michael Selter,
  • Steven Wardle,
  • Eleri Adams,
  • Minesh Khashu,
  • Shameel Mattara,
  • Peter De Halpert,
  • Paul Settle,
  • Paul Munyard,
  • Joanne Fedee,
  • Natasha Maddock,
  • Kirsten Mack,
  • Charlotte Huddy,
  • Ngozi Edi-osagie,
  • Nick Brennan,
  • Carrie Heal,
  • Majd Abu-harb,
  • Jacqeline Birch,
  • Chris Knight,
  • Hamudi Kisat,
  • Delyth Webb,
  • Bird,
  • Sankara Narayanan,
  • Ian Evans,
  • Caroline Sullivan,
  • Wynne Leith,
  • Vimal Vasu,
  • Katia Vamvakiti,
  • Megan Eaton,
  • Vadivelam Murthy,
  • Aiwyne Foo,
  • Faith Emery,
  • Pinki Surana,
  • Anand Kamalanathan,
  • Kavi Aucharaz,
  • Nicola Paul,
  • Lindsay Halpern,
  • Matt Nash,
  • Jo Anderson,
  • Alex Allwood,
  • Nigel Brooke,
  • K Abdul Khader,
  • Sanghavi Rekha,
  • Anas Olabi,
  • Geraint Lee,
  • Sobia Balal,
  • Poornima Pandey,
  • Ravindra Bhat,
  • Simon Rhodes,
  • Vinay Pai,
  • Savi Sivashankar,
  • Michael Grosdenier,
  • Ajay Reddy,
  • Christopher Dewhurst,
  • Ghada Ramadan Krishnamurthy,
  • Rob Negrine,
  • Prakash Thiagarajan,
  • P Kamath,
  • Laura Winder,
  • Andreea Bontea,
  • Chinnappa Reddy,
  • Elizabeth Sleight Deshpande,
  • Lidia Tyszcuzk,
  • Anne Dale,
  • Glynis Rewitzky,
  • Olutoyin Banjoko,
  • Bushra Abdul-Malik,
  • Dominic Muogbo,
  • Angela D'Amore,
  • John McIntyre,
  • Chrissie Oliver,
  • Lucinda Winckworth,
  • Jyoti Kapur,
  • P Amess Ben Obi,
  • Naveen Athiraman,
  • Chandan Gupta,
  • Jim Baird,
  • Ralf Hartung,
  • Akinsola Ogundiya,
  • Pamela Cairns,
  • Porus Bastani,
  • Marice Theron,
  • Siba Paul,
  • Giles Kendall,
  • Puneet Nath,
  • Ozioma Obi,
  • Yee Mon Aung,
  • Eleanor Hulse,
  • Ros Garr,
  • Sundeep Sandhu

DOI
https://doi.org/10.1136/bmjpo-2020-000897
Journal volume & issue
Vol. 5, no. 1

Abstract

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Objective To describe temporal changes in inhaled nitric oxide (iNO) use in English neonatal units between 2010 and 2015.Design Retrospective analysis using data extracted from the National Neonatal Research Database.Setting All National Health Service neonatal units in England.Patients Infants of all gestational ages born 2010–2015 admitted to a neonatal unit and received intensive care.Main outcome measures Proportion of infants who received iNO; age at initiation and duration of iNO use.Results 4.9% (6346/129 883) of infants received iNO; 31% (1959/6346) were born <29 weeks, 18% (1152/6346) 29–33 weeks and 51% (3235/6346)>34 weeks of gestation. Between epoch 1 (2010–2011) and epoch 3 (2014–2015), there was (1) an increase in the proportion of infants receiving iNO: <29 weeks (4.9% vs 15.9%); 29–33 weeks (1.1% vs 4.8%); >34 weeks (4.5% vs 5.0%), (2) increase in postnatal age at iNO initiation: <29 weeks 10 days vs 18 days; 29–33 weeks 2 days vs 10 days, (iii) reduction in iNO duration: <29 weeks (3 days vs 2 days); 29–33 weeks (2 days vs 1 day).Conclusions Between 2010 and 2015, there was an increase in the use of iNO among infants admitted to English neonatal units. This was most notable among the most premature infants with an almost fourfold increase. Given the cost of iNO therapy, limited evidence of efficacy in preterm infants and potential for harm, we suggest that exposure to iNO should be limited, ideally to infants included in research studies (either observational or randomised placebo-controlled trial) or within a protocolised pathway. Development of consensus guidelines may also help standardise practice.