This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. Inhaled nitric oxide (iNO) therapy is a safe and effective treatment for term newborns with persistent pulmonary hypertension of the newborn and hypoxemic respiratory failure. However, little is known about the potential role of iNO in premature newborns with respiratory failure. The premature newborn is particularly susceptible to the adverse effects of ventilator-induced lung injury, oxygen toxicity, and lung inflammation which contribute to the development of chronic lung disease (CLD). Despite treatment with exogenous surfactant and steroids, CLD remains a major cause of morbidity and mortality in premature newborns. Moreover, there is increasing evidence that steroid treatment causes long-term adverse neurodevelopmental and cardiopulmonary sequelae. Early clinical observations suggest that low-dose iNO improves oxygenation and decreases the need for mechanical ventilator support in the premature infant. In addition to its effects on gas exchange, recent laboratory and clinical observations suggest that iNO may also act as a lung-specific anti-inflammatory treatment and reduce the contribution of lung inflammation to the evolution of acute and chronic lung injury in premature infants.
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