| Objective To appraise the effectiveness and safety and clinical significance of inhaled nitric oxide(i NO) for protecting preterm infants from bronchopulmonary dysplasia(BPD)Methods Firstly, Establishment of search strategy, electronic search, retrieval of randomized controlled trials(RCT) or quasi randomized controlled trials from Pub Med,Chinese journal full text database(CNKI),Embase,Chinese Technological Journals Database(VIP) and Wan Fang Digital Journal and Cochrane Library(The Cochrane Library), Cochrane Psyclnfo, and the Pediatric Conferences of 2009 and 2014 Thesis by free text and Medical Subject Headings(net) of conference papers retrieved, and to all of the included trials all reference document retrieval, Documents collected during December 2014. and trace information obtained academic meeting minutes and related references, a comprehensive collection of publishedinhaled nitric oxide and placebo or control group prevention of BPD in preterm children randomized controlled trials(Randomized Controlled Trial, RCT) and Quasirandomized controlled trials series literature.Secondly,The risk biases of the RCTs were assessed strictly, then The Data were extracted and cross checked independently by two people.Thirdly, Statistical analysis was performed by fixed or random effect model of Meta-analysis using the latest Revman 5.2 offered by Cochrane.Results There had fourteen randomized controlled trials in the study, including 7 follow-up study and 1 observation research in this study. 3520 premature infants were involved. Six 0f fourteen randomized controlled trials(and its follow-up study of 5) were assessed as having low risk of bias. Three of the RCTs were determined to have an unclear risk of bias, and the remaining 5 RCTs were at high risk of bias. The observational study had a low risk of bias. The Meta-analysis showed that: when inhaled nitric oxide treatment group compared with the placebo or control group, we found:(1).Premature babies inhaled nitric oxide has a certain difference between treatment group and control group, but no significant statistical significance.(2).Inhaled nitric oxide with certain dose requirement, Intaking of 5 PPM for BPD occur more frequently, RR:0.94, 95%CI:(0.87–1.02), and mortality are smaller than the control group, RR:0.97, 95%CI:(0.70–1.35); Intaking of 10 PPM compared with control group the morbidity and mortality of BPD have no significant differences; Intaking of 20 PPM or titrating reaction, children with BPD and the risk of mortality(RR = 1), indicate that the amount of mortality and the incidence of BPD has no ef-fect.(3).For different birth weight according to the results after inhaled nitric oxide for different birth weight: Only when the birth weigh is for 1000g-1250 g having a significant reduction in the combined outcome of death or BPD for the i NO-treated infants compared with controls(38.5% vs 64.1%), risk rate was(RR, 0.60), 95% confidence interal(CI: 0.42-0.86).(4).No matter when inhaled nitric oxide for premature babies on mortality and the incidence of BPD have influence, no significant increased risk. But when the birth weigh is for 1000 g- 1250 g within the scope of the premature babies when 28 days after birth still have dependent children can be inhaled nitric oxide for oxygen treatment.Conclusions No significant adverse reactions in premature children inhaled nitric oxide therapy, There is no need for regular inhaled nitric oxide for premature babies, Unless patients with severe respiratory failure in children. the best dose of treatment should be: 5 PPM < inhalation dose < 20 PPM range.If in a state of satisfies the above conditions, inhaled nitric oxide therapy could reduce the incidence and mortality of BPD. No obvious clinical significance for the incidence and mortality of single BPD. |
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