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Inhaled Nitric Oxide for Preterm Infants With Severe Respiratory Failure (Preemie iNO)

This study has been terminated.
(Preliminary results showed increased intraventricular hemorrhage (IVH) in experimental arm)
National Center for Research Resources (NCRR)
Information provided by:
NICHD Neonatal Research Network Identifier:
First received: May 14, 2001
Last updated: June 3, 2015
Last verified: June 2015
This multicenter trial tested whether inhaled nitric oxide would reduce death or the need for oxygen in preterm infants (less than 34 weeks gestational age) with severe lung disease.

Condition Intervention Phase
Infant, Newborn
Infant, Low Birth Weight
Infant, Small for Gestational Age
Infant, Premature
Respiratory Distress Syndrome (RDS)
Hypertension, Pulmonary
Drug: Inhaled nitric oxide
Drug: Placebo
Phase 3

Study Type: Interventional
Study Design: Allocation: Randomized
Intervention Model: Single Group Assignment
Masking: Double Blind (Subject, Caregiver, Investigator, Outcomes Assessor)
Primary Purpose: Treatment
Official Title: Inhaled Nitric Oxide for Preterm Infants With Severe Respiratory Failure

Resource links provided by NLM:

Further study details as provided by NICHD Neonatal Research Network:

Primary Outcome Measures:
  • Death or Bronchopulmonary Dysplasia [ Time Frame: At 36 weeks post-conceptional age ]

Secondary Outcome Measures:
  • Intraventricular Hemorrhage Grade III and IV [ Time Frame: At 36 weeks post-conceptional age ]
  • Days on assisted ventilation [ Time Frame: At 36 weeks post-conceptional age ]
  • Length of hospitalization [ Time Frame: At hospital discharge ]
  • Retinopathy of prematurity [ Time Frame: At hospital discharge ]
  • Air leaks [ Time Frame: At 36 weeks post-conceptual age ]
  • Days on oxygen [ Time Frame: At 36 weeks post-conceptual age ]
  • Supplemental oxygen [ Time Frame: At 36 weeks post-conceptual age ]
  • Neurodevelopmental outcome [ Time Frame: 18-22 months corrected age ]

Enrollment: 420
Study Start Date: January 2001
Study Completion Date: May 2006
Primary Completion Date: September 2003 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Inhaled Nitric Oxide
Inhaled Nitric Oxide
Drug: Inhaled nitric oxide
Started at 5 ppm and could be increased to 10 ppm
Active Comparator: Placebo
Inhaled Oxygen
Drug: Placebo
Started at 5 ppm and could be increased to 10 ppm

Detailed Description:

This multicenter, randomized, double-masked, controlled clinical trial evaluated the efficacy of inhaled nitric oxide (iNO) in the treatment of the preterm infant with respiratory failure secondary to respiratory distress syndrome (RDS), sepsis/pneumonia, aspiration syndrome, idiopathic pulmonary hypertension and/or suspected pulmonary hypoplasia.

Infants were followed until death or discharge to home. The trial compared iNO therapy to mock gas delivery as the control, and otherwise incorporated conventional management strategies (including treatment with surfactant and high frequency ventilation as adjuncts to iNO therapy).

During the initial dosing, iNO was started at 5 ppm and could be increased to 10 ppm. If the infant did not respond, study gas was discontinued. For infants who responded to study gas, a gradual weaning was initiated. The total exposure to study gas did not exceed 336 hours (14 days). Infants were monitored for signs of toxicity.

Medical and neurodevelopmental outcome of surviving infants were assessed at 18 to 22 months corrected age by masked, certified examiners.


Ages Eligible for Study:   up to 120 Hours   (Child)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria

  • Any infant with a birth weight 401 - 1500 grams and < 34 weeks gestational age with an OI (mean Paw x FiO2 x 100/PaO2) > 10 on two consecutive blood gases at least 30 minutes apart, but no more than 12 hours apart.


  • Infants > 1500 grams and < 34 weeks gestational age will be entered in the Larger Preemie Pilot Study if they have an OI greater than or equal to 15 on two consecutive blood gases at least 30 minutes apart, but no more than 12 hours apart.
  • Infants requiring assisted ventilation with a diagnosis of RDS/HMD, pneumonia and/or sepsis, aspiration syndrome, idiopathic pulmonary hypertension, or suspected pulmonary hypoplasia associated with PROM and/or oligohydramnios.
  • Greater than or equal to 4 hours after one dose of surfactant.
  • Less than or equal to 120 hours of age.
  • All infants must have an indwelling arterial line.

Exclusion Criteria

  • Any infant in whom a decision has been made not to provide full treatment (e.g. chromosomal anomalies or severe birth asphyxia).
  • Known structural congenital heart disease, except patent ductus arteriosus and atrial-level shunts.
  • Infants with any major abnormality involving the respiratory system such as congenital diaphragmatic hernia, tracheoesophageal fistula or cystic fibrosis.
  • Any bleeding diathesis considered to be clinically significant or thrombocytopenia with platelet count < 50,000.
  • Prior enrollment into a conflicting clinical trial such as the Neonatal Network Surfactant CPAP trial.Inclusion Criteria
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its identifier: NCT00016523

United States, Alabama
University of Alabama at Birmingham
Birmingham, Alabama, United States, 35233
United States, California
Stanford University
Palo Alto, California, United States, 94304
University of California at San Diego
San Diego, California, United States, 92103-8774
United States, Connecticut
Yale University
New Haven, Connecticut, United States, 06504
United States, Florida
University of Florida
Jacksonville, Florida, United States, 32209
University of Miami
Miami, Florida, United States, 33136
United States, Illinois
Northwestern University
Chicago, Illinois, United States, 60614
United States, Indiana
Indiana University
Indianapolis, Indiana, United States, 46202
United States, Michigan
Wayne State University
Detroit, Michigan, United States, 48201
United States, New York
University of Rochester
Rochester, New York, United States, 14642
United States, North Carolina
Wake Forest University
Charlotte, North Carolina, United States, 27157
RTI International
Durham, North Carolina, United States, 27705
United States, Ohio
Cincinnati Children's Medical Center
Cincinnati, Ohio, United States, 45267
United States, Rhode Island
Brown University, Women & Infants Hospital of Rhode Island
Providence, Rhode Island, United States, 02905
United States, Texas
University of Texas Southwestern Medical Center at Dallas
Dallas, Texas, United States, 75235
University of Texas Health Science Center at Houston
Houston, Texas, United States, 77030
United States, Wisconsin
Medical College of Wisconsin
Milwaukee, Wisconsin, United States, 53226
Sponsors and Collaborators
NICHD Neonatal Research Network
National Center for Research Resources (NCRR)
Study Director: Krisa P. Van Meurs, MD Stanford University
Principal Investigator: Waldemar A. Carlo, MD University of Alabama at Birmingham
Principal Investigator: Abbot R. Laptook, MD Brown University, Women & Infants Hospital of Rhode Island
Principal Investigator: Edward F. Donovan, MD Children's Hospital Medical Center, Cincinnati
Principal Investigator: James A. Lemons, MD Indiana University
Principal Investigator: Shahnaz Duara, MD University of Miami
Principal Investigator: Charles R. Rosenfeld, MD University of Texas, Southwestern Medical Center at Dallas
Principal Investigator: Jon E. Tyson, MD MPH The University of Texas Health Science Center, Houston
Principal Investigator: Seetha Shankaran, MD Wayne State University
Principal Investigator: Richard A. Ehrenkranz, MD Yale University
Principal Investigator: T. Michael O'Shea, MD MPH Wake Forest University
Principal Investigator: Neil N. Finer, MD University of California, San Diego
Principal Investigator: Dale L. Phelps, MD University of Rochester
Principal Investigator: Mark L. Hudak, MD University of Florida
Principal Investigator: Robin H. Steinhorn, MD Northwestern University
Principal Investigator: G. Ganesh Konduri, MD Medical College of Wisconsin, Milwaukee
  More Information

Additional Information:

Responsible Party: Krisa P. Van Meurs, MD, Lead Principal Investigator, Stanford University Identifier: NCT00016523     History of Changes
Other Study ID Numbers: NICHD-NRN-0026  U10HD034216  M01RR000032  U10HD027904  U10HD027853  M01RR008084  U10HD027856  M01RR000750  U10HD021397  M01RR016587  U10HD027880  M01RR000070  U10HD040689  M01RR000633  U10HD021373  U10HD021385  U10HD027871  M01RR006022  U10HD040498  M01RR007122  U10HD040461  U10HD040521  M01RR000044 
Study First Received: May 14, 2001
Last Updated: June 3, 2015

Keywords provided by NICHD Neonatal Research Network:
NICHD Neonatal Research Network
Extremely Low Birth Weight (ELBW)
Very Low Birth Weight (VLBW)
Inhaled nitric oxide
Aspiration syndrome
Idiopathic pulmonary hypertension
Pulmonary hypoplasia

Additional relevant MeSH terms:
Molecular Mechanisms of Pharmacological Action
Respiratory Distress Syndrome, Newborn
Respiratory Distress Syndrome, Adult
Respiratory Insufficiency
Birth Weight
Hypertension, Pulmonary
Vascular Diseases
Cardiovascular Diseases
Lung Diseases
Respiratory Tract Diseases
Respiratory Tract Infections
Respiration Disorders
Infant, Premature, Diseases
Infant, Newborn, Diseases
Body Weight
Signs and Symptoms
Nitric Oxide
Bronchodilator Agents
Autonomic Agents
Peripheral Nervous System Agents
Physiological Effects of Drugs
Anti-Asthmatic Agents
Respiratory System Agents
Free Radical Scavengers
Neurotransmitter Agents
Endothelium-Dependent Relaxing Factors
Vasodilator Agents processed this record on February 23, 2017