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Improving Outcomes, Improving Lives
Encouraging New Study Confirms Benefits of Nitric Oxide Treatment for Bronchopulmonary Dysplasia in Premature Infants

In recent decades, clinical research has made great gains in the treatment of premature infants. However, bronchopulmonary dysplasia, or chronic lung disease, remains one of the more challenging conditions affecting premature babies.

“Bronchopulmonary dysplasia, or BPD, occurs in a very large percentage of the smallest and most premature babies,” explains David Durand, MD, a clinical scientist at CHORI and the director of clinical research in neonatology at Children’s Hospital Research Center Oakland (CHRCO). “It occurs as a result of babies having to breathe before their lungs are fully developed."

"Lungs that must both breath and continue to develop at the same time often develop abnormally, which is particularly a problem for infants who are born three or four months prematurely," explains Dr. Durand.

Dr. Durand and Jeanette Asselin are two of the CHRCO authors of a study just published in the New England Journal of Medicine, that provides encouraging results for the treatment of this problematic condition. In a collaboration involving over 12 centers nation-wide, the study conclusively demonstrates that inhaled nitric oxide improves the outcome of premature babies at risk for bronchopulmonary dysplasia.

“For the last 20 or 30 years, everyone in neonatology has been looking for ways to decrease the severity of bronchopulmonary dysplasia. Nitric oxide is the latest in a series of therapies which has resulted in decreased incidence and severity,” says Dr. Durand.

Nitric oxide was initially authorized for use in premature populations as a result of its successful application in full term babies. While a variety of studies have looked at its use in premature babies, Dr. Durand’s is the first to provide the most definitive results.

In spite of the promising results of this study, more research is still necessary before its use can be recommended as a routine treatment, however.

“That will depend on the results of data that we’re collecting now to look at the neurodevelopmental status of these babies at 2 years of age,” Dr. Durand explains. “We’re in the process of collecting that data in order to make sure that nitric-oxide treated babies are just as healthy, or healthier, than babies who don’t receive treatment.”

Nevertheless, the study is a breakthrough in nitric oxide research and provides a wealth of data for clinical researchers like Dr. Durand who are trying to answer more subtle questions about how the mechanisms of nitric oxide and whether there are certain subpopulations that are more susceptible to its benefits than others. The study also represents the best of what is possible with multi-center collaborations.

“Most of the easy questions, those that can be answered with studies of only a few babies, have already been answered,” notes Dr. Durand.

Instead, there continues to be increasing need for just this kind of multi-center collaboration in order to provide a large enough amount of clinical data, which is why one of the main areas of research focus in the Division of Neonatology at CHRCO is to have large, multi-center clinical trials.

“This is a great example of multiple investigators and multiple institutes from across the country working together to solve fundamental questions about how best to care for these small babies,” says Dr. Durand. It’s also another example of the ways in which CHORI continues to provide cutting-edge translational research geared toward improving children’s lives.


Monday, May 16, 2011 11:33 PM

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