The changing pattern of inhaled nitric oxide use in the neonatal intensive care unit

J Perinatol. 2010 Dec;30(12):800-4. doi: 10.1038/jp.2010.37. Epub 2010 Mar 18.


Objective: The purpose of this study was to evaluate the demographic characteristics and outcomes of neonates who were admitted to a neonatal intensive care unit and treated with inhaled nitric oxide (iNO) during the years 2000-08. The goal of studying this group of neonates was to evaluate how iNO use has evolved in infants and to estimate the frequency of off-label use of this drug in this population.

Study design: Retrospective review of the Pediatrix Clinical Data Warehouse de-identified data set. Pediatrix Medical Group provides intensive care services in 244 hospitals in 32 states and Puerto Rico. Nine (3.7%) centers provide extracorporeal membrane oxygenation.

Result: There were 494 255 neonates in the data set; 4316 (0.9%) were treated with iNO. The use of iNO increased from 154 of 32 967 patients in 2000 to 921 of 75 911 patients in 2008; a 2.6-fold increase (0.47 to 1.23%). There were 155 872 infants <34 weeks estimated gestational age discharged between 1 January 2000 and 31 December 2008; 1656 (1.1%) were treated with iNO. Since approval in 2000, the reported use of iNO in neonates <34 weeks increased from 0.3 to 1.8% in 2008; a sixfold increase in the reported use of iNO. The biggest increase occurred in infants between 23 and 26 weeks' gestational age (0.8 to 6.6%). In contrast, the increase in iNO use among neonates born ≥34 weeks has only increased from 0.5 to 1%.

Conclusion: The use of iNO has increased and the greatest increase has been the off-label use among preterm neonates.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Administration, Inhalation
  • Bronchodilator Agents / administration & dosage*
  • Drug Utilization / trends
  • Female
  • Gestational Age
  • Humans
  • Hypertension, Pulmonary / drug therapy
  • Hypoxia / drug therapy
  • Infant, Extremely Low Birth Weight
  • Infant, Newborn
  • Infant, Premature, Diseases / drug therapy*
  • Intensive Care Units, Neonatal*
  • Male
  • Nitric Oxide / administration & dosage*
  • Off-Label Use / statistics & numerical data
  • Respiratory Distress Syndrome, Newborn / drug therapy
  • Respiratory Insufficiency / drug therapy
  • Retrospective Studies
  • United States


  • Bronchodilator Agents
  • Nitric Oxide