The NICHD, in case you didn’t know, supports the neonatal Cochrane reviews,  they are all on their website at this address. I don’t really like the way they are formatted on their website, you have to click on links to see the Forest plots, but they are freely available around the world, with only a few weeks delay between publication and availability here.

My new Cochrane reviews about nitric oxide are now freely available on-line.

The review of inhaled nitric oxide for the preterm infant and the review for term and near-term infants with hypoxic respiratory failure are here.

As you will see, we have added new authors to both reviews, younger authors with much energy who will ensure that the reviews are continually updated, for the rest of their lives.

As I previously mentioned, the updated reviews give a little more evidence about use of nitric oxide.

In the preterm there is no clearly defined situation at present where nitric oxide has been proven to be effective in improving clinically important outcomes, such as lung injury or mortality. There remain question about use in infants with clear evidence of pulmonary hypertension, and during acute deteriorations in developing chronic lung injury.

In full-term infants earlier use is now being promoted by some manufacturers, but the evidence does not show that this improves survival, or survival without ECMO. Earlier use does seem to decrease the number of babies that go on to more severe disease, but if you wait until later, you may still respond, and have the same overall benefit. The power for some of these outcomes is low, however.

I hope you find these analyses useful.