Examining the Use of Non-Invasive Inhaled Nitric Oxide to Reduce Chronic Lung Disease in Premature Newborns

Study Overview
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Brief Summary
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Bronchopulmonary dysplasia (BPD) is a serious lung condition that affects premature newborns. The condition involves abnormal development of lung tissue and is characterized by inflammation and scarring in the lungs. Treatment with inhaled nitric oxide (iNO) may reduce the incidence of BPD and another commonly associated condition called pulmonary hypertension, which is high blood pressure in the vessels carrying blood to the lungs.. This study will determine if early treatment with low-dose iNO reduces the incidence of BPD, pulmonary hypertension, and death in premature newborns.

Detailed Description
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BPD is a serious lung condition that primarily affects premature newborns and newborns with low birth weights. iNO has been proven to be a safe and effective treatment for pulmonary hypertension and hypoxemic respiratory failure-both of which are abnormal lung conditions-in full-term newborns. However, in babies born prematurely, the effects of iNO on lung function are not well defined. Also, previous studies have mainly examined whether iNO reduces the incidence of BPD in newborns who are on mechanical ventilation. However, intubation and mechanical ventilation of premature newborns is now increasingly being avoided, and non-invasive support, including the use of nasal continuous positive airway pressure (NCPAP), is being used. Early treatment with low-dose iNO may reduce the incidence of BPD in premature newborns who do not require mechanical ventilation and intubation after delivery. The purpose of this study is to determine if low-dose, non-invasive iNO reduces the risk of BPD, pulmonary hypertension, and death in premature newborns who do not require mechanical ventilation. This study will enroll premature newborns who require extra oxygen but do not require intubation or mechanical ventilation for respiratory failure in the first 72 hours of life. Participants will be randomly assigned to receive low-dose, non-invasive iNO or nitrogen (placebo) during their hospital stay. While hospitalized, participants' heart rate, blood oxygen level breathing rate, blood pressure, and medications will be monitored, and blood collection will occur at various times. Monitoring will continue until participants are 30 weeks corrected gestational age or for at least 14 days if participants are born at 29 weeks or more. All participants will undergo an ultrasound of the head when they are 7 days, 28 days, and 36 weeks of age. They will undergo an echocardiogram, which is an ultrasound of the heart, at 7 and 21 days of age and 4 weeks before the original expected due date. A chest x-ray will be performed before hospital discharge, and a breathing status test will be performed either 4 weeks before participants' original expected due date or before hospital discharge. Follow-up study visits will occur at Years 1 and 2, and will include a physical examination and developmental and behavioral testing. Another echocardiogram will also be performed at the Year 1 visit.

Official Title
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Examining the Use of Non-Invasive Inhaled Nitric Oxide to Reduce Chronic Lung Disease in Premature Newborns

Conditions
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Bronchopulmonary Dysplasia

Intervention / Treatment
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* Drug: Inhaled Nitric Oxide (iNO)
* Drug: Nitrogen (placebo)


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Birth weight of 500-1250 grams and gestational age of less than 34 weeks Age at enrollment is less than 72 hours Supplemental oxygen or 21% requirement by nasal cannula or NCPAP only Exclusion Criteria: Presence of structural heart disease (other than patent ductus arteriosus, atrial septal defect less than 1 cm, or muscular ventricular septal defect less than 2 mm) Presence of lethal congenital anomaly Participating in another concurrent experimental study Requires mechanical ventilation in the first 72 hours of life (patients are not excluded if they are intubated briefly but they must be extubated at the time of consent and study entry prior to 72 hours of life)

Ages Eligible for Study
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Maximum Age: 72 Hours

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Triple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Inhaled Nitric Oxide (iNO)<br>Participants will receive a low concentration of iNO until they are 30 weeks corrected gestational age or for 14 days if they were born at 29 weeks or more. | Drug: Inhaled Nitric Oxide (iNO)<br>* iNO will be delivered using the iNOVent device to provide 10 ppm proximally (yielding approximately 5 ppm to the posterior pharynx).<br>|
| Placebo Comparator: Nitrogen (placebo)<br>Participants will receive nitrogen (placebo) while in the hospital. | Drug: Nitrogen (placebo)<br>* Nitrogen will be delivered using the iNOVent device to provide 10 ppm proximally (yielding approximately 5 ppm to the posterior pharynx).<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Combined Endpoint of Bronchopulmonary Dysplasia (BPD) or Mortality | Number of participants that developed bronchopulmonary dysplasia and/or that died | Week 36 or earlier, if participants are discharged from the hospital | 
| Combined Endpoint of Bronchopulmonary Dysplasia (BPD) or Mortality Stratified by Birth Weight | Number of participants that developed bronchopulmonary dysplasia and/or that died, stratified by birth weight (grams) | Randomization to discharge | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Severity of Bronchopulmonary Dysplasia (BPD) | Assessment of the severity of BPD as defined by the oxygen reduction test | 36 weeks corrected gestational age | 
| Need for Mechanical Ventilation | Number of participants who required endotracheal intubation and mechanical ventilation | Anytime after randomization up to 36 weeks corrected gestational age | 
| Total Ventilation Days | Of those participants who required mechanical ventilation, the total number of days receiving ventilation | After randomization up until hospital discharge | 
| Necrotizing Enterocolitis (NEC) | Number of participants diagnosed with necrotizing enterocolitis | After randomization through hospital discharge | 
| Symptomatic PDA Requiring Medical Treatment | Number of participants with a symptomatic PDA that required medical treatment | From randomization until discharge | 
| Symptomatic PDA Requiring Surgical Ligation | Number of participants with symptomatic PDA that required surgical ligation | Randomization through discharge | 
| Threshold Retinopathy of Prematurity (ROP) | Threshold ROP defined as requiring interventional therapy | Randomization to discharge | 
| Severe Intracranial Hemorrhage | Number of participants that developed severe intracranial hemorrhage (grade 3-4) | Randomization to discharge | 
| Sepsis | Number of participants that developed sepsis | Randomization to discharge | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Premature Newborns, Inhaled Nitric Oxide