Honing an Established Treatment for a
VULNERABLE POPULATION
The instant babies gasp their first breaths , their lungs undergo a crucial change : the pulmonary vasculature , constricted in the womb , begins to open up . For a number of possible reasons , this change fails to occur in some infants , resulting in persistent pulmonary hypertension of the newborn ( PPHN ).
The treatment for the condition is well established . Developed in the early 1990s by neonatologist John Kinsella , MD , and pediatric pulmonologist Steven Abman , MD , at Children ’ s Hospital Colorado , inhaled nitric oxide ( iNO ) is now the international standard of care , widely celebrated for its safety , effectiveness , and localized effects .
JOHN KINSELLA , MD
Neonatologist
“ After demonstrating the role of iNO in near-term and term newborns with PPHN ,” says Dr . Kinsella , “ we turned our attention to the potential effects of iNO in preventing bronchopulmonary dysplasia ( BPD ) in premature babies .”
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Common in premature infants , BPD occurs when mechanical ventilation , needed to support underdeveloped lungs , damages and inflames lung tissue . Early data suggested iNO might have some anti-inflammatory effects .
“ But it turned out that in the smallest preemies , there are so many factors in lung development that the signals weren ’ t strong enough to prove that iNO reduced the incidence of BPD ,” says Dr . Kinsella .
However , some premature infants also suffer from PPHN , and preemies with PPHN responded just as well as the full-term infants to iNO .
Here , Dr . Kinsella and his team believe iNO is the best treatment for PPHN in both term and premature newborns . The problem is that , because the initial research focused on BPD , there ’ s little data supporting the use of iNO to treat PPHN in preemies specifically , as well as a lack of clinical consensus – all of which makes it difficult to study with a conventional randomized trial today .
In an article published in the Journal of Pediatrics last year , Dr . Kinsella described a registry he and his team are developing to amass clinical data to study the various ways iNO is currently used in premature newborns around the country – and their results .
“ It ’ s not a formal randomized trial , but it ’ s almost a randomization by practice pattern ,” says Dr . Kinsella . “ Then we can look at the outcomes . There ’ s a lot we can learn .”