Inhaled Nitric Oxide as an Independent Intervention to Lower the Risk of Bronchopulmonary Dysplasia in Preterm Infants (<33 Weeks) with Pulmonary Hypertension within the Initial 3 Days of Life

Background: Bronchopulmonary dysplasia (BPD) is a major complication in preterm infants, particularly those born before 33 weeks of gestation. Inhaled nitric oxide (iNO) is widely used to manage pulmonary hypertension (PH) and improve oxygenation, but its role in reducing BPD incidence in preterm infants with PH during the early postnatal period remains unclear. Objective: This study aimed to evaluate the impact of early iNO administration, both alone and in combination with pulmonary surfactant (PS), on the incidence of BPD in preterm infants diagnosed with PH within the first three days of life. Methods: A retrospective cohort study was conducted on 56 preterm infants (<33 weeks gestation) with confirmed PH and hypoxemia (PaO₂ < 50 mmHg at FiO₂ ≥ 30%). Clinical outcomes, including BPD incidence, were compared between infants receiving iNO and/or PS and those who did not. Multivariate logistic regression was used to identify independent predictors of BPD. Results: The incidence of BPD was significantly lower in the iNO group (15%) compared to the non-iNO group (63.9%) (P = 0.012). Infants receiving both iNO and PS demonstrated the best outcomes, with a marked reduction in BPD risk. Male gender and lack of PS therapy were associated with increased BPD risk. Multivariate analysis confirmed iNO (OR = 0.097, 95% CI: 0.014–0.682; P = 0.019) and PS (OR = 0.125, 95% CI: 0.021–0.728; P = 0.021) as independent protective factors against BPD . Conclusion: Early administration of iNO, particularly in combination with PS, significantly reduces the incidence of BPD in preterm infants with PH. These findings highlight the potential benefits of iNO and PS as preventive therapies in this high-risk population. Further prospective studies are needed to validate these results and guide clinical practice.