In the current issue of the journal, Ellsworth et al report a small but significant increase (from 5.0% to 6.2%) in the off-label use of inhaled nitric oxide (iNO) between 2009 and 2013 in preterm infants born earlier than 30 weeks. This increase occurred in spite of the publication of the iNO Consensus Statement in 2011 and the 2014 report from the American Academy of Pediatrics. Both reports conclude, on the basis of quality A evidence, with recommendations against using iNO to reduce mortality and morbidity in preterm infants with respiratory failure. The findings of Ellsworth et al are probably generalizable. They cite a usage rate of 6.9% for a comparable preterm cohort in the Vermont Oxford Network and review of data in the same gestational group from the New South Wales/Australian Capital Territory network (by NE) shows a rate of 7.2%.

So why this continued use...

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