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Improving Outcomes in Premature Births: Nitroglycerin Shows Promise for Helping Preterm Infants

The costs due to complications from preterm birth are staggering. In Canada, outlays for specialized care of surviving preterm infants are estimated to be almost $2 billion per year.

In a 5-year, randomized, placebo-controlled clinical study, researchers found that giving nitroglycerin to mothers who had entered premature labor led to significant improvement in their baby’s health. The results of the study are reported in the January issue of the American Journal of Obstetrics & Gynecology.

In previous studies of drugs to suppress labor contractions to allow the fetus more time to develop in utero, some drugs were able to delay delivery, but none improved the baby’s health outcome. This study is the first to show that the baby benefited from the therapy, especially those who are born very prematurely (at 24 to 28 weeks). Using a composite measure of the newborn’s health including perinatal death, markers of brain damage and serious lung and bowel complications, mothers treated with nitroglycerin had significantly healthier babies.

Graeme N. Smith, MD, PhD, states, “Our team is very excited about these findings. It is estimated that it costs the Canadian health system almost $2 billion a year to take care of premature babies and their medical complications. Given the immeasurable societal and family costs associated with preterm birth and having a sick baby or child, treatment with nitroglycerin may result in major cost saving and longer-term health benefits for these babies.”

In an accompanying editorial, Associate Editor Jay D. Iams, MD, writes about the study, “Their work is notable not only for their interesting results but also for the quality of the study design, execution, and report.” He continues, “Perhaps most importantly, the authors chose neonatal morbidity, a ‘health outcome,’ as the primary endpoint instead of a surrogate such as days gained or percent of births before 32 or 35 weeks of gestation.”

The article is “Randomized double-blind placebo-controlled trial of transdermal nitroglycerin for preterm labor” by Graeme N. Smith, MD, PhD, Mark C. Walker, MD, MSc, Arne Ohlsson, MD, MSc, Karel O’Brien, MD and Rory Windrim, MD, MSc. The editorial is “Transdermal nitroglycerin for preterm labor” by Jay D. Iams, MD. Both appear in the American Journal of Obstetrics & Gynecology, Volume 196, Issue 1 (January 2007) published by Elsevier.

Pamela Poppalardo | alfa
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