Treatment with nitric oxide in the neonatal intensive care unit is associated with increased risk of childhood cancer

Aim: This study aimed to determine whether neonatal intensive care therapies increase the risk of carcinogenesis in childhood. Methods: This study used population-based data on 1 072 957 infants born in New South Wales, Australia, between 2000 and 2011 and multivariate logistic regression to examine any associations between therapies used in the neonatal intensive care unit and diagnoses of cancer until mid 2012. Results: A total of 1126 of 1 072 957 (0.1%) children were diagnosed with cancer. Cancer risk was significantly increased by preterm birth (gestation <37 weeks; adjusted odds ratio (aOR) 1.3 (95% confidence interval: 1.0–1.6), birth weight ≥4 kg (aOR 1.4, 1.2–1.6) and caesarean delivery (aOR 1.2, 1.1–1.4). Extremely preterm (<28 weeks of gestation) infants were more likely to develop hepatic tumours (aOR 12.7, 3.3–48.3) than term infants. The only therapy used in the neonatal intensive care that was independently associated with an increased risk of cancer was nitric oxide (aOR 8.6, 4.3–17.4). Eight of the 790 (1%) infants treated with nitric oxide developed cancer (gestation range 30–41 weeks, age of cancer diagnosis: four months–five years). Conclusion: Treatment with nitric oxide was associated with a higher risk of childhood cancer. These findings require further research.