Prevention of Transfusion Related Acute Gut Injury (TRAGI) in Extremely Low Gestational Age Neonates (ELGANs) Using iNO

Inclusion Criteria: * Neonates 24 0/7 to 27 6/7 weeks gestational age * More than 2 weeks postnatal age. * Anemia with hematocrit (Hct) less than 28 % * More than 50 % total daily fluids is enteral * History of at least 1 prior PRBC transfusion (preferably same donor) Exclusion Criteria: * Prior history of necrotizing enterocolitis (NEC) to avoid a confounder * Clinically significant patent ductus arteriosus (PDA) requiring treatment (Rx) within 24h * Hypotensive for age or active bleeding * \< 50% of total fluids are enteral (breast milk or formula) * Major congenital or surgical malformations * Known chromosomal anomalies detected by antepartum testing or direct physical examination with subsequent postnatal laboratory confirmation * Absence of parental or treating physician consent * A concurrent randomized clinical trial (RCT) with another randomized drug * Death expected \< 48h * Another major concern by the treating physician that either mandates or prohibits study treatment such as known adverse reaction to prior transfusion (Tx)