Low-dose inhaled nitric oxide for neonates with pulmonary hypertension

Swee Fong Tang, O. I. Miller

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Objective: Inhaled nitric oxide (iNO) has been shown to cause selective pulmonary vasodilatation and improve ventilation-perfusion matching and may be an important therapeutic option for the treatment of persistent pulmonary hypertension of the newborn (PPHN). We report our experience on the use of iNO in neonates with severe PPHN. Methodology: Inhaled NO was administered to 10 infants with PPHN and persistent hypoxaemia (meconium aspiration syndrome, n = 9; pneumonia, n = 1) after failure of conventional therapy to improve oxygenation. With the exception of one infant, iNO was commenced at 10 ppm. Results: After 30 min exposure to iNO, the arterial oxygen tension (PaO2,) rose from a median of 49 mmHg (6.5 kPa) [range 12-82 mmHg (1.6-10.9 kPa)] to 75 mmHg (10 kPa) [range 17-450 mmHg (2.3-60 kPa)] (P = 0.005), while the median oxygenation index fell (pre-iNO of 37 vs post-iNO 20) (P = 0.005) and median systemic arterial pressure rose (pre-iNO 46.5 mmHg (6.2 kPa) [range 32-63 mmHg (4.3 to 8.4 kPa vs post-iNO 54.5 mmHg (7.3 kPa) [range 36-74 kPa]) P = 0.005). All infants subsequently continued to receive iNO with the duration of exposure to iNO ranging from 12 to 168 h (median duration 100 h). Three infants died despite showing an initial beneficial response to iNO. The mean duration of intubation for survivors was 11.9 ± 2.6 days. Methaemoglobinaemia and toxic levels of nitrogen dioxide were not seen during iNO administration. Of the seven survivors, 12 month follow up in two infants and 4 month follow up in four infants showed age-appropriate neurodevelopmentat skills, with one infant having very mild hearing loss. Conclusions: Inhaled NO reduces the oxygenation index by improving the PaO2 and decreasing ventilation pressures, and appears to be clinically useful in severely hypoxaemic infants with PPHN refractory to conventional treatment.

Original languageEnglish
Pages (from-to)419-423
Number of pages5
JournalJournal of Paediatrics and Child Health
Volume32
Issue number5
Publication statusPublished - 1996
Externally publishedYes

Fingerprint

Pulmonary Hypertension
Nitric Oxide
Newborn Infant
Persistent Fetal Circulation Syndrome
Ventilation
Arterial Pressure
Meconium Aspiration Syndrome
Methemoglobinemia
Nitrogen Dioxide
Poisons
Therapeutics
Hearing Loss
Intubation
Vasodilation
Pneumonia
Perfusion
Oxygen
Pressure
Lung

Keywords

  • Inhaled nitric oxide
  • Meconium aspiration syndrome
  • Neonates
  • Persistent pulmonary hypertension of the newborn

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Low-dose inhaled nitric oxide for neonates with pulmonary hypertension. / Tang, Swee Fong; Miller, O. I.

In: Journal of Paediatrics and Child Health, Vol. 32, No. 5, 1996, p. 419-423.

Research output: Contribution to journalArticle

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