Nitric oxide in the treatment of neonatal pulmonary hypertension

This study describes the effects of nitric oxide in newborns with persistent pulmonary hypertension. We studied 9 infants with severe respiratory failure characterized by hypoxemia and pulmonary hypertension. All infants met ECMO criteria and the oxygenation index (OI) was greater than 25. Mean birth weight was 2698 -/+ 661 g and gestational age was 36.4 -/+ 2.6 weeks. Nitric oxide was administered in a Y circuit in the inspiratory line of the mechanical ventilator. Nitric oxide and NO2 concentrations were monitored with electrochemical analyzers (PACI and PACII-Draeger). Pulmonary hypertension was diagnosed with clinical and echocardiografic criteria, with detection of right to left shunt with color doppler. All patients showed a dramatic improvement in oxigenation after nitric oxide administration. The drug reduced the mean OI, which was 48.5 before its administration, to 17.7 after 30', 14.1 after 6 hours, and 10.5 after 12 hours. We observed in all patients a reduction in pulmonary vascular resistance, reversal of the right to left shunt without any effects on systemic arterial pressure. Metahemoglobin levels did not reach 1.5% in any patient. Only one out of the 9 patients died, after reversal of the pulmonary hypertension, from other complications of perinatal asphyxia. Our data show that nitric oxide is a promising drug in the treatment of neonatal pulmonary hypertension and that it may reduce the need of ECMO in severe respiratory failure.