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Uncertainties about the use of inhaled nitric oxide in preterm infants
Author(s) -
Mercier JC
Publication year - 2001
Publication title -
acta pædiatrica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.772
H-Index - 115
eISSN - 1651-2227
pISSN - 0803-5253
DOI - 10.1111/j.1651-2227.2001.tb01622.x
Subject(s) - medicine , persistent pulmonary hypertension , pulmonary hypertension , nitric oxide , mechanical ventilation , oxygenation , respiratory failure , ventilation (architecture) , respiratory system , respiratory disease , anesthesia , intensive care medicine , lung , cardiology , mechanical engineering , engineering
Respiratory failure in the premature neonate is frequently complicated by pulmonary hypertension. When conventional therapies including administration of exogenous surfactant, conventional mechanical ventilation or high‐frequency oscillatory ventilation using an appropriate high‐volume strategy have failed, one should assess the pulmonary circulation status with colour‐coded Doppler echocardiography. There is now considerable evidence that the regulation of foetal and postnatal pulmonary circulation occurs via nitric oxide (NO), and that persistent pulmonary hypertension of the neonate may be related to a relative deficiency in NO release. Low‐dose (10–20 ppm), short‐duration (1–2 d) inhaled NO has generally been shown to improve the oxygenation and relieve pulmonary hypertension in premature neonates with severely hypoxaemic respiratory failure. Whether this therapy (eventually prolonged >1‐3 wk?) would improve survival and lessen morbidity (e.g. intracranial haemorrhage and chronic lung disease) remains to be proven by appropriately designed controlled trials. Until these issues can be clarified, NO therapy for premature neonates should be still considered as an experimental drug, and its use restricted to clinical studies.