Inhaled nitric oxide in persistent pulmonary hypertension of the newborn

Roberts, Jesse D.; Polaner, David M.; Lang, Peter; Zapol, Warren M.

doi:10.1016/0140-6736(92)92686-a

Cited by 856 publications

(256 citation statements)

References 7 publications

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“…In pivotal studies of late preterm and term neonates with hypoxic respiratory failure (HRF) and pulmonary hypertension (PH), iNO therapy has been shown to improve oxygenation and reduce the need for extracorporeal membrane oxygenation [3][4][5][6]. In the United States, iNO is indicated for the treatment of late preterm and term (>34 weeks' gestation) neonates with HRF associated with clinical or echocardiographic evidence of PH [7].…”

Section: Introductionmentioning

confidence: 99%

Efficacy of inhaled nitric oxide in neonates with hypoxic respiratory failure and pulmonary hypertension: the Japanese experience

Suzuki

Togari

Potenziano

et al. 2018

Journal of Perinatal Medicine

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Objective: To analyze data from a registry of Japanese neonates with hypoxic respiratory failure associated with pulmonary hypertension (PH) to compare the effectiveness of inhaled nitric oxide (iNO) in neonates born <34 weeks vs. ≥34 weeks gestational age (GA). Materials and methods: iNO was administered according to approved Japanese product labeling. Study data were collected before iNO administration and at predefined intervals until discontinuation. Results: A total of 1,114 neonates were included (n = 431, <34 weeks GA; n = 675, ≥34 weeks GA; n = 8, missing age data). Mean decrease from baseline oxygenation index (OI) was similar in both age groups. OI reduction was more pronounced in the <34 weeks subgroups with baseline OI ≥25. Survival rates were similar in the <34 weeks GA and ≥34 weeks GA groups stratified by baseline OI (OI < 15, 89% vs. 93%; 15 ≤ OI < 25, 85% vs. 91%; 25 ≤ OI ≤ 40, 73% vs. 79%; OI > 40, 64% vs. 66%). Conclusion: iNO improved oxygenation in preterm neonates as effectively as in late preterm and term neonates, without negative impact on survival. If clinically significant PH is present, as measured by pulse oximetry or echocardiography, a therapeutic trial of iNO might be indicated for preterm neonates.

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Section: Introductionmentioning

confidence: 99%

Efficacy of inhaled nitric oxide in neonates with hypoxic respiratory failure and pulmonary hypertension: the Japanese experience

Suzuki

Togari

Potenziano

et al. 2018

Journal of Perinatal Medicine

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“…Inhaled nitric oxide decreases the need for ECMO in patients with PPHN, 3,4,6,7 and following its approval for clinical use, the number of patients entered in the national registry of ECMO patients with a diagnosis of sepsis, idiopathic PPHN or meconium aspiration declined by about 50%. 16 In a randomized trial, improvement in oxygenation occurred more frequently in infants with PPHN treated with HFOV plus iNO as compared to infants treated with either HFOV or iNO alone.…”

Section: Discussionmentioning

confidence: 99%

“…5 iNO has been shown to reduce the need for ECMO in term and near-term neonates with pulmonary hypertension. 3,4,6,7 High-frequency ventilation (HFV) has been used with increasing frequency for PPHN, 8 and when combined with iNO results in an acute rise in arterial oxygen saturation, 9 and reduces the likelihood of ECMO treatment. 10 Studies of iNO delivered by HFV have, to date, utilized high-frequency oscillatory ventilation (HFOV).…”

Section: Introductionmentioning

confidence: 99%

Neonatal pulmonary hypertension treated with inhaled nitric oxide and high-frequency ventilation

2008

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Term and near-term infants with pulmonary hypertension are frequently treated with inhaled nitric oxide. This therapy can be delivered with highfrequency ventilation, but there has been limited study of the relative effectiveness of high-frequency jet ventilation and high-frequency oscillatory ventilation.Objective: To compare short-term clinical outcomes of neonates with pulmonary hypertension treated with inhaled nitric oxide plus either high-frequency jet ventilation or high-frequency oscillatory ventilation.Study Design: Study infants met the following criteria: X35 weeks gestation, respiratory failure with pulmonary hypertension, no congenital malformations and treatment in the first week of life with inhaled nitric oxide plus either high-frequency jet ventilation (n ¼ 22) or high-frequency oscillatory ventilation (n ¼ 43). Data were collected from medical records. Result:The jet ventilation and oscillatory ventilation groups were similar in terms of gestational age, but the jet ventilation group had less severe respiratory illness (that is, lower oxygenation index) just prior to initiation of the combination of nitric oxide and high-frequency ventilation. The jet ventilation group spent more hours on inhaled nitric oxide (71.4 versus 40.8; P ¼ 0.004) but was less likely to require extracorporeal membrane oxygenation (2(9%) versus 19(44%); P ¼ 0.004). No difference was found in the ages at which oxygen and high-frequency ventilation were discontinued. Keywords: persistent pulmonary hypertension; inhaled nitric oxide; hypoxic respiratory failure; high-frequency ventilation; high-frequency oscillatory ventilation; high-frequency jet ventilation Introduction Persistent pulmonary hypertension of the newborn (PPHN) refers to a lack of normal cardiopulmonary adaptation following delivery, 1 including persistence of the elevated pulmonary vascular resistance that is characteristic of fetuses. 2 Most often PPHN occurs in infants with meconium aspiration syndrome (34 to 51%), pneumonia/sepsis (20 to 23%), idiopathic PPHN (17 to 25%), congenital diaphragmatic hernia (10 to 15%) or respiratory distress syndrome (9 to 12%). 3,4 Prior to the introduction, in the late 1990s, of inhaled nitric oxide (iNO), therapies for PPHN included induced alkalosis, supplemental oxygen, mechanical ventilation and neuromuscular blockade; and patients who failed to respond to these measures were treated with extracorporeal membrane oxygenation (ECMO). 5 iNO has been shown to reduce the need for ECMO in term and near-term neonates with pulmonary hypertension. 3,4,6,7 High-frequency ventilation (HFV) has been used with increasing frequency for PPHN, 8 and when combined with iNO results in an acute rise in arterial oxygen saturation, 9 and reduces the likelihood of ECMO treatment. 10 Studies of iNO delivered by HFV have, to date, utilized high-frequency oscillatory ventilation (HFOV). However, since patients treated with high-frequency jet ventilation (HFJV), as compared to conventional ventilation, require lower peak pressures to achieve t...

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“…Roberts et al 12 enrolled term newborn infants (n ¼ 58) with PPHN and a postductal partial pressure of arterial oxygen of <55 on 1.0 fraction of inspired oxygen. Inhaled NO was administered at a starting dose of 80 parts per million (p.p.m.).…”

Section: Nitric Oxide In Term Infantsmentioning

confidence: 99%

Inhaled nitric oxide in term and preterm infants

Sekar

2006

J Perinatol

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Nitric oxide (NO) is a gas that has potent vasodilator properties. It can be administered via inhalation in situations where NO production is impaired and results in vasodilatation of the pulmonary capillaries. In term infants, the administration of inhaled NO, at a dose of 20 parts per million, may reduce the need for extracorporeal membrane oxygenation by reducing pulmonary vascular resistance and improving oxygenation. Inhaled NO is an approved therapy in term babies with severe hypoxemic respiratory failure. In premature infants, inhaled NO may increase bleeding time and decrease platelet aggregation resulting in an increased risk for intraventricular hemorrhage. Early administration of inhaled NO may also potentially decrease the risk for developing chronic lung disease in premature infants. However, since studies show conflicting results, inhaled NO should only be used in premature neonates following investigational review board approved protocols.

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Inhaled nitric oxide in persistent pulmonary hypertension of the newborn

Cited by 856 publications

References 7 publications

Efficacy of inhaled nitric oxide in neonates with hypoxic respiratory failure and pulmonary hypertension: the Japanese experience

Efficacy of inhaled nitric oxide in neonates with hypoxic respiratory failure and pulmonary hypertension: the Japanese experience

Neonatal pulmonary hypertension treated with inhaled nitric oxide and high-frequency ventilation

Inhaled nitric oxide in term and preterm infants

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