Safety of inhaled nitric oxide in premature neonates

Ahluwalia, Jag; Kelsall, AW; Raine, J; Rennie, Janet M.; Mahmood, Muhammad Khurram; Oduro, A.; Latimer, R.D.; Pickett, J.A.; Higenbottam, Tim

doi:10.1111/j.1651-2227.1994.tb18115.x

Cited by 13 publications

(9 citation statements)

References 5 publications

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“…Although, theoretically of serious concern, particularly in preterm infants, impairment of platelet function does not appear to occur clinically during iNO therapy. This is consistent with the findings of the recently published North American multicentre studies [11,12], including infants from 34 weeks onward as well as a series of premature infants treated with iNO [8][9][10]. The fact that gestational age and weight ruled out proceeding to extracorporeal membrane oxygenation (ECMO) in the 29 weeks infant, and the profound hypoxaemia, led to the decision to apply iNO, despite the theoretically increased risk of intraventricular haemorrhage.…”

Section: Discussionsupporting

confidence: 75%

“…According to several publications this is not only the case in term infants [4,5,22], but also in premature neonates [7][8][9]. Although it still has to be regarded as an experimental treatment and a variety of potential side-effects have to be looked at, iNO has emerged as a very promising therapeutic approach in PPHN.…”

Section: Discussionmentioning

confidence: 99%

“…The female premature infant, 29 weeks of gestation, had a birth weight of 1,060 g, Apgar 7,8,8 (1',3',5'). She suffered severe postnatal asphyxia at age 20 min following spontaneous vaginal delivery.…”

Section: Casementioning

confidence: 99%

“…The results of recent studies investigating the theoretically diminished baro-and volutrauma remain equivocal. Nonetheless there is evidence for a decreased secretion of inflammatory mediators [2] and a reduced amount of lung oedema [3] using high-frequency oscillatory ventilation (HFOV) with or without additional application of exogenous surfactant.Inhaled nitric oxide (iNO) as a treatment for neonatal pulmonary hypertension has been in use for the past few years, both in premature infants and in term neonates [4][5][6][7][8][9]. It is worth noting that the first published application of iNO in a premature infant, and the subsequent improvement of oxygenation, occurred during HFOV [10].…”

mentioning

confidence: 99%

“…Inhaled nitric oxide (iNO) as a treatment for neonatal pulmonary hypertension has been in use for the past few years, both in premature infants and in term neonates [4][5][6][7][8][9]. It is worth noting that the first published application of iNO in a premature infant, and the subsequent improvement of oxygenation, occurred during HFOV [10].…”

mentioning

confidence: 99%

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High-frequency ventilation augments the effect of inhaled nitric oxide in persistent pulmonary hypertension of the newborn

Hoehn¹,

Krause²,

Hentschel³

1998

Eur Respir J

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aaHigh-frequency ventilation (HFV) is widely used for rescue treatment of hypoxaemic neonates and premature infants [1]. Although its role as a first-line mode of ventilation has not been established, it is often applied in newborns with respiratory failure, who cannot be successfully managed with conventional mechanical ventilation (CMV). The results of recent studies investigating the theoretically diminished baro-and volutrauma remain equivocal. Nonetheless there is evidence for a decreased secretion of inflammatory mediators [2] and a reduced amount of lung oedema [3] using high-frequency oscillatory ventilation (HFOV) with or without additional application of exogenous surfactant.Inhaled nitric oxide (iNO) as a treatment for neonatal pulmonary hypertension has been in use for the past few years, both in premature infants and in term neonates [4][5][6][7][8][9]. It is worth noting that the first published application of iNO in a premature infant, and the subsequent improvement of oxygenation, occurred during HFOV [10]. Although still an experimental treatment, NO inhalation plays an important therapeutic role in severe hypoxaemia of the newborn due mainly to extrapulmonary shunting [11,12].Recently, a randomized, multicentre trial showed that the combination of iNO and HFOV was superior in term neonates, as compared to either treatment alone [13]. We report a similar experience in a full-term neonate, but also in a premature infant of 29 weeks of gestation. Case 1The term infant was delivered by caesarean section because of maternal hypertension. There was no maternal history of infection. The infant was male and had a birth weight of 3,810 g and Apgar 9,10,10 (1',5',10'); he became symptomatic at the age of 15 min with intercostal retractions and grunting. At that stage, capillary blood gases were: pH 7.23, capillary carbon dioxide tension (Pc,CO 2 ) 8.0 kPa (60 mmHg), capillary oxygen tension (Pc,O 2 ) 4.0 kPa (30 mmHg) in combination with an increasing inspiratory oxygen fraction (FI,O 2 ). At the age of 2 h the neonatal transport team was called, which arrived about 1 h later. The infant was intubated and ventilated because of persistent cyanosis, antibiotic treatment was started and he was transferred to our neonatal intensive care unit. Upon arrival, bovine surfactant (100 mg·kg -1 ) was applied; in order to achieve adequate oxygenation, peak inspiratory pressures (PIPs) up to 4.6 kPa were required (positive endexpiratory pressure (PEEP) 0.5 kPa, rate 70 breaths·min -1 , inspiratory time 0.35 s, mean airway pressure (MAP) 1.8 kPa, FI,O 2 1.0). After approximately 6 h a sudden deterioration of oxygenation and arterial blood pressure occurred, caused by a pneumopericard, which was relieved by drainage. During this event, profound hypoxia occurred for about 15 min, the continuously recorded arterial oxygen saturation (Sa,O 2 ) (measured by pulsoximetry) was approximately 20%. Following drainage of the pneumopericard We report two cases of newborn infants with profound hypoxaemia, who did not respond with ...

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Section: Discussionsupporting

confidence: 75%