Single breath analysis of endogenous nitric oxide in the newborn

Nitric oxide (NO) is found in the exhaled gas of humans immediately after birth. However, variations of endogenous NO concentration during the breathing cycle have not been studied in newborns. We examined 24 newborns without acute respiratory compromise during spontaneous nasal breathing. Gas was sampled from the tip of a thin nasal catheter placed in the hypopharynx. Endogenous NO concentrations measured by chemiluminescence were assigned to the breathing cycle using synchronized CO2 recording. Exhaled NO could reproducibly be measured at 1.9 +/- 0.2 parts per billion (ppb, mean +/- SEM). Autoinhaled nasal NO peaks during regular breathing were 12.0 +/- 1.7 ppb and reached intermittent maxima of 52.2 +/- 5.8 ppb. During regular breathing 6 infants exhibited sudden decreases of nasal NO peaks to periods with <50% amplitude suggesting transient shortage of autoinhaled nasal NO. We conclude that tidal NO analysis can be used to assess upper and lower airway NO production noninvasively during spontaneous breathing in the newborn.