Inhaled nitric oxide use in newborns

Area of Science:

• Neonatal Medicine
• Pediatric Pulmonology
• Cardiovascular Research

Background:

• Persistent pulmonary hypertension of the newborn (PPHN) causes hypoxemic respiratory failure (HRF) in infants.
• Inhaled nitric oxide (iNO) is a selective pulmonary vasodilator used in treating HRF associated with PPHN.
• Echocardiography is crucial for confirming PPHN before initiating iNO therapy.

Purpose of the Study:

• To outline the recommended use of inhaled nitric oxide (iNO) in infants with hypoxemic respiratory failure (HRF).
• To define specific clinical scenarios for iNO initiation and contraindications.
• To provide guidance on iNO as a rescue therapy and for specific conditions like congenital diaphragmatic hernia.

Main Methods:

• Literature review and synthesis of current clinical guidelines on iNO use in neonates.
• Analysis of evidence supporting iNO efficacy and safety in various HRF contexts.
• Expert consensus on optimal timing and patient selection for iNO therapy.

Main Results:

• iNO is recommended for late preterm and term infants with HRF despite optimal support.
• Routine iNO use is not advised for preterm infants on respiratory support.
• iNO may be considered as rescue therapy for specific preterm infant conditions and for congenital diaphragmatic hernia with severe pulmonary hypertension.

Conclusions:

• iNO is a valuable therapeutic tool for PPHN-associated HRF in term and late preterm infants.
• Careful patient selection and echocardiographic confirmation are essential for effective iNO use.
• iNO's role as a rescue therapy in specific preterm populations and congenital diaphragmatic hernia warrants consideration.