Inhaled nitric oxide therapy for pulmonary disease in pediatrics

Inhaled nitric oxide (iNO) therapy improves gas exchange and lowers pulmonary vascular resistance in neonates and children with diverse cardiac and pulmonary disorders. Recent multicenter studies have shown that iNO reduces the need for rescue therapy with extracorporeal membrane oxygenation in term neonates with severe hypoxemic respiratory failure. In neonates with severe lung disease, responsiveness to iNO therapy can be enhanced by therapies which enhance lung recruitment, especially high-frequency oscillatory ventilation. Although early studies suggest that iNO therapy is not associated with significant clinical toxicity or adverse effects, more data are needed on long-term neurodevelopmental and pulmonary outcomes. Acute iNO treatment can improve oxygenation in nearly 70% of older infants and children with acute respiratory distress syndrome, but multicenter studies have yet to demonstrate that prolonged iNO therapy can improve outcome in these patients. Further studies are needed to better identify the exact role for iNO therapy in cardiopulmonary diseases associated with hypoxemia or pulmonary hypertension.