INHALED NITRIC-OXIDE IN HYPOXEMIC NEWBORNS WHO ARE CANDIDATES FOR EXTRACORPOREAL LIFE-SUPPORT

The aim of this study was to evaluate the effect of inhaled nitric oxi de (NO) in newborns with acute hypoxaemic respiratory failure and the impact of this NO therapy on survival and the need for extracorporeal membrane oxygenation (ECMO). A cohort of newborns with a gestational a ge of greater than or equal to 34 weeks and an oxygenation index (OI) >25 were prospectively evaluated, Patients mere given NO at an initial dose of 10 parts per million (ppm), Oxygenation parameters mere evalu ated prior and during NO inhalation. From January 1994 to December 199 6, 20 infants mere enrolled in the study, Based upon their outcome, pa tients mere divided into two groups: survivors with no need for ECMO, group A (n=8) and survivors requiring ECMO or nonsurvivors, group B (n =12). All infants approached or met ECMO criteria before NO inhalation , Eight patients (40%) mere successfully managed with NO and conventio nal treatment (group A), Newborns in this group showed a rapid and sus tained improvement of systemic oxygenation during NO inhalation. Mean arterial oxygen tension (Pa,O-2) increased significantly from 4.5 kPa (34 mmHg) (95% confidence interval (95% CI) 1.9-7.1 kPa (14.4-53.7 mmH g)) to 10.1 kPa (75.7 mmHg) (95% CI 6.5-13.6 kPa (49.1-102.3 mmHg)) af ter 1 h and was 9.0 kPa (67.7 mmHg) (95% CI 7.1-11.0 kPa (53.1-82.4 mm Hg)) at 24 h, Conversely, none of the oxygenation parameters improved in the 12 patients who ultimately required ECMO or died (group B). The results indicate that inhaled nitric oxide can improve systemic oxyge nation in newborns with acute respiratory failure and may reduce the n eed for extracorporeal membrane oxygenation support in candidates, Lac k of a rapid response to nitric oxide may be an early predictor of unf avourable short-term outcome, prompting a move towards alternative tre atments.