S. Al-alaiyan et E. Neiley, Inhaled nitric oxide in persistent pulmonary hypertension of the newborn refractory to high-frequency ventilation, CRIT CARE, 3(1), 1999, pp. 7-10
Background: This study was designed to evaluate the effect of nitric oxide
(NO) on the management of neonates with severe persistent pulmonary hyperte
nsion refractory to high-frequency oscillatory ventilation.
Methods: The birth weight and the gestational age of infants were 3125.5 +/
- 794 g (mean +/- SD) and 39 +/- 2.4 weeks, respectively. All neonates were
ventilated for an average of 137.5 min (range 90-180 min) prior to NO ther
apy. The mean oxygenation index (OI) of all neonates prior to NO was 46.3 /- 5 (mean +/- SEM). NO was initially administered at 20 parts per million
(ppm) for at least 2 h and increased gradually by 2 ppm to a maximum of 80
ppm.
Results: Eighteen infants (75%) responded and six (25%) did not respond to
the treatment. Three neonates died in the responding group, while all the n
onresponders died (P = 0.0001). The survival rate was 62.5% among all neona
tes. NO significantly decreased OI (P < 0.0001) and improved the arterial/a
lveolar (a/A) oxygen ratio (P < 0.0001) within the first 2 h of NO therapy
in 61.1% of the responders. However, the OI and the a/A oxygen ratio remain
ed almost the same throughout the treatment in the non-responders and the n
on-survivors.
Conclusion: Inhaled NO at 20 ppm, following adequate ventilation for 2 h wi
thout significant response, could be used to identify the majority of the n
onresponders in order to seek other alternatives.