REVERSAL OF RIGHT-TO-LEFT SHUNTING AND SU STAINED IMPROVEMENT OF OXYGENATION WITH INHALED NITRIC-OXIDE IN A PREMATURE-INFANT WITH LUNG HYPOPLASIA AND ASPHYXIA

We report the case of a 29 weeks gestation female premature infant who suffered from severe postnatal asphyxia following spontaneous vaginal delivery. Prenatally lung hypoplasia due to prematurely ruptured memb ranes with subsequent oligohydramnios was suspected sonographically. E chocardiography revealed right-to-left shunting via PDA and foramen ov ale, in addition to that tricuspid incompetence with a pulmonary arter ial pressure gradient of 40 mmHg was demonstrated. At an oxygenation i ndex (OI) of 34, an arterio-alveolar oxygen difference (AaDO(2)) of 63 9 mmHg, an FiO(2) of 1.0 and a maximal paO(2) of 37 mmHg during high f requency ventilation (HFV), we applied inhaled nitric oxide (up to 70 ppm) for a duration of approximately 30 hours. Within two hours the in spiratory oxygen concentration could be weaned to an FiO(2) of 0.21, m ean airway pressures were reduced markedly. Echocardiographically tric uspid incompetence had disappeared, the PDA was closed and now left-to -right shunting across the foramen ovale was demonstrated. The infant was extubated on day 5 and subsequently had oxygen requirements up to an FiO(2) of 0.3 during spontaneous breathing for 20 days.