Residual pulmonary hypertension in children after treatment with inhaled nitric oxide: a follow-up study regarding cardiopulmonary and neurological symptoms

Inhaled nitric oxide is a potent vasodilator in acute severe pulmonary hype rtension and is increasingly used as rescue treatment in intensive care alg orithms aiming at reducing severe hypoxaemia in neonates and children. Alth ough the immediate effects may seem impressive, longterm outcome regarding residual pulmonary hypertension and other sequelae has been studied in only a very few patients. The aim of the present study was to evaluate residual pulmonary hypertension, cardiopulmonary or neurological symptoms in childr en after treatment with inhaled nitric oxide in severely hypoxaemic and/or pulmonary hypertensive mechanically ventilated children. The study was perf ormed in four paediatric intensive care units in university hospitals in Sw eden, Norway and Australia. Patients who had received inhaled nitric oxide as part of their intensive care treatment for severe hypoxaemia and/or pulm onary hypertension, and in whom 6 mo had elapsed since treatment, were incl uded for evaluation. Thus 36 paediatric or neonatal patients were examined for circulatory, respiratory or neurological disorders with clinical examin ation, echocardiography, chest X-ray and a capillary blood sample. Four pat ients with congenital heart disease had residual pulmonary hypertension. Ni ne patients were receiving bronchodilators. Sixteen patients had minor (n = 15) or moderate (n = 1) changes on a chest X-ray. One patient had a possib le delay in psychomotor development. Conclusions: In spite of the severity of their primary illness, we found th at the overwhelming majority of the surviving children were asymptomatic an d doing well. The few residual circulatory and respiratory symptoms could b e related to the initial condition.