Inhaled nitric oxide in severe bronchopulmonary dysplasia

Introduction. Bronchopulmonary dysplasia (BPD) is widely regarded as a seri ous complication of neonatal respiratory distress syndrome. We report a cas e of severe BPD in which inhaled nitric oxide (NO) allowed persistent reduc tion of oxygen supplementation. Case report. The girl was born at 24 weeks gestation. She developed respira tory distress syndrom and was mechanically ventilated, but remained hypoxic despite early surfactant therapy and high frequency oscillatory ventilatio n. Application of iNO improved oxygenation rapidly. She was extubated three weeks later but developed severe BPD so that she was considered for lung t ransplantation when she was 1 year old. In this situation long term applica tion of iNO via nCPAP allowed for persistent reduction of supplemental oxyg en. At 2 years of age she could finally be weaned from additional inspired oxygen. Conclusion. The application of NO via nCPAP may be a relatively non-invasiv e yet highly effective treatment in some cases of severe BPD with predomina ntly elevated pulmonary vascular resistance and ventilation/perfusion misma tch in whom conventional therapy has failed. Particularly the deleterious e ffects of high oxygen concentrations on lung tissue may be avoided.