The use of dipyridamole to wean from inhaled nitric oxide in congenital diaphragmatic hernia

A full-term neonate with a left-sided congenital diaphragmatic hernia (CDH) was ventilated mechanically by high-frequency oscillatory ventilation (HFO V). Despite inhaled nitric oxide (iNO) at a dose of 15 ppm, the neonate had severe respiratory acidosis and was placed on extracorporeal membrane oxyg enation (ECMO) for 2 days. On day 7 of life, surgical repair of the CDH was performed, After the intervention, iNO (20 ppm) had to be restarted becaus e of severe pulmonary hypertension (PHT). Ventilatory support and iNO then were weaned progressively. However, each daily attempt to discontinue iNO ( from 2 ppm to 0 ppm), led to severe desaturation with significant right-to- left shunting. At the age of 33 days, dipyridamole (persantin) was administ ered intravenously at a dose of 0,4 mg/kg/min over 10 minutes and repeated every 12 hours for a total of 3 doses. After the second administration of d ipyridamole, iNO could be stopped without rebound of PHT, and the neonate w as extubated 1 week later. The authors report the use of dipyridamole for s uccessful withdrawal of iNO, By inhibition of phosphodiesterase type 5, dip yridamole has the potential to increase the level of cyclic guanosine monop hosphate in vascular smooth muscle cells, permitting vasodilation and resto ration of endogenous NO. Copyright (C) 2007 by W.B. Saunders Company.