Clinical Application of Inhaled Nitric Oxide Therapy in Persistent Pulmonary Hypertension of the Newborn.

Lee,  Eun Hee; Choi,  Byung Min

doi:2015.22.2.61

Neonatal Med > Volume 22(2); 2015 > Article

Review

Neonatal Medicine 2015;22(2):61-70.
DOI: https://doi.org/10.5385/nm.2015.22.2.61 Published online May 29, 2015.

Clinical Application of Inhaled Nitric Oxide Therapy in Persistent Pulmonary Hypertension of the Newborn.

Eun Hee Lee, Byung Min Choi

Department of Pediatrics, Korea University College of Medicine, Seoul, Korea. cbmin@korea.ac.kr

Abstract

Inhaled nitric oxide (iNO) is recognized as a potent and selective pulmonary vasodilator that does not decrease systemic vascular tone. The therapeutic application of iNO in human was first described in 1991. Subsequent reports showed that iNO therapy was effective to improve oxygenation in infants with persistent pulmonary hypertension of the newborn (PPHN). Owing to its selective pulmonary vasodilator effects, iNO therapy is an important treatment for term newborns with hypoxemic respiratory failure due to PPHN. The Food and Drug Administration of the United States of America first approved iNO in 1999 for use as a medical gas to treat hypoxic respiratory failure associated with clinical or echocardiographic evidence of pulmonary hypertension in term and late preterm neonates. Thereafter, iNO therapy is clinically applied to treat PPHN in term and late preterm neonates without consensus. In this review, we focused on the clinical practice of iNO therapy in PPHN. Based on published studies, we discuss iNO initiation and withdrawal methods, respiratory support devices that complement iNO therapy, and the patient and gas monitoring during iNO therapy.

Key Words: Nitric oxide inhalation; Newborn; Clinical practice; Persistent fetal circulation syndrome