Inhaled nitric oxide therapy might reduce the need for hyperventilation therapy in infants with persistent pulmonary hypertension of the newborn
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Shigeharu Hosono
Abstract
Aim: To determine whether inhaled nitric oxide might reduce the need for excessive respiratory alkalosis to maintain systemic oxygenation in infants with persistent pulmonary hypertension of the newborn (PPHN).
Materials and methods: A retrospective historical cohort study of 34 infants with PPHN with oxygenation index (OI) of 25 or more, including 19 infants without inhaled nitric oxide (i-NO) therapy (control group) and 15 infants with inhaled nitric oxide therapy (i-NO group) was performed. The initial dose of 10 ppm of i-NO was administered and no responders received the maximum dose of 25 ppm. We evaluated the mortality rate and the change of OI index and PaCO2 during the first 6 days.
Results: There were no significant differences in characteristics between groups. Two of 15 in the i-NO group and 6 of 19 infants in the control group died during the first 48 h. Baseline OI, PaCO2 and arterial pH were similar in the two groups. OI in the i-NO group was significantly higher than in the control group between 12 and 96 h. PaCO2 in the i-NO group was higher than in the control group between 24 and 144 h.
Conclusion: i-NO therapy for PPHN might improve systemic oxygenation without excessive hypocapnia. However there was no reduction in duration of ventilation support or oxygen supply.
References
1 Ambalavanan N, WA Carlo: Hypocapnia and hypercapnia in respiratory management of newborn infants. Clin Perinatol28 (2001) 517Suche in Google Scholar
2 Clark RH, TJ Kueser, MW Walker, WM Southgate, JL Huckaby, JA Perez, et al.: Low-dose nitric oxide therapy for persistent pulmonary hypertension of the newborn. Clinical Inhaled Nitric Oxide Research Group. N Engl J Med342 (2000) 469Suche in Google Scholar
3 Finer NN, KJ Barrington: Nitric oxide for respiratory failure in infants born at or near term. Cochrane Database Syst Rev2 (2001) CD00039910.1002/14651858.CD000399Suche in Google Scholar PubMed
4 Frostell C, MD Fratacci, JC Wain, R Jones, WM Zapol: Inhaled nitric oxide. A selective pulmonary vasodilator reversing hypoxic pulmonary vasoconstriction. Circulation83 (1991) 2038Suche in Google Scholar
5 Furchgott RF, PM Vanhoutte: Endothelium-derived relaxing and contracting factors. FASEB J3 (1989) 2007Suche in Google Scholar
6 Gupta A, S Rastogi, R Sahni, A Bhutada, D Bateman, D Rastogi, et al.: Inhaled nitric oxide and gentole ventilation in the treatment of pulmonary hypertension of the newborn – a single-center, 5-year experience. J Perinatol22 (2002) 435Suche in Google Scholar
7 Hendricks-Munoz KD, JP Walton: Hearing loss in infants with persistent fetal circulation. Pediatrics81 (1988) 650Suche in Google Scholar
8 Ignarro LJ, GM Buga, KS Wood, RE Byrns, G Chaudhuri: Endothelium-derived relaxing factor produced and released from artery and vein is nitric oxide. Proc Natl Acad Sci USA84 (1987) 9265Suche in Google Scholar
9 Kennealy JA, JE McLennan, RG Loudon, RL McLaurin: Hyperventilation-induced cerebral hypoxia. Am Rev Respir Dis122 (1980) 407Suche in Google Scholar
10 Konduri GG, A Solimano, GM Sokol, J Singer, RA Ehrenkranz, N Singhal, et al.: A randomized trial of early versus standard inhaled nitric oxide therapy in term and near-term newborn infants with hypoxic respiratory failure. Pediatrics113 (2004) 559Suche in Google Scholar
11 Kusuda S, N Shishida, N Miyagi, M Hirabayashi, TJ Kim: Cerebral blood flow during treatment for pulmonary hypertension. Arch Dis Child Fetal Neonatal Ed80 (1999) F3010.1136/fn.80.1.F30Suche in Google Scholar
12 Leavitt AM, JF Watchko, FC Bennett, RC Folsom: Neurodevelopmental outcome following persistent pulmonary hypertension of the neonate. J Perinatol11 (1987) 288Suche in Google Scholar
13 Marron MJ, MA Crisafi, JM Driscoll Jr, JT Wung, YT Driscoll, TH Fay, et al.: Hearing and neurodevelopmental outcome in survivors of persistent pulmonary hypertension of the newborn. Pediatrics90 (1992) 392Suche in Google Scholar
14 Rossaint R, KJ Falke, F Lopez, K Slama, U Pison, WM Zapol: Inhaled nitric oxide for the adult respiratory distress syndrome. N Engl J Med328 (1993) 399Suche in Google Scholar
15 Thome UH, WA Carlo: Permissive hypercapnia. Semin Neonatol7 (2002) 409Suche in Google Scholar
16 The Acute Respiratory Syndrome Network: Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. New Engl J Med 342 (2000) 1301Suche in Google Scholar
17 The Neonatal Inhaled Nitric Oxide Study Group: Inhaled nitric oxide in full-term and nearly full-term infants with hypoxic respiratory failure. N Engl J Med 336 (1997) 59710.1056/NEJM199702273360901Suche in Google Scholar PubMed
18 Walsh-Sukys MC, JE Tyson, LL Wright, CR Bauer, SB Korones, DK Stevenson, et al.: Persistent pulmonary hypertension of the newborn in the era before nitric oxide: practice variation and outcomes. Pediatrics105 (2000) 14Suche in Google Scholar
19 Walton JP, K Hendricks-Munoz: Profile and stability of sensorineural hearing loss in persistent pulmonary hypertension of the newborn. J Speech Hear Res34 (1991) 1362Suche in Google Scholar
20 Wung JT, LS James, E Kilchevsky, E James: Management of infants with severe respiratory failure and persistence of the fetal circulation, without hyperventilation. Pediatrics76 (1985) 488Suche in Google Scholar
©2006 by Walter de Gruyter Berlin New York
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Artikel in diesem Heft
- Advances in Perinatal Medicine - 5th Annual meeting of the Italian Society of Perinatal Medicine held in Parma, Italy on June 15th – 17th 2006
- Hemorrhagic shock in obstetrics
- Altered protease expression by periarterial trophoblast cells in severe early-onset preeclampsia with IUGR
- Gestational diabetes mellitus in patients receiving long-term corticosteroid therapy during pregnancy
- Accuracy and influence of ascorbic acid on glucose-test with urine dip sticks in prenatal care
- Protein C, protein S, and thrombomodulin in amniotic fluid. A preliminary study
- Timing of cord clamping revisited
- Intrapartum cardiotocography – the dilemma of interpretational variation
- Maturation of the autonomic nervous system: differences in heart rate variability in premature vs. term infants
- Four chamber view plus three-vessel and trachea view for a complete evaluation of the fetal heart during the second trimester
- Pleural fluid/serum immunoglobulin ratio is a diagnostic marker for congenital chylothorax in utero
- Fetal brain sparing is strongly related to the degree of increased placental vascular impedance
- Outcome of fetuses in women with pregestational diabetes mellitus
- Outcome of fetuses in women with pregestational diabetes mellitus
- Inhaled nitric oxide therapy might reduce the need for hyperventilation therapy in infants with persistent pulmonary hypertension of the newborn
- To drain or not to drain: a single institution experience with neonatal intestinal perforation
- Infective puerperal endocarditis caused by Escherichia coli
- Correlation between plasma and urinary caffeine levels in preterm infants
- Fetal ascites secondary to urinary hydrocolpos
- Congress Calendar
- Suppression of IL-2 and IFN-γ production in women with spontaneous preterm labor
