[Persistent pulmonary hypertension in premature and newborn infants: selective pulmonary vasodilation with inhaled nitric oxide (iNO)].

Severe respiratory failure of the newborn often results in persistent pulmonary hypertension, which is characterized by increased pulmonary vascular resistance, decreased pulmonary blood flow and severe hypoxaemia. Since 3 years inhaled nitric oxide (iNO) has been used as a selective pulmonary vasodilator with variable success in the treatment of persistent pulmonary hypertension. In the present clinical pilot study 10 patients (4 newborns and 6 preterm infants) suffering from severe respiratory failure were treated with iNO. The aim of this study was to evaluate the effectiveness of inhaled NO and to discuss whether or not extracorporeal membrane oxygenation (ECMO) could be delayed or avoided. In all patients oxygenation improved without a decrease in systemic blood pressure. The median OI decreased from 41 to 16.5 during the first 4 hours of treatment and to 12 during the first 12 hours. One patient with congenital diaphragmatic hernia required ECMO therapy and died post operative. One preterm infant with primary pulmonary hypertension died during prolongated hypotension and hypoxemia. iNO may have reduced the need for ECMO which however should be available as an ultimate therapeutic option.