Controversies in the use of inhaled nitric oxide therapy in the newborn.

Inhaled nitric oxide (NO) causes sustained improvement in oxygenation in near-term and term newborns with persistent pulmonary hypertension of the newborn (PPHN), and reduces the need for extracorporeal membrane oxygenation (ECMO). However, many questions remain concerning the application of inhaled NO to less severely ill infants, its use in units without immediate access to adjuvant therapies for hypoxemic respiratory failure, and in centers without ECMO. Particular vigilance must be given to the potential impact of widespread dissemination on inhaled NO therapy on time ECMO initiation, and the inappropriate use of inhaled NO in premature neonates.