Controversies in neonatology: The efficacy of inhaled nitric oxide in preterm infants with persistent pulmonary hypertension

Abstract

Introduction: There is limited and conflicting information in literature regarding use of inhaled nitric oxide (iNO) in preterm infants. In this study we examined the characteristics of preterm infants with persistent pulmonary hypertension (PHT) who responded and did not respond to iNO therapy . Material and Method: We retrospectively reviewed data of infants <34 weeks of gestational age with hypoxic respiratory failure that received iNO for PHT after being diagnosed with severe respiratory distress syndrome after birth. The data of responders and non-responders to iNO therapy were compared. Results: Twenty-five infants were included in our study. Twelve (48%) had a positive response to iNO administration for PHT. As an antenatal characteristic, oligohydramnios was significantly higher in responders [5 (41.7%) vs 0%, p=0.015] and mortality rate was lower (66% vs. 100%, p=0.039). The SpO2/FiO2 ratio before iNO treatment predicted the response to iNO in preterm neonates with PHT. The ROC analysis yielded an area under curve AUC for SpO2/FiO2 ratio before iNO of AUCSpO2/FiO2before was 0.756; 95% CI, 0.554-0.959; P=0.03. A cut-off value of 79 point by the SpO2/FiO2 ratio before iNO treatment predicted the response to iNO treatment with 83% sensitivity and 70% specificity. Conclusion: In infants born <34 weeks gestation, response to iNO in PHT has a significant effect on improving survival. The presence of oligohydramnios may be an important factor in prediction of positive response. SpO2/FiO2 ratio can be useful for estimating the effectiveness of iNO.

Keywords

• Nitric oxide therapy
• premature
• pulmonary hypertension

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