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Introduction

Neonatal respiratory problems account for most admissions to Intensive Care Units in the immediate newborn period. The goal of respiratory treatment is to provide oxygen to the tissues and carbon dioxide removal in a safe and effective manner. Artificial breathing by using ventilators a method to mechanically assist or replace spontaneous breathing. However, certain lung conditions (meconium aspiration syndrome, pneumonia) are associated with high pressures in lung blood vessels due to narrowing of diameter and thereby preventing effective oxygenation and blood supply to organs- ‘pulmonary hypertension’. Pulmonary hypertension in the neonatal period, if not treated effectively can lead to many complications including brain damage, prolonged stay in the NICU and even death.

What is Inhaled Nitric Oxide?

Nitric oxide is a chemical compound in gas form that is sometimes used to treat infants with severe breathing problems associated with narrow blood vessels in the lungs. It acts as a pulmonary vasodilator, widening the diameter of blood vessels in the lungs. In term and near-term infants, use of this therapy will improve the blood flow through the lungs and thereby improve oxygenation and carbon dioxide removal.

What are benefits of Inhaled Nitric Oxide?

  • Improves oxygenation and ventilation
  • Decrease in the duration of artificial ventilation
  • Decrease in the ventilator induced lung injury
  • Improves survival
  • Improves long-term lung health and brain development and function
  • In combination with High frequency ventilation- improves oxygenation and decreases need for ECMO in cases of Meconium Aspiration Syndrome

How does the Inhaled Nitric Oxide delivery device work?

Nitric oxide is delivered to baby’s lungs with a special device/machine attached to the ventilator. With this machine nitric oxide is delivered to a baby in a controlled fashion. The desired dose can be adjusted and monitored using this device and the unnecessary byproducts are scavenged out of the environment.

Is iNO safe?

iNO is safe in trained and experienced hands. iNO has side effects like methhaemoglobinemia, bleeding if not used in accurate doses and monitored appropriately. Use of iNO needs proper training and expertise.

When to use iNO?

iNO is indicated in patients who have severe breathing problems requiring artificial ventilation and show signs narrowing of lung blood vessels. Certain lung conditions have the higher risk of developing narrowing of lung blood vessels like meconium aspiration syndrome, severe pneumonia, perinatal asphyxia and may benefit from iNO therapy.

Is iNO expensive?

iNO is expensive as compared to artificial ventilation alone as it requires a specific device to deliver to patient, additional cost of medical nitric oxide gas, monitoring during therapy and need for trained personnel- doctors and nurses. However, it is cost-effective as it can reduce days on ventilator and need for higher expensive technology like ECMO.
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