Abstract 1783 Poster Session I, Saturday, 5/1 (poster 19)

Objective: To evaluate whether early treatment with inhaled nitric oxide (iNO) will prevent newborns with moderate respiratory failure and pulmonary hypertension from developing severe persistent pulmonary hypertension (PPHN) {oxygenation index (OI) 40}.

Methods: 29 near-term newborns with acute lung disease (excluding lung hypoplasia) with moderate respiratory failure (10 <OI < 35) and echocardiographic evidence of pulmonary hypertension were randomized before their first 72 hours after birth to treatment with 20 parts per million iNO (n=15) or conventional therapy (n=14). Infants received iNO and/or High Frequency Oscillatory Ventilation (HFOV) if they developed an OI> 40. There were no differences in birth-weight, gestational age, gender, lung diseases, age at randomization and baseline arterial blood gases between groups.

Results: 3 patients receiving early iNO and 10 patients on conventional therapy developed an OI > 40 (p< 0.05, X2 test). As shown in the table, mean ± SD OI was significantly decreased at 1-4 h in the group of early iNO compared its baseline (φ: p< 0.05). OI in the control group were significantly higher during first 48 h after randomization compared to the early iNO group (*: p< 0.05). γ: Length of oxygen therapy is expressed as median (range). Four of the 10 control-patients who developed an OI > 40 were successfully treated with iNO later. The other 6 control-patients and the 3 early iNO patients who had an IO > 40 responded with HFOV + iNO. One patient of the control group who had a severe asphyxia expired, but unrelated to respiratory failure.

Table 1 No caption available
Full size table

Conclusions: Early use of iNO in newborns with acute lung disease and moderate respiratory failure improves oxygenation and decreases the probability of developing severe PPHN (OI > 40).