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Previous Volume 336:605-610 February 27, 1997 Number 9 Next

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ABSTRACT

Background Persistent pulmonary hypertension of the newborn causes systemic arterial hypoxemia because of increased pulmonary vascular resistance and right-to-left shunting of deoxygenated blood. Inhaled nitric oxide decreases pulmonary vascular resistance in newborns. We studied whether inhaled nitric oxide decreases severe hypoxemia in infants with persistent pulmonary hypertension.

Methods In a prospective, multicenter study, 58 full-term infants with severe hypoxemia and persistent pulmonary hypertension were randomly assigned to breathe either a control gas (nitrogen) or nitric oxide (80 parts per million), mixed with oxygen from a ventilator. If oxygenation increased after 20 minutes and systemic blood pressure did not decrease, the treatment was considered successful and was continued at lower concentrations. Otherwise, it was discontinued and alternative therapies, including extracorporeal membrane oxygenation, were used.

Results Inhaled nitric oxide successfully doubled systemic oxygenation in 16 of 30 infants (53 percent), whereas conventional therapy without inhaled nitric oxide increased oxygenation in only 2 of 28 infants (7 percent). Long-term therapy with inhaled nitric oxide sustained systemic oxygenation in 75 percent of the infants who had initial improvement. Extracorporeal membrane oxygenation was required in 71 percent of the control group and 40 percent of the nitric oxide group (P = 0.02). The number of deaths was similar in the two groups. Inhaled nitric oxide did not cause systemic hypotension or increase methemoglobin levels.

Conclusions Inhaled nitric oxide improves systemic oxygenation in infants with persistent pulmonary hypertension and may reduce the need for more invasive treatments.

Source Information

From the Departments of Anesthesia (J.D.R., W.M.Z.) and Pediatrics (J.D.R.), Massachusetts General Hospital and Harvard Medical School, Boston; the Departments of Pediatrics (J.R.F., M.A.H.) and Anesthesia (M.S.Z.), University of California at San Francisco, San Francisco; and the Departments of Pediatrics at the State University of New York at Buffalo, Buffalo (F.C.M., M.M.Z.), the University of Texas Southwestern Medical Center, Dallas (P.W.S.), Yale University, New Haven, Conn. (S.R., I.G.), the University of Chicago, Chicago (M.D.S.), and Children's Hospital of Philadelphia, Philadelphia (R.A.P.). Other authors were Kajori G. Thusu, M.D. (State University of New York at Buffalo), Thomas M. Zellers, M.D. (University of Texas Southwestern Medical Center), Mark E. Wylam, M.D. (University of Chicago), and Alan Zaslavsky (Department of Statistics, Harvard University).

Address reprint requests to Dr. Roberts at the Department of Anesthesia and Critical Care, Massachusetts General Hospital, Boston, MA 02114.

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