Noninvasive inhaled nitric oxide for persistent pulmonary hypertension of the newborn: A single center experience

INTRODUCTION: Nitric oxide is a potent, selective pulmonary vasodilator that has been proven to decrease pulmonary vascular resistance and has been part of the treatment arsenal for persistent pulmonary hypertension of the newborn (PPHN). In 2009, the approach to the administration of inhaled nitric oxide (iNO) at Winnie Palmer Hospital for Women and Babies (WPH) changed to emphasize avoiding invasive ventilation while maintaining optimal ventilation to perfusion ratio, avoiding hyperventilation and alkalosis agents, and avoiding hyperoxemia and hyperoxia exposure. Our aim is to describe the outcomes of babies whose primary treatment for PPHN was noninvasive (NIV) iNO.
METHODS: A retrospective chart review of neonates born at WPH from October 1, 2009 through October 1, 2014. Inclusion criteria: >34 weeks’ gestation, echocardiographic evidence of PPHN within the first week of life, and NIV iNO as the primary treatment.
RESULTS: Twenty-four babies met criteria: 21 solely treated noninvasively, 3 required invasive support. Supplemental oxygen need was ≥50% for 21 babies pre-iNO treatment and dropped to <30% for all babies post-iNO. Average exposure to supplemental oxygen was 6.3 days. Mean duration of iNO administration was 2.5 days. Average length of stay was 14 days. All babies survived.
CONCLUSION: Our review revealed a low incidence of escalation to invasive ventilation. Non-invasive iNO was found to be an effective and well-tolerated frontline approach for treating PPHN in near-term and term infants with an intact respiratory drive. Further studies could provide the necessary evidence on clinical outcomes as well as cost effectiveness to guide best practice.

*Corresponding Author: 

Denise P. Smith, NICU Research and Clinical Trials, Winnie Palmer Hospital for Women and Babies, 83 W. Miller Street, Mail Point 377, Orlando, FL 32806, USA. Tel.: +1 321 841 7816; Fax: +1 321 843 1789; E-mail: