Clinical Indications for Inhaled Nitric Oxide Therapy in Neonates

ABSTRACT

Nitric oxide (NO) is a colorless, odorless gas that acts as a potent pulmonary vasodilator. When administered via inhalation, NO rapidly diffuses across the alveolarcapillary membrane and binds to hemoglobin, and thus has little effect on the systemic circulation. NO was approved by the United States Food and Drug Administration (US FDA) for the treatment of hypoxic respiratory failure associated with pulmonary hypertension in 1999. Neonatal hypoxic respiratory failure may be caused by persistent pulmonary hypertension of the newborn and other diseases such as meconium aspiration syndrome, sepsis, birth asphyxia, and respiratory distress syndrome that contribute to pulmonary arterial hypertension. Inhaled NO is the only approved treatment in term and late preterm (>34 weeks) neonates with hypoxic respiratory failure associated with pulmonary hypertension, and it reduces the need for extracorporeal membrane oxygenation. The present article will review the clinical indications for US FDA-approved inhaled NO therapy according to evidence-based clinical studies.