Infant Journal
for neonatal and paediatric healthcare professionals

Non-invasive use of inhaled nitric oxide for neonatal pulmonary hypertension

Inhaled nitric oxide (iNO) is a selective pulmonary vasodilator used as primary treatment for babies with persistent pulmonary hypertension of the newborn (PPHN). Evidence shows that its use reduces mortality and need for extracorporeal membrane oxygenation (ECMO).1 iNO is normally commenced at a concentration of 20 parts per million (ppm) when babies have been intubated and ventilated and then slowly weaned off prior to extubation.

Dr Peter Reynolds
Consultant Neonatologist

Gemma Finch
Advanced Neonatal Nurse Practitioner

St Peter’s Hospital, Chertsey
peter.reynolds1@nhs.net
@neonataldoc

Reynolds P., Finch G. Non-invasive use of inhaled nitric oxide for neonatal pulmonary hypertension. Infant 2025; 21(1): 6-7.

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Keywords
inhaled nitric oxide; intubation; ventilation; non-invasive ventilation; persistent pulmonary hypertension of the newborn; pulmonary vasodilator
Key points
  1. Minimisation of exposure to invasive ventilation is important.
  2. Inhaled nitric oxide (iNO) is a selective pulmonary vasodilator used as primary treatment for babies with PPHN.
  3. Inhaled nitric oxide is used as primary treatment for babies with persistent pulmonary hypertension of the newborn.
  4. iNO can be given via non-invasive ventilation in certain scenarios.

Also published in Infant:

VOLUME 15/ISSUE 3, MAY 2019
Airway management in neonatal intensive care units: the PIC-NIC survey
Improvements in airway management have occurred in almost all UK adult intensive care units following the publication of the Fourth National Audit Project (NAP4) in 2011. Subsequently the PIC-NIC survey investigated whether the lessons learned from NAP4 had filtered into paediatric practice. This article highlights the relevant findings for neonatal healthcare professionals by discussing the high-risk nature of neonatal airway management and strategies that might be used to improve safety including planning for difficulty, immediate access to emergency airway equipment and the role of continuous waveform capnography and videolaryngoscopy.

Read more...