[Inhaled nitric oxide in the therapy of acute hypoxemic respiratory failure of newborn].
OBJECTIVE
To determine the efficiency of inhaled nitric oxide(INO) in term and preterm newborns with acute hypoxemic respiratory failure(AHRF), influence of this therapy on the systemic circulation and efficiency of the therapy in relation to the applied ventilation (conventional or oscillatory (HFOV)).


METHODS
Term and preterm ventilated newborns with acute hypoxemic respiratory failure with oxygenation index(OI) >/= 15 were included. The mode of ventilation was not changed before initiation and was continued during INO therapy. Starting dose of INO was 20 parts per million (ppm) and during the last two years it was 1 Oppm. Heart rate, arterial blood pressure, methaemoglobin level, diuresis (in urinary catheterized newborns) were monitored. The efficiency of INO was determined on the ground of 20% decrease of 01.


RESULTS
Investigations were performed in 43 term and premature newborns. After initiation of INO there was a statistically significant fall of 01. Therapy was effective in 72.1 % patients. There was no influence of the therapy on the systemic circulation heart rate and medial artery pressure were statistically unchanged. In 16 catheterized newborns statistically essential increase of diuresis was observed. This effect was more distinct in patients in whom INO therapy was effective. INO therapy was more effective in newborns with respiratory distress syndrome, congenital infection and adult respiratory distress syndrome and less effective in newborns with respiratory distress syndrome with congenital infection and meconium aspiration syndrome. There were no essential differences in efficiency of INO between patients ventilated conventionally and oscillatory.


CONCLUSIONS
INO improves oxygenation in term and preterm newborns with AHRF. INO does not cause depression of the systemic circulation. The increase of diuresis after initiation of INO seems to be associated with improving of oxygenation of the patients. This observation needs to be confirmed by subsequent investigations. The efficacy of INO therapy depends on the cause of hypoxemic respiratory failure. The synergistic effect of INO and HFOV was not confirmed.
Wilkowski
J
J
Klinika Neonatologi, Instytut Centrum Zdrowia Matki Polki, Rzgowska 281/289, 93-338 Lodz, Poland.
D000208:Acute Disease; D000280:Administration, Inhalation; D001993:Bronchodilator Agents / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D000860:Hypoxia / Q000150:complications*; D007231:Infant, Newborn; D007234:Infant, Premature; D008297:Male; D009569:Nitric Oxide / Q000008:administration & dosage*; D012121:Respiration, Artificial / Q000379:methods; D012131:Respiratory Insufficiency / Q000188:drug therapy* / Q000209:etiology* / Q000628:therapy; D013997:Time Factors; D016896:Treatment Outcome
D001993:Bronchodilator Agents; D009569:Nitric Oxide