Noninvasive delivery of inhaled nitric oxide therapy for late pulmonary hypertension in newborn infants with congenital diaphragmatic hernia.
OBJECTIVE
To determine the incidence of late pulmonary hypertension (late PH) in congenital diaphragmatic hernia (CDH) and whether prolonged treatment with noninvasive inhaled NO therapy delivered through a nasal cannula (NC) would sustain pulmonary vasodilation during a period of transition from mechanical ventilation to spontaneous breathing.


METHODS
We collected data on all patients with a diagnosis of CDH admitted to the Children's Hospital, Denver, from January 1996 through December 2001. Patients who had suprasystemic pulmonary hypertension when inhaled NO was discontinued before extubation were treated with inhaled NO delivered with the nasal cannula.


RESULTS
Newborn infants (n = 47) with CDH were treated during this time period. Short-term (<3 months) and long-term (>1 year) survival was 85% and 75%, respectively; 30 newborn infants were treated with inhaled NO (64%). Inhaled NO was successfully discontinued in 16 patients before extubation, and 10 (21%) were treated with inhaled NO through NC after extubation because of pulmonary hypertension and marked hypoxemia when trials off inhaled NO were performed. Nasopharyngeal NO concentrations were 5.4 +/- 0.5 ppm and 2.4 +/- 0.4 ppm with inhaled NO measured proximally in the delivery device at 10 and 5 ppm, respectively.


CONCLUSIONS
Late PH occurs in a significant subset of newborn infants with CDH. Noninvasive inhaled NO treatment may reduce the duration of mechanical ventilation while safely treating late PH.
Kinsella
John P
JP
Department of Pediatrics, Divisions of Neonatology, Cardiology, and Pulmonary and Critical Care Medicine, The Children's Hospital and the University of Colorado School of Medicine, Denver, Colorado 80218-1088, USA.
Parker
Thomas A
TA
Ivy
D Dunbar
DD
Abman
Steven H
SH
D000280:Administration, Inhalation; D005260:Female; D006548:Hernia, Diaphragmatic / Q000150:complications* / Q000628:therapy; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D006976:Hypertension, Pulmonary / Q000188:drug therapy* / Q000453:epidemiology* / Q000209:etiology; D015994:Incidence; D007231:Infant, Newborn; D008297:Male; D009569:Nitric Oxide / Q000008:administration & dosage* / Q000627:therapeutic use*; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies; D013997:Time Factors; D014665:Vasodilator Agents / Q000008:administration & dosage* / Q000627:therapeutic use*; D015300:Ventilator Weaning
D014665:Vasodilator Agents; D009569:Nitric Oxide