Inhaled nitric oxide (iNO) has emerged as a promising therapeutic agent in the treatment of persistent pulmonary hypertension of the newborn. Several theories exist regarding causes of both response and nonresponse to iNO. Clinical trials differentiate disease entities (primary vs secondary persistent pulmonary hypertension associated with meconium aspiration syndrome, pneumonia or congenital diaphragmatic hernia) and their specific response rates. iNO combined with high-frequency ventilation appears to be superior to inhalation of nitric oxide (NO) during conventional ventilation. Little is known regarding the role of the degree of lung expansion and its modification — no matter what mode of ventilation is applied. Gestational age plays an important role in relation to the potential adverse effects of NO. Of particular concern in the premature neonate is the effect of NO on bleeding time and the inhibition of platelet aggregation. Those potentially hazardous effects need to be carefully weighed against early intervention with iNO at a comparably low oxygenation index in order to prevent the vicious cycle of hypoxaemia and subsequent increased right-to-left shunting. Further studies are required to determine the optimal timing, mode of delivery and mode of ventilation used with iNO therapy in order to optimise the response of premature and term neonates.
吸入
一氧化氮(iNO)已成为治疗新生儿持续性肺动脉高压的一种很有前景的治疗药物。关于对 iNO 有反应和无反应的原因存在多种理论。临床试验对疾病实体(与胎粪吸入综合征、肺炎或先天性膈疝相关的原发性和继发性持续性肺动脉高压)及其具体反应率进行了区分。 iNO 与高频通气相结合似乎优于在常规通气过程中吸入
一氧化氮(NO)。无论采用哪种通气模式,人们对肺扩张程度的作用及其改变知之甚少。妊娠年龄对
一氧化氮的潜在不良影响起着重要作用。早产新生儿尤其需要关注 NO 对出血时间和血小板聚集抑制的影响。为了防止低氧血症的恶性循环以及随之而来的右向左分流的增加,需要仔细权衡这些潜在的有害影响与在氧合指数相当低的情况下尽早使用 iNO 进行干预的利弊。需要进一步研究确定 iNO 治疗的最佳时机、分娩方式和通气模式,以优化早产儿和足月新生儿的反应。