For nearly 2 decades inhaled nitric oxide (iNO) has played an essential role in the management of severe hypoxic respiratory failure in term and late-preterm neonates. Selective vasodilation with iNO decreases ventilation-perfusion mismatch in the lung and thereby improves oxygenation in various forms of neonatal lung disease. Randomized clinical trials have demonstrated the safety and effectiveness of iNO as a treatment for persistent pulmonary hypertension of the newborn, with recipients less often requiring extracorporeal membrane oxygenation. Unfortunately, subgroup analyses in these studies have failed to demonstrate a benefit for neonates with congenital diaphragmatic hernia (CDH), congruent with that of an early clinical trial1 of iNO in this high-risk population.
Carey WA, Ellsworth MA, Harris MN. Inhaled Nitric Oxide Use in the Neonatal Intensive Care UnitRising Costs and the Need for a New Research Paradigm. JAMA Pediatr. 2016;170(7):639-640. doi:10.1001/jamapediatrics.2016.0228