Nitric Oxide for Children

Abstract

The introduction of inhaled nitric oxide (iNO) for the treatment of hypoxemic respiratory failure in neonates ushered in a new era in neonatal intensive care. This inhalational therapeutic redefined the medical management of the infant with persistent pulmonary hypertension of the newborn (PPHN). With a selective pulmonary vasodilator in hand, a kinder, gentler approach to ventilation was embraced in many neonatal intensive care units, aggressive hyperventilation and alkaline therapy were abandoned, and the number of infants referred for extracorporeal membrane oxygenation (ECMO) declined. Yet, iNO is not a panacea. A significant number of infants fail to respond or sustain a response to iNO. Furthermore, iNO is being increasingly used off-label for populations in which its safety and efficacy have not been adequately studied. In this chapter on iNO in children, we will review the spectrum of approved and off-label uses of iNO in pediatrics, and address gaps in our knowledge regarding the optimal dosing, weaning, and patient selection.