Non-invasive nitric oxide inhalation therapy for severe neonatal chronic lung disease

DOI
  • Nagaoka Mitsuhide
    Division of Neonatology, Maternal and Perinatal Center, Toyama University Hospital
  • Makimoto Masami
    Division of Neonatology, Maternal and Perinatal Center, Toyama University Hospital
  • Inomata Satomi
    Division of Neonatology, Maternal and Perinatal Center, Toyama University Hospital
  • Saito Yu
    Division of Neonatology, Maternal and Perinatal Center, Toyama University Hospital
  • Tamura Kentaro
    Division of Neonatology, Maternal and Perinatal Center, Toyama University Hospital
  • Kawasaki Yukako
    Division of Neonatology, Maternal and Perinatal Center, Toyama University Hospital
  • Yoshida Taketoshi
    Division of Neonatology, Maternal and Perinatal Center, Toyama University Hospital

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  • 非侵襲的一酸化窒素吸入療法を施行した重症新生児慢性肺疾患の一例

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Abstract

<p> Non-invasive nitric oxide（NO）inhalation therapy has been reported as an effective treatment for chronic lung disease（CLD）complicated with pulmonary hypertension（PH）. However, there are few reports on the environmental effects of excreted NO and nitrogen dioxide（NO2）. This study aims to evaluate the effectiveness of non-invasive NO inhalation therapy for patients with CLD–PH（chronic lung disease associated PH）and the environmental effects of NO and NO2.</p><p> We report a patient who was born at 25 weeks of gestation by cesarean section from a 24-year-old mother. Postnatally, the neonate was provided inhaled NO therapy from 1st to 31th days of age for persistent pulmonary hypertension of the neonate. He was intubated and placed on mechanical ventilation for 60 days. Although he was supported by non-invasive positive airway pressure after extubation, labored breathing emerged as an exacerbation of PH at 7 months of age. Because he needed a high concentration of oxygen, non-invasive NO inhalation therapy was initiated. His PH findings immediately improved after the initiation of NO inhalation, and no side effects were observed. However, from 11 months of age, he continued to show cyanosis when he was crying and non-invasive NO inhalation therapy was re-initiated. He was unable to withdraw from NO therapy. He diagnosed to have tracheomalacia using fiberoptic bronchoscopy. Therefore, he received a tracheostomy at 15 months and was discharged home with a mechanical ventilator at 19 months. During the treatment, concentrations of NO and NO2 were not detected around 40cm away from him.</p><p> Thus, non-invasive NO inhalation for patients with CLD–PH is effective and safety therapy. In addition, we should consider early intervention for severe CLD-PH with airway involvement.</p>

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