Persistent Pulmonary Hypertension of the Newborn (PPHN) is a life-threatening condition that prevents normal blood flow to the lungs, leading to severe oxygen deprivation. In severe cases where standard oxygen therapy is not enough, inhaled nitric oxide (iNO) therapy has been a groundbreaking treatment, helping newborns breathe better and improving survival rates.
🩺 How Does Inhaled Nitric Oxide (iNO) Therapy Work?
Nitric oxide (NO) is a naturally occurring gas in the body that relaxes and widens (dilates) blood vessels, improving circulation. In babies with PPHN, the pulmonary arteries remain abnormally constricted, limiting blood flow to the lungs.
When a baby receives inhaled nitric oxide (iNO) through a ventilator or oxygen mask, it:
✔ Relaxes the lung blood vessels, reducing pulmonary hypertension.
✔ Increases blood flow to the lungs, improving oxygen uptake.
✔ Enhances oxygen delivery to the rest of the body, reducing hypoxemia.
📌 Fact: iNO therapy is most effective in babies with “oxygen-resistant” PPHN, where normal oxygen therapy alone does not improve blood oxygen levels.
📊 How Effective Is iNO for PPHN?
🔹 Studies show that inhaled nitric oxide reduces the need for extracorporeal membrane oxygenation (ECMO) by 40-50%.
🔹 It improves oxygen levels in 50-70% of newborns with severe PPHN.
🔹 It significantly lowers the risk of long-term complications like brain damage from prolonged hypoxia.
💡 Before iNO therapy was introduced, severe PPHN cases had high mortality rates. Now, with proper treatment, most affected newborns survive and recover fully.
⚠️ Limitations and Risks of iNO Therapy
While iNO is highly effective, it is not suitable for all cases and has some limitations:
🔸 Not effective for all types of PPHN – Some babies may not respond and need alternative treatments like ECMO (life support).
🔸 Potential side effects – Long-term use may lead to methemoglobinemia (a rare condition that affects oxygen transport in the blood).
🔸 High cost – iNO therapy is expensive and may not be available in all neonatal care centers.
📌 Final Thoughts
Inhaled nitric oxide therapy has revolutionized the treatment of severe PPHN, offering a safe and effective way to improve oxygenation when standard treatments fail. While not a cure, iNO can significantly increase survival rates and reduce complications in critically ill newborns.
