Analysis On The Effect Of Inhaled Nitric Oxide Therapy In Neonatal Refractory Respiratory Failure

ObjectiveTo Study the efficacy and safety of inhaled nitric oxide （Inhaled nitric oxide, iNO） intreatment of intractable neonatal hypoxic respiratory failure （Hypoxic RespiratoryFailure, HRF）, to observe the decrease of the mortality rate and improvement ofoxygenation and the effects on complications, to explore the operation difficulty andadverse reactions, in order to improve the critical neonates the success rate of andaccumulate experience for promoting the use of the treatment in our province medicalunits in future.MethodsInclusion criteria: Children who were still hypoxemic respiratory failure after2hours ofregular mechanical ventilation, high frequency ventilation and/or surfactant therapy（FiO₂>80%, PaO₂<50mmHg, SpO₂<85%, or OI>15）. Treatment methods: The initialconcentration of iNO is10ppm. To adjust the concentration according to theoxygenation in infants, decreasing the concentration of NO below3ppm and evacuationon responders. Monitoring blood gas analysis, ventilator parameters, transcutaneousoxygen saturation, the inspired oxygen concentration, the dynamic monitoring of vitalsigns, blood coagulation time and platelet, nitrogen dioxide and high iron hemoglobinbefore treatment,1H,12h,24h and then every24hours after treatment by own controlmethod. Doing statistical analysis of the data obtained. monitoring and judge theconsequences of possible adverse reactions at the same time. ResultsA total of40patients met the inclusion criteria, including30cases of full-term infants,10preterm infants, with5late preterm infants（GA≥34W）,5premature infants whoborn at≤34weeks’gestation. Inhalation of oxygen were improved after1h with iNOtreatment in all patients. Percutaneous oxygen concentration and arterial oxygenpressure werre raised. Inhaled oxygen concentration and oxygenation index weredecreased. The difference was significant （P<0.05）. No obvious adverse reaction wasmonitored. Although oxygenation can rapidly improve on5preterm infants cases withiNO treatment. But4cases were complicated by intracranial hemorrhage,1cases withBPD. In the process of iNO, the data of platelet, coagulation, methemoglobin were inthe normal range by monitoring life signs of all children.ConclusionFor refractory HRF patients （CMV or HFOV） who can’t treated by ventilation, iNOtherapy can rapidly improve oxygenation, correct hypoxemia, shorten the highconcentration oxygen inhalation time and improve the success rate of rescue. Noadverse reaction was found during treatment. Premature infants whose gestational age<34weeks should be used with caution.