Inhaled nitric oxide for oligohydramnios-induced pulmonary hypoplasia: A report of two cases and review of the literature

Divisions of Neonatology and Pulmonary Biology, Children's Hospital Medical Center and Good Samaritan Hospital, Cincinnati, OH 45229-3039, USA.
Journal of Perinatology (Impact Factor: 2.35). 02/2002; 22(1):82-5. DOI: 10.1038/
Source: PubMed

ABSTRACT We describe the clinical courses of two premature infants, a male born at 29(4/7) weeks' gestational age after an 8-week period of rupture of membranes (ROM) and severe oligohydramnios, and a female infant born at 31 weeks' gestational age after an 18-week period of ROM and severe oligohydramnios. Within hours after birth, despite intubation and aggressive ventilation, both infants developed fulminant hypoxic respiratory failure. Their clinical courses were consistent with pulmonary hypertension and both infants were transferred for trials of inhaled nitric oxide (iNO). Both infants had dramatic responses to iNO, suggesting that the pulmonary disease seen after prolonged oligohydramnios may have a component of nitric oxide-sensitive pulmonary hypertension. The goals of this article are to (1) review oligohydramnios-induced pulmonary hypoplasia, (2) discuss patients at highest mortality risk, and (3) describe the effects of iNO on pulmonary hypertension in infants with hypoxemia following prolonged ROM and severe oligohydramnios.

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    • "Gestational age at PPROM and the latency period between rupture of membranes and delivery are significant risk factors for the development of pulmonary hypoplasia, which is associated with a poor neonatal outcome [2]. However, it is increasingly recognised, that many infants with pulmonary hypoplasia have an element of reversible pulmonary hypertension that is sensitive to inhaled nitric oxide (iNO) therapy [3] [4] [5]. Furthermore, animal data suggest that iNO therapy enhances distal lung growth and promotes pulmonary vascular angiogenesis [6]. "
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