The immediate efficacy of inhaled nitric oxide treatment in preterm infants with acute respiratory failure during neonatal transport

Aim: The aim of our review was to describe the clinical response to inhaled nitric oxide (iNO) in a series of preterm babies in respiratory failure during uplift transfers to a neonatal intensive care unit.

Methods: We performed a retrospective review of critical newborns with gestational age <34⁺⁰ weeks transferred from January 2013 to December 2018. Data were extracted from our Clinical Information System for transport. The primary measure of this review was to assess whether a significant improvement in the oxygenation saturation index (OSI) occurred following the use of iNO.

Results: Thirty preterm babies <34⁺⁰ weeks were included in our review. OSI, as a measure of oxygenation, did not statistically improve as an immediate response to iNO from referral to receiving hospital (17.1 vs 16.4; P = .7). We found that pH (7.15 vs 7.29; P = .004) and pCO2 (8.1 vs 6.3; P = .05) significantly improved probably based on ventilation management.

Conclusion: Following the recommendations of the American Academy of Paediatrics and other organizations, iNO should not routinely be used during the neonatal transfer of preterm babies <34⁺⁰ in respiratory failure. We need to conduct further studies to establish which selected preterm patients would benefit from being treated with iNO.