Inhaled nitric oxide enhances oxygenation but not survival in infants with alveolar capillary dysplasia

Robin H Steinhorn, P. N. Cox, J. R. Fineman, N. N. Finer, E. M. Rosenberg, M. M. Silver, J. Tyebkhan, M. S. Zwass, F. C. Marin

Research output: Contribution to journalArticle

51 Citations (Scopus)

Abstract

A complex vascular abnormality in the lungs, termed alveolar capillary dysplasia (ACD) and misalignment of the lung vessels, has been recently recognized in some infants with persistent pulmonary hypertension. These infants die despite maximal medical support including extracorporeal membrane oxygenation (ECMO). Inhaled nitric oxide has been reported to improve oxygenation in neonates with persistent pulmonary hypertension of the newborn, and may allow some infants to avoid the need for ECMO. We identified five infants who had received inhaled nitric oxide to treat refractory hypoxemia caused by persistent pulmonary hypertension of the newborn, and who subsequently died and had autopsy confirmation of ACD. Each infant received care of a different medical center. In each patient, inhaled NO increased the arterial partial pressure of oxygen dramatically. Despite initial clinical improvement, the response to NO was not sustained in any patient. As responsiveness was lost, each infant with ACD required inhaled NO concentrations of 80 ppm or higher to sustain oxygenation. Each infant died, four after extensive periods of ECMO support. This experience demonstrates that a short-term improvement after inhalation of nitric oxide does not lead to long-term survival in ACD. Further, in three infants the diagnosis of ACD was established by lung biopsy before death. Increasing awareness of this clinical entity may allow for the avoidance of costly, invasive procedures such as ECMO until more specific therapies become available.

Original languageEnglish (US)
Pages (from-to)417-422
Number of pages6
JournalJournal of Pediatrics
Volume130
Issue number3
DOIs
StatePublished - 1997
Externally publishedYes

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Nitric Oxide
Extracorporeal Membrane Oxygenation
Survival
Persistent Fetal Circulation Syndrome
Lung
Infant Care
Partial Pressure
Alveolar capillary dysplasia
Pulmonary Hypertension
Inhalation
Blood Vessels
Autopsy
Arterial Pressure
Newborn Infant
Oxygen
Biopsy

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Steinhorn, R. H., Cox, P. N., Fineman, J. R., Finer, N. N., Rosenberg, E. M., Silver, M. M., ... Marin, F. C. (1997). Inhaled nitric oxide enhances oxygenation but not survival in infants with alveolar capillary dysplasia. Journal of Pediatrics, 130(3), 417-422. https://doi.org/10.1016/S0022-3476(97)70203-8

Inhaled nitric oxide enhances oxygenation but not survival in infants with alveolar capillary dysplasia. / Steinhorn, Robin H; Cox, P. N.; Fineman, J. R.; Finer, N. N.; Rosenberg, E. M.; Silver, M. M.; Tyebkhan, J.; Zwass, M. S.; Marin, F. C.

In: Journal of Pediatrics, Vol. 130, No. 3, 1997, p. 417-422.

Research output: Contribution to journalArticle

Steinhorn, RH, Cox, PN, Fineman, JR, Finer, NN, Rosenberg, EM, Silver, MM, Tyebkhan, J, Zwass, MS & Marin, FC 1997, 'Inhaled nitric oxide enhances oxygenation but not survival in infants with alveolar capillary dysplasia', Journal of Pediatrics, vol. 130, no. 3, pp. 417-422. https://doi.org/10.1016/S0022-3476(97)70203-8
Steinhorn, Robin H ; Cox, P. N. ; Fineman, J. R. ; Finer, N. N. ; Rosenberg, E. M. ; Silver, M. M. ; Tyebkhan, J. ; Zwass, M. S. ; Marin, F. C. / Inhaled nitric oxide enhances oxygenation but not survival in infants with alveolar capillary dysplasia. In: Journal of Pediatrics. 1997 ; Vol. 130, No. 3. pp. 417-422.
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