OXYGEN REQUIREMENT
WITH LOW DOSE INHALED NITRIC OXIDE IN BABIES WITH SEVERE CHRONIC LUNG DISEASE
OF PREMATURITY.
R. Malloy,
BS RRT, B. Glynn, BS RRT, A. Kunig, MD. Depatments of Pulmonary Care and Neonatology,
Thomas Jefferson University Hospital, Philadelphia, Pa.
OBJECTIVE: To determine if
Oxygen (02) requirement changes with inhaled Nitric Oxide (iNO) in babies with
severe chronic lung disease (CLD) of prematurity.
BACKROUND: Babies with severe
CLD of prematurity who are dependent on the ventilator often require significantly
high inspired 02 concentration as the disease progresses. Lung injury and associated
pulmonary hypertension reported in these babies is thought to be due in part,
to continuous oxidant damage which is related to the amount of inspired 02.
Since iNO is known to selectively decrease pulmonary vascular resistance and
potentially improve ventilation perfusion, we theorize that low dose iNO will
reduce 02 requirement in premature babies with CLD of prematurity.
METHOD: 6 premature babies
with initial diagnosis of respiratory distress syndrome were studied using the
VIP Gold Ventilator to optimize ventilation and oxygenation. Inclusion criteria
include > 2 wks old and 02 requirement of >0.60. iNO was started at 10ppm
and weaned to 5 ppm and then to 1 ppm for 02 saturations >92% before discontinuation.
FI02 was weaned by 2-4% and 02 saturations were maintained between 88 and 92%.
All MetHb levels were <2 during the study.
| Duration (days): |
Gest. Age: |
Day of life
on NO: |
FI02: (pre) |
FI02: (post
1 hr) |
FI02: (5
days on NO) |
FI02: OFF
NO |
| 17 |
27 |
53 |
60 |
40 |
50 |
60 |
| 6 |
30 |
92 |
60 |
40 |
25 |
25 |
| 1 |
29 |
13 |
100 |
100 |
100 |
100 |
| 3 |
25 |
27 |
100 |
100 |
50 |
40 |
| 19 |
27 |
18 |
100 |
96 |
78 |
58 |
| 22 |
26 |
48 |
100 |
70 |
54 |
70 |
Results: The patients studied
were started on iNO at a mean age of 41.8 days of life. Average gestational
age was 27.3 weeks. FI02 requirement decreased by an average of 12.3% after
1 hour on iNO and by an average 27.1% after 5 days on iNO. FI02 requirement
decreased by an average of 27.8% after iNO was discontinued.
CONCLUSION: These data suggest
that 02 dependent chronically ventilated premature babies may benefit from low
dose iNO by requiring less inspired oxygen concentration. This may potentially
reduce lung injury and associated morbidity and mortality. Further studies need
to be done to determine the efficacy, possible complications and for how long
low dose iNO can be used for these babies.
OF-02-045
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