Inhaled nitric oxide use in newborns

Inhaled nitric oxide (iNO) is a pulmonary vasodilator that plays a major role in regulating vascular muscle tone. It has emerged as a treatment for hypoxemic respiratory failure in newly born infants that is associated with persistent high pulmonary vascular pressure and resultant right-to-left shunting of blood (persistent pulmonary hypertension of the newborn). Current evidence shows that iNO improves oxygenation and decreases the combined outcome of death or need for extracorporeal membrane oxygenation in infants >= 35 weeks' gestational age at birth. Its role in managing preterm infants <35 weeks' gestational age is not yet established. iNO is safe when administered in tertiary care settings using strict protocols and monitoring. The recommended starting dose is 20 ppm with gradual reduction of the dose following improvement in oxygenation.