Uso de óxido nítrico inalado como terapia de resgate em recém-nascidos de pré-termo: uma série de casos

Abstract

Introduction and Objectives: Inhaled nitric oxide (iNO) is a potent selective pulmonary vasodilator used, in neonatology, in the treatment of hypoxic respiratory failure associated to pulmonary hypertension (PH) in term and near-term neonates. Its usage in newborns with gestational age less than 34 weeks is controversial and considered off-label. This study aims to describe the experience of a level III Neonatal Intensive Care Unit with iNO treatment of PH in preterm infants. Materials and Methods: Retrospective case series description of preterm newborns treated with iNO for PH between January 2000 and October 2020. Results: Twelve preterm newborns underwent treatment with iNO, three (25%) presented gestational age less than 34 weeks, nine (75%) had severe PH and three (25%) moderate PH. Nine (75%) started treatment with iNO shortly after birth and five (42%) required doses higher than 30 ppm. Treatment time ranged from 8 hours to 22 days. In six (50%) cases benefit with iNO therapy was documented. Mortality was 50%. Conclusions: This series demonstrates the importance of iNO usage as rescue therapy in the treatment of PH in the preterm newborn. Large scale studies and specific treatment guidelines for this age group are needed.