Inhaled nitric oxide in severe bronchopulmonary dysplasia

Introduction. Bronchopulmonary dysplasia (BPD) is widely regarded as a serious complication of neonatal respiratory distress syndrome. We report a case of severe BPD in which inhaled nitric oxide (NO) allowed persistent reduction of oxygen supplementation. Case report. The girl was born at 24 weeks gestation. She developed respiratory distress syndrom and was mechanically ventilated, but remained hypoxic despite early surfactant therapy and high frequency oscillatory ventilation. Application of iNO improved oxygenation rapidly. She was extubated three weeks later but developed severe BPD so that she was considered for lung transplantation when she was 1 year old. In this situation long term application of iNO via nCPAP allowed for persistent reduction of supplemental oxygen. At 2 years of age she could finally be weaned from additional inspired oxygen. Conclusion. The application of NO via nCPAP may be a relatively non-invasive yet highly effective treatment in some cases of severe BPD with predominantly elevated pulmonary vascular resistance and ventilation/perfusion mismatch in whom conventional therapy has failed. Particularly the deleterious effects of high oxygen concentrations on lung tissue may be avoided.