Background: Therapy with inhaled nitric oxide (iNO) is effective in the
management of pulmonary hypertension and severe hypoxemia. However, these benefits
have not been demonstrated in preterm infants (<34 weeks). The objective of this
report is to present the experience of eight cases of preterm neonates with respiratory
distress syndrome (RDS) and refractory hypoxemia, with oligohydramnios history.
Methods: We evaluated the clinical feature of 8 preterm neonates with severe hypoxemia
who had maternal antecedents of oligoamnios, mainly due to premature rupture of
membranes. They were treated with conventional management, with poor clinical response.
Therefore, these neonates were treated with iNO, as a rescue strategy. iNO has
been used with a dosage of 5 – 10 ppm. An echocardiogram was performed to determine
the presence of structural malformations or persistent ductus arteriosus.
Results: All the infants showed improvement in oxygenation. The neonates had signs
of low flow pulmonary, confirmed by echocardiogram. Five preterm infants survived
without complications associated with the therapy. Two died from pulmonary bleeding
secondary to ductus arteriosus and another for pneumothorax.
Conclusion: iNO therapy can be useful in a subgroup of preterm infants with a high
risk of death secondary to hypoxemia. Although this report is based on a small number
of cases, it follows the directions of other studies that suggest that iNO therapy
can benefit preterm neonates, particularly those exposed to oligohydramnios.