INHALED NITRIC OXIDE ON NEONATAL PNEUMONIA WITH INTRAPULMONARY SHUNT IN LATE PRETERM NEWBORN
Sardito Phan,Jessica Christy Limanjaya,Markus Mualim Danusantoso
RSIA BUNDA JAKARTA
Background : Therapeutic potential of inhaled Nitric Oxide (iNO) is known as selective pulmonary vasodilator to reduce vascular resistance in Persistent Pulmonary Hypertension of Newborn (PPHN). It is known to be safe when used in neonates more than 35 weeks Gestational Age (GA), although its benefit in Indonesia is not widely used due to lack of availability. It is also demonstrated that iNO could improve arterial oxygenation in patient with life threatening hypoxemia due to intrapulmonary shunt.
Case Presentation Summary : Baby was born at 36 weeks GA through caesarean section with Apgar Score of 9/9. The mother had a history of recurring infections. Thirty minutes after birth, the oxygen saturation (SpO2) dropped to 45%, without any sign of respiratory distress. Baby was suspected with Congenital Heart Disease (CHD) and was transferred to NICU. Echocardiography was performed and showed PDA and PFO, appropriate to its age. Chest x-ray suggest the diagnosis of pneumonia. On the next day the SpO2 was unstable despite receiving antibiotics, bubble CPAP, or NIPPV. Echocardiography was reevaluated and neither significant cardiac anomaly nor pulmonary hypertension was found, and considered as pneumonia with intrapulmonary shunt. Baby was intubated, supported with mechanical ventilation, and continuous iNO of 20 ppm was given. The baby was stable for the next 48 hours, iNO was weaned and the baby was successfully extubated.
Learning Points/Discussion : In addition of its usefulness to treat PPHN in neonates, iNO can also be used in pulmonary disease with intrapulmonary shunt to improve oxygenation. A further research is needed to provide more representable data on its effectiveness and safety in neonates with respiratory failure other than PPHN.