The immediate efficacy of inhaled nitric oxide treatment in preterm infants with acute respiratory failure during neonatal transport

Aim The aim of our review was to describe the clinical response to inhaled nitric oxide (iNO) in a series of preterm babies in respiratory failure during uplift transfers to a neonatal intensive care unit. Methods We performed a retrospective review of critical newborns with gestational age <34(+0) weeks transferred from January 2013 to December 2018. Data were extracted from our Clinical Information System for transport. The primary measure of this review was to assess whether a significant improvement in the oxygenation saturation index (OSI) occurred following the use of iNO. Results Thirty preterm babies <34(+0) weeks were included in our review. OSI, as a measure of oxygenation, did not statistically improve as an immediate response to iNO from referral to receiving hospital (17.1 vs 16.4; P = .7). We found that pH (7.15 vs 7.29; P = .004) and pCO2 (8.1 vs 6.3; P = .05) significantly improved probably based on ventilation management. Conclusion Following the recommendations of the American Academy of Paediatrics and other organizations, iNO should not routinely be used during the neonatal transfer of preterm babies <34(+0) in respiratory failure. We need to conduct further studies to establish which selected preterm patients would benefit from being treated with iNO.