Nitric oxide via inhalation in the newborn infant and the child with acute hypoxemic respiratory failure

Inhaled nitric oxide (NO) has been recently proposed as a new treatment in newborns and children with severe hypoxemic respiratory failure. Differently from other vasodilators, inhaled nitric oxide selectively lowers pulmonary vascular resistance and pulmonary arterial pressure, and improves the ventilation/perfusion matching by directing pulmonary blood flow toward better ventilated areas, ultimately improving systemic oxygenation. In our experience, we have observed that inhaled NO may acutely ameliorate gas exchange in patients with severe respiratory failure. This may allow a reduction of both ventilatory parameters and fraction of inspired oxygen, thus limiting further damage to the lungs. Nonetheless, the underlying disease and the clinical conditions before NO treatment seem to maintain a crucial role in the ultimate prognosis of these patients. Further studies are needed in order to better define indications, dosages, and safety of nitric oxide treatment, and to verify its authentic prognostic value in neonates and children with acute respiratory failure.