Hipertensión pulmonar e hipoxemia grave en recién nacidos

Severe hypoxemia and pulmonary hypertension in newborns Inhaled nitric oxide (iNO) through direct pulmonary vasodilator action and without sistemyc effects, is the gold standard treatment for pulmonary hypertension of the newborn (HTPP). This work was designed with the aim of evaluating the response to this treatment in 16 newborn patients in an intensive care unit, by changes in oxygen saturation (SO2), medium airway pressure (MAP) and inspirited fraction of O2 (FiO2). Two groups were anaylized: 1) under iNO treatment during the first 72 hs of life, where the most frequent diagnosis was meconium aspiration syndrome and 2) newborns with severe respiratory failure (n = 3), refractary to treatment, in which iNO was begun alter 14 days of life. Among patients of group 1 it was evident an increase in SO2 after the first 6 hs of treatment with iNO. The decrease FiO2 and MAP occurred later. The mortality rate was 23% (2/13) in this group. In group 2 the SO2 increased, leading to a decrease in ventilatory support in the first 72 hours of treatment in one case. iNO doses were lesser than 20 ppm in 8/13 patients, there were neither platelet impairment, nor bleeding or metahemoglobinemia. There was no rebound effect after finishing iNO therapy from minimum doses (2 ppm). In this unit the inclusion of iNO treatment in HTPP or respiratory failure was associated with improvement in SO2 and a decrease in ventilatory support, without adverse effects resulting in a benefit over the globally support therapy. (Key words: Hypertension, pulmonary, nitric oxide, anoxemia, infant, newborn). Arch Pediatr Urug 2007; 78(4): 270-280