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Rescue therapy for children

Treatment with inhaled nitric oxide is an effective therapy for hypoxic respiratory failure in babies and infants.

The transition to life outside the womb doesn’t always go smoothly. Complications during birth can send an infant into respiratory distress, which can worsen to hypoxic respiratory failure.

Treatment with inhaled nitric oxide is an effective therapy for hypoxic respiratory failure in babies and infants, according to a number of nurses.

Hypoxic respiratory failure is a potentially fatal condition in which newborn infants, for a variety of reasons, can’t breathe in enough oxygen to survive. Among the causes of hypoxic respiratory failure are meconium aspiration, in which an infant, shortly before birth, inhales amniotic fluid which has been contaminated by a bowel movement and pulmonary hypertension, or high blood pressure in the lungs.
Before nitric oxide therapy, the only effective treatment for hypoxic respiratory failure has been a surgical treatment called ECMO (extracorporeal membrane oxygenation), a highly invasive procedure in which blood is removed from a large vein that empties into the infants heart, pumped into a system that oxygenates the blood, and then returned to the large vessels in the infant’s neck.
Critical care neonatal nurse, Dr Catherine Brown from the Children’s Hospital at Westmead, is one of the pioneering nurses that adopted nitric oxide therapy when it was introduced over 15 years ago. She has since the used it to help save thousands of neonates with respiratory failure.
She said this approach revolutionised the way we treated many critical care neonates.
“Babies who have pulmonary hypertension are very unstable and need a lot of support from ventilation,” she said.
“If high pressure venilation is needed on babies there is a risk of damage to their lungs.
“Nitric oxide is far better than other invasive approaches for treating respiratory failure in neonates, such as ECMO, which has significant side effects.”
Hospitals around Australia will soon have access to a nitric oxide therapy to help save the lives of hundreds of critical care newborns, with the introduction of the TGA approved INOtherapy.
Nitric oxide therapy was first introduced into Australian hospitals to treat newborns in the 1990’s, however from this month, neonatal and paediatric ICU units in hospitals around the country will have access to a new standard of care for nitric oxide therapy, said Lorna Meldrum, CEO of Ikaria, the company which developed INOtherapy.
“Unlike other treatments that expand the blood vessels in the lung, nitric oxide does not decrease blood pressure elsewhere in the body,” she said.
According to Ikaria, INOtherapy is an all in one nitric oxide therapeutic package that enables hospitals to “ensure the safe and effective delivery of nitric oxide therapy protecting the health and welfare of the patient and those who administer the treatment including doctors and nurses”.
“When it comes to delivering nitric oxide, getting the correct dosage is critical,” Meldrum said.
“Nurses are key to this, so we will be offering training and technical help as part of the package.”
Although nitric oxide therapy has been around since 1775 when it was first synthesized by English chemist and natural philosopher Joseph Priestley, its medical applications have been limited.
Today, Nitric oxide is no longer an experimental therapeutic gas with clinical trials and a Cochrane Review supporting the use of nitric oxide for use in pediatrics for pulmonary hypertension, for infants with hypoxic respiratory failure and for use in adults.

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