At birth, one of the most critical physiological transitions a newborn must make is the opening of the pulmonary circulation. In the womb, the lungs do not need to oxygenate the blood, and the pulmonary vessels are therefore maintained in a state of high resistance that diverts blood away from the lungs through foetal shunts. At birth, with the first breaths, this resistance normally drops rapidly, the shunts close, and blood begins flowing through the lungs to pick up oxygen.
When this transition fails, persistent pulmonary hypertension of the newborn develops. Blood continues to bypass the lungs, oxygen levels in the blood remain critically low despite aggressive ventilatory support, and the baby deteriorates rapidly without specific intervention.
Inhaled nitric oxide is the only medication that can selectively dilate the pulmonary blood vessels in this situation, reducing pulmonary vascular resistance and restoring normal blood flow through the lungs, without the systemic vasodilation that intravenous pulmonary vasodilators produce. At KIMS Cuddles at KIMS Hospitals, Electronic City, inhaled nitric oxide for neonatal care at Electronic City Bengaluru is available as a standard NICU treatment for persistent pulmonary hypertension of the newborn and other conditions causing severe hypoxaemia.
What Persistent Pulmonary Hypertension Is
Pulmonary hypertension in newborns in Electronic City can occur as a primary condition in term or near-term babies, where the pulmonary vascular transition at birth fails without an identifiable structural cause, or secondary to other conditions including meconium aspiration syndrome, congenital diaphragmatic hernia, birth asphyxia, and neonatal sepsis. All of these conditions can produce pulmonary vasoconstriction severe enough to cause life-threatening right-to-left shunting, where deoxygenated blood passes through the lungs and enters the systemic circulation.
The clinical picture is of severe hypoxaemia out of proportion to the degree of lung illness seen on chest X-ray, typically with considerable lability where oxygen saturation swings dramatically with modest handling or stimulation. Echocardiography confirms the diagnosis by displaying higher pulmonary arterial pressure and the direction of shunting across persisting foetal shunts.
How Inhaled Nitric Oxide Works
In the NICU in Electronic City, the patient is given nitric oxide as a gas added to the inspiratory limb of the ventilator circuit, and it reaches the alveoli with every ventilated breath. In the alveoli it diffuses over the pulmonary epithelium into the adjacent pulmonary vascular smooth muscle where it activates guanylate cyclase, raises cyclic GMP and promotes smooth muscle relaxation and vasodilation.
The main benefit of this technique is its selectivity. Inhaled nitric oxide is delivered selectively to the ventilated areas of the lung where it is immediately inactivated by haemoglobin in the blood. This limits the vasodilator impact to the pulmonary circulation. Systemic blood pressure is not changed, distinguishing it from intravenous vasodilators that create undesirable systemic hypotension with their pulmonary action.
Conditions Treated With Inhaled Nitric Oxide
PPHN treatment at South Bengaluru using inhaled nitric oxide is indicated in the following neonatal conditions:
- Idiopathic persistent pulmonary hypertension of the newborn, where the transition of the pulmonary circulation at birth fails
- Meconium aspiration syndrome with pulmonary hypertension, where aspirated meconium produces both mechanical airway obstruction and pulmonary vasoconstriction
- Congenital diaphragmatic hernia, where pulmonary hypoplasia and vascular abnormality combine to produce severe pulmonary hypertension
- Sepsis-associated pulmonary hypertension, where inflammatory mediators drive pulmonary vasoconstriction
- Respiratory distress syndrome with secondary pulmonary hypertension in term or near-term newborns
Administration and Monitoring
Inhaled nitric oxide is delivered through the ventilator circuit at concentrations typically between five and twenty parts per million, with the initial dose determined by the severity of the pulmonary hypertension and the response assessed by monitoring oxygenation and echocardiographic parameters.
Our team monitors methaemoglobin levels regularly during treatment, as nitric oxide can oxidise haemoglobin to methaemoglobin, which does not carry oxygen. Nitrogen dioxide, a toxic byproduct of nitric oxide in the presence of oxygen, is also monitored to ensure levels remain within safe limits. These safety checks are built into our nitric oxide treatment protocol as mandatory monitoring rather than optional safety measures.
Response to treatment is assessed through improvement in oxygenation indices, typically within thirty minutes to two hours of initiation. Babies who do not respond to inhaled nitric oxide are assessed for ECMO candidacy where this is available within our network.
Weaning Inhaled Nitric Oxide
Weaning inhaled nitric oxide is a gradual process with careful dose reduction when the baby has shown consistent clinical improvement. In our practice, we adopt a planned weaning approach, which involves watching the baby’s response to each step of dose reduction before moving on to the next step, because abrupt discontinuation might induce rebound pulmonary vasoconstriction and acute worsening.
Why Choose KIMS Cuddles at KIMS Hospitals, Electronic City
Inhaled nitric oxide treatment requires specific delivery equipment integrated with the ventilator circuit, clinical expertise in its indications and monitoring, and the NICU infrastructure to manage the critically ill newborns in whom it is indicated. At KIMS Cuddles at KIMS Hospitals, Electronic City, this capability is available within a fully equipped NICU in South Bengaluru, reducing the risk and delay associated with transferring the most critically hypoxaemic newborns to distant facilities for this treatment.
Contact Our Team
If you have a newborn with suspected or confirmed pulmonary hypertension requiring specialist neonatal care, contact KIMS Cuddles at KIMS Hospitals, Electronic City immediately. Our neonatal team is available around the clock.
