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 oxygenate the blood, and the pulmonary vessels are maintained in a state of high resistance that diverts blood away from the lungs through foetal shunts.
With the first breaths after birth, this resistance normally falls rapidly, the shunts close, and blood flows through the lungs to pick up oxygen. When this transition fails, the consequences unfold quickly and can be fatal without specific intervention.
Persistent pulmonary hypertension of the newborn is the condition that results when this transition does not occur. Blood continues to bypass the lungs, oxygen levels in the blood remain critically low despite ventilatory support, and the baby deteriorates rapidly. Standard ventilation and supportive care are not enough.
The pulmonary blood vessels themselves need to be dilated, and they need to be dilated selectively without dropping the systemic blood pressure at the same time.
Inhaled nitric oxide is the only medication that achieves this with the selectivity that safe treatment requires. At KIMS Cuddles at KIMS Hospitals, Mahadevapura, inhaled nitric oxide for neonatal care in Mahadevapura, Bengaluru is available as a standard NICU treatment, giving critically ill newborns with pulmonary hypertension access to this life-saving therapy without the additional risk of transfer to a distant facility.
How Inhaled Nitric Oxide Works?
Inhaled nitric oxide is delivered as a gas via the inspiratory limb of the ventilator circuit, and so enters the alveoli on every ventilated breath. It diffuses through the pulmonary epithelium to the pulmonary vascular smooth muscle, where it activates a pathway resulting in smooth muscle relaxation and vasodilation.
The critical advantage of this mechanism is its selectivity. Because neonatal nitric oxide therapy in Bengaluru acts only where it can reach, which is the ventilated alveoli, and because it is rapidly inactivated by haemoglobin in the blood before it can circulate, its vasodilatory effect is confined to the pulmonary circulation.
Systemic blood pressure is not affected. This distinguishes it from intravenous pulmonary vasodilators that produce unwanted systemic hypotension alongside their pulmonary effect, a complication that in a critically ill newborn can be as dangerous as the original problem.
Conditions Treated With Inhaled Nitric Oxide
PPHN treatment in Bengaluru at our unit uses inhaled nitric oxide for the following neonatal conditions:
- Idiopathic persistent pulmonary hypertension of the newborn (IPPHN), in which the expected change of pulmonary circulation at birth does not occur, for no apparent structural reason.
- When aspiration of meconium causes airway obstruction and then causes pulmonary vasoconstriction as well (meconium aspiration syndrome with pulmonary hypertension).
- Congenital diaphragmatic hernia in which there is a combination of pulmonary hypoplasia and vascular abnormality resulting in a severe pulmonary hypertension which may be present for days after surgery.
- PAPH is a form of pulmonary hypertension that is caused by inflammatory mediators causing pulmonary vasoconstriction during sepsis.
- Respiratory Distress Syndrome (RDS) with secondary pulmonary hypertension in term or near-term newborns.
In each of these situations, the pulmonary hypertension is contributing directly to the baby's critical hypoxaemia, and treating it selectively with inhaled nitric oxide allows the ventilatory management to work more effectively without the haemodynamic complications that systemic vasodilators introduce.
Administration and Monitoring
Inhaled nitric oxide is delivered through the ventilator circuit at concentrations typically between five and twenty parts per million, with the starting dose determined by the severity of the pulmonary hypertension and the response assessed through oxygenation monitoring and echocardiographic parameters.
We routinely monitor methemoglobin levels during treatment as nitric oxide can oxidise haemoglobin to methemoglobin which does not carry oxygen. Nitrogen dioxide is a toxic by-product of nitric oxide in the presence of oxygen and is monitored to ensure it remains within safe limits throughout the course of treatment. These safety checks are part of our mandatory monitoring in our nitric oxide treatment protocol, not optional extras.
The effectiveness of treatment is evaluated by examining improvement in oxygenation indices, generally within 30 minutes to 2 hours of treatment, after the treatment has begun. Babies who respond well have a significant and ongoing improvement in their oxygen saturation level which lessens the ventilatory pressures required to keep the baby oxygenated.
Weaning Inhaled Nitric Oxide
When the baby is showing sustained clinical improvement, inhaled nitric oxide should be weaned slowly and carefully over a period of time. Rebound pulmonary vasoconstriction occurs if the drug is stopped suddenly, which may lead to sudden, severe, and even life-threatening deterioration.
Weaning is done according to a well-established protocol that looks at how the baby responds to each step of the weaning process before proceeding to the next step, and can immediately increase the dose if the baby experiences any signs of rebound hypertension during the weaning process.
Why Choose KIMS Cuddles at KIMS Hospitals, Mahadevapura
Inhaled nitric oxide neonatal treatment in Mahadevapura, Bengaluru 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, Mahadevapura, this capability is available within a fully equipped NICU, reducing the risk and delay associated with transferring the most critically hypoxaemic newborns to distant facilities for this treatment. For families in Mahadevapura, Whitefield, and East Bengaluru, access to this treatment close to home is meaningful when every hour matters.
Contact Our Team
Contact KIMS Cuddles at KIMS Hospitals, Mahadevapura immediately if you have a newborn with suspected or confirmed pulmonary hypertension requiring specialist neonatal care. We have a 24-hour neonatal team.
