Exhaled nitric oxide in neonates with or without hypoxemic respiratory failure

doi:10.5847/wjem.j.1920-8642.2011.03.007

Abstract

Abstract:

BACKGROUND: Exhaled nitric oxide (eNO) is one of the airway condensate derived markers, reflecting mainly airway inflammation in asthma and other lung diseases. The changes of eNO levels as pathophysiology of neonatal hypoxemic respiratory failure (HRF) in early postnatal life have not been thoroughly studied. The present study was to establish a method for measuring eNO concentrations in neonates with or without HRF.
METHODS: Twenty-two newborn infants with HRF and 26 non-NRF controls were included within the first 24 hours of postnatal life. Their eNO levels were detected with a rapid-response chemiluminescence analyzer daily during the first week of their postnatal life, and lung mechanics and gas exchange efficiency were monitored at the same time, such as pulse oxygen saturation (SpO₂), inspired fraction of oxygen (FiO₂) and other parameters.
RESULTS: During the first two days of postnatal life, eNO values of HRF neonates were significantly higher than those of the control neonates (day 1, 7.9±3.2 vs. 5.8±1.8 parts per billion [ppb], P<0.05; day 2, 8.8±3.2 vs. 6.0±2.4 ppb, P<0.05), but there were no significant differences in the following days. With SpO₂/FiO₂ increasing, difference of eNO values between the HRF and non-HRF neonates became narrowed, but there was still a two-fold difference of eNO/[SpO₂/(FiO₂×100)] on days 5-7.
CONCLUSION: We established a method for measuring eNO and found difference in neonates with or without HRF, which diminished with prolonged postnatal days, reflecting pathophysiological characteristics of HRF.

Key words: Neonates, Respiratory failure, Respiratory therapy, Nitric oxide, Respiratory physiology, Nitric oxide synthase

Li-juan Liu, Xi-rong Gao, Pan-pan Wu, Li-ling Qian, Chao Chen, Bo Sun. Exhaled nitric oxide in neonates with or without hypoxemic respiratory failure[J]. World Journal of Emergency Medicine, 2011, 2(3): 195-200.

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Variables	HRF (n=22)	Control (n=26)
Birth weight (mean±SD) (g)	2490±1039	2238±757
Gestational age (mean±SD) (week)	34.8±4.2	35.6±3.6
M/F	19/3^*	11/15
Delivery mode (n, %)
Vaginal delivery	11 (50)	10 (39)
Cesarean delivery	11 (50)	16 (61)
1-min Apgar M (IQR)	8 (7-9)^*	9 (8-10)
5-min Apgar M (IQR)	8 (7-10)^*	10 (9-10)

Postnatal day (d)	Control (n=26)		HRF (n=22)
Postnatal day (d)	eNO	Range	eNO	Range
1	5.8±1.8	3.1-9.8	7.9±3.2^*	3.6-12.6
2	6.0±2.4	3.1-10.7	8.8±3.2^*	4.5-15.7
3-4	6.7±2.0	3.6-10.0	8.9±3.0	4.7-15.4
5-7	7.1±2.4	2.7-9.4	8.7±1.6	6.8-11.6

Parameters	1	2	3-4	5-7
SpO₂(%)
HRF group	93±5^*	97±3	96±2	96±3
Control group	98±3	98±3	97±3	99±2
SpO₂/FiO₂
HRF group	227±101^*	311±89^*	372±74^*	419±34^*
Control group	468±13	468±15	463±14	464±9
eNO/[SpO₂/(FiO₂×100)]
HRF group	4.5±2.4^#	3.2±1.9^#	2.9±1.5^#	2.1±0.4^#
Control group	1.2±0.4	1.2±0.3	1.1±0.3	0.9±0.2

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