Few things are more terrifying to new parents than the premature birth of their baby. Premature babies have not been afforded the opportunity for proper lung development and are susceptible to severe respiratory distress that could result in death. Fortunately, for both baby and parents, nitric oxide is an FDA-approved medication that aids in a premature infant’s breathing. This can prevent respiratory failure and help the baby to continue to develop in an incubator until it is in a stronger and safer physical state. As with any medication, it is important to understand the facts surrounding this drug.
Nitric Oxide Basics
Nitric oxide is an inhaled gas that relaxes the body’s smooth muscle tissue. This, in turn, dilates the blood vessels, increasing oxygenation of the blood. The reason nitric oxide is used in the treatment of premature babies is because it works particularly well in relaxing the muscle tissue and dilating the blood vessels in the lungs. To enhance its effects on the lungs, nitric oxide is dispensed in conjunction with a ventilator and usually administered in a neo-natal intensive care unit under close medical supervision.
What to Expect
Depending on the condition of the infant, nitric oxide will be administered through the baby’s nose or mouth. In severe cases where the baby is connected to a breathing tube, the medicated gas will be dispersed through the tube and into the infant’s lungs. Of course, medical staff will keep a close eye on the baby’s vital signs during treatment, including blood pressure, pulse, body temperature, and respiration. Generally, the infant will not undergo nitric oxide treatment for longer than two weeks.
Parents need not concern themselves with the dosage of this medication, as it is administered and monitored by professional medical staff. This ensures that doses are not missed and there isn’t a risk of accidental overdose of the drug. Should an overdose occur, however, too much nitric oxide does not generally cause severe harm to the patient. Of course, once the baby is released from nitric oxide treatments and the hospital, parents should follow all post-care instructions as accurately as possible.
The most concerning side effects surrounding this drug are generally alleviated simply because the infant is likely under constant medical supervision. That said, common side effects include blood in the baby’s urine, the possibility of a collapsed lung(s), and notable raspy breathing. Some babies also have difficulty breathing once the nitric oxide treatment is stopped. Medical professionals will monitor for these side effects while the infant remains in the hospital; parents should keep a wary eye for them once the baby is home.
Additional side effects parents should keep an eye out for include odd behavior from the infant, such as confusion, dizziness, or unconsciousness. Parents should note if their infant seems weaker or more tired than normal. If the baby begins to sweat, this is also a sign of a possible nitric oxide side effect, as is blurred vision. With a premature infant, these side effects are extremely difficult to isolate because the baby is not yet developed enough to sit or exhibit notable behaviors. Therefore, if the parents suspect the child is any type of danger whatsoever, they should seek medical attention right away.
On the Medical Side
Although the parents themselves are not administering nitric oxide, it’s always comforting to gain the same knowledge of this drug as the professionals have. The maximum dosage of nitric oxide is 20ppm for neonatal babies who are at a term of 34 weeks and are under 14 days of age. Nitric oxide does not generally interact negatively with other medications, and alongside the side effects listed above, the medical professionals will also monitor for the baby’s inability to carry oxygen in the blood (methemoglobinemia), hyperglycemia, hypotension, cellulitis, infection, and sepsis. These side effects are extremely rare, and the benefits of nitric oxide treatment in premature infants suffering from respiratory distress far outweigh the risks.
The birth of a premature baby is a traumatic experience on the parents and the child. Thankfully, modern medicine offers the newborn a far greater chance of survival than it did even 50 years ago. Nitric oxide is part of an arsenal of treatment to strengthen the newborn preemie and encourage continued development and growth outside of the womb. Overall, this medication is extremely effective and safe for use, a reassurance to the distressed parents that their baby will likely be just fine.
For more information on nitric oxide, please consult the following links:
- Nitric Oxide Helps Some Tiny Preemies
- Inhaled Nitric Oxide in Preterm Infants (PDF)
- Nitric Oxide Reduces Brain Damage Risk in Premature Newborns
- Inhaled Nitric Oxide Protects the Brains of High-risk Premature Infants
- Inhaled Nitric Oxide Reduces Lung Disease in Premature Babies
- Inhaled Nitric Oxide
- Premature Babies Benefitting from Nitric Oxide at Shands at the University of Florida
- Inhaled Nitric Oxide is Safe for Tiny Lungs
- Study Suggests Nitric Oxide Could Aid Premature and Low-Birth-Weight Infants
- Physician’s Update: New Role of Nitric Oxide (PDF)
- Current Pharmacologic Approaches for Prevention and Treatment of Bronchopulmonary Dysplasia
- Nitric Oxide (By Breathing)
- Persistent Pulmonary Hypertension of the Newborn
- Medical Management Guidelines for Nitrogen Oxides
- Nitric Oxide (Inhalation Route)
- Evidence Based Guideline: Inhaled Nitric Oxide