Managing persistent pulmonary hypertension of the newborn (PPHN) is a clinical priority, often requiring inhaled nitric oxide neonatal transport for stabilization. For infants needing transfer to tertiary centers, this therapy serves as a vital bridge to ensure adequate gas exchange. Consequently, since 2018, specific services have pioneered this therapy to maintain intensive care standards during long-distance transfers.

A recent retrospective cohort study analyzed 41 newborns who received this therapy between 2018 and 2025. The results showed that meconium aspiration syndrome (MAS) was the most common primary diagnosis, followed by congenital diaphragmatic hernia (CDH). Notably, more than half of the infants received surfactant therapy prior to transport. Additionally, nearly 60% of the cases required high-frequency oscillatory ventilation (HFOV).

Improving Stabilization with Inhaled Nitric Oxide Neonatal Transport

The study results indicate that inhaled nitric oxide neonatal transport is both feasible and safe. Specifically, 43.7% of the neonates responded to treatment, achieving at least a 20% reduction in oxygen requirements by the journey's conclusion. Moreover, the neonatal transport team successfully initiated therapy within the first six hours of life for more than one-third of the patients. This early intervention potentially prevents clinical deterioration during high-risk transfers.

Furthermore, the administration of iNO does not interfere with advanced ventilation techniques like HFOV. Consequently, clinicians can maintain intensive care standards throughout the journey. Although some infants eventually required extracorporeal membrane oxygenation (ECMO) at the tertiary center, the transport therapy provided necessary support until handover.

In the Indian context, where transport times to regional NICUs can be significant, the availability of portable iNO delivery systems is essential. Therefore, implementing standardized protocols for iNO during transport could improve outcomes for neonates with refractory hypoxemia.

FAQs

Is inhaled nitric oxide safe for neonatal transport?

Yes, research confirms that providing inhaled nitric oxide during neonatal transport is a safe and feasible procedure when specialized teams manage the equipment and monitoring.

What was the oxygenation response rate observed in the study?

Approximately 43.7% of the neonates showed a clinical response, which researchers defined as at least a 20% reduction in their oxygen requirements by the end of the transport.

Disclaimer: This content is for informational and educational purposes only. It does not constitute medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may require regarding a medical condition. Refer to the latest local and national guidelines for clinical practice.

References

Lantos L et al. [Use of inhaled nitric oxide during neonatal transport - a review of seven years of experience]. Orv Hetil. 2026 May 24. doi: 10.1556/650.2026.33539. PMID: 42177754.

Kinsella JP, et al. Inhaled Nitric Oxide in the Management of Neonatal Hypoxemic Respiratory Failure. Clinics in Perinatology. 2024.

DiBlasi RM, et al. Evidence-Based Clinical Practice Guideline: Inhaled Nitric Oxide for Neonates With Acute Hypoxic Respiratory Failure. Respiratory Care. 2025.