The Benefits of Nitric Oxide Treatment in the Intensive Care Nursery
- Crozer-Chester Medical Center is using nitric oxide to effectively treat newborns with Persistent Pulmonary Hypertension of the Newborn (PPHN).
- PPHN occurs when a newborn’s circulation system does not adapt to breathing outside the womb.
- Once the diagnosis has been made, a neonatologist will provide a treatment plan to maximize the amount of oxygen delivered to the baby’s lungs, so 100 percent oxygen will be given through a tube inserted directly into the baby’s trachea.
The first few cries of her newborn are the most important sounds to a new mother; they often indicate that the baby is healthy and strong. However, some babies may experience breathing and lung problems immediately after birth that require additional medical attention.
Persistent Pulmonary Hypertension of the Newborn (PPHN) is a rare, but life-threatening condition that occurs most often in full-term or post-term infants. This condition occurs in babies who have had a difficult birth, or who have conditions such as infection or birth asphyxia, in which a baby has received an inadequate amount of oxygen during delivery.
PPHN occurs when a newborn’s circulation system does not adapt to breathing outside the womb. While a fetus is in the womb, it gets its oxygen from its mother through the umbilical cord, so the lungs need little blood supply. There is high blood pressure in the lungs, so blood in the pulmonary artery is sent away from the lungs to the other organs through a fetal blood vessel called the ductus arterious.
When the baby is born and takes its first breaths, the blood pressure in the lungs falls, allowing an increase in blood flow to the lungs, where oxygen and carbon dioxide are exchanged. The oxygenated blood is then returned to the heart and pumped out to the body. The ductus arterious constricts and permanently closes over the first few days of life. However, in babies with PPHN, the pressure in the lungs remains high and the ductus arterious remains open, and blood is directed away from the lungs.
Kelly Ecker, D.O. and Andrew Meyer, M.D., neonatologists at Crozer-Chester Medical Center, are using nitric oxide to effectively treat newborns with PPHN. Nitric oxide relaxes contracted lung blood vessels and improves blood flow to the lungs, thus improving oxygenation in the baby. “Having this option at Crozer is exciting, because now we can treat a newborn with PPHN without having to transport him/her to another hospital, allowing the baby to stay with the mother in the Intensive Care Nursery,” says Meyer.
Newborns that are diagnosed with PPHN first undergo a series of imaging and laboratory tests to help determine their treatment. Testing usually includes a chest X-ray, an ultrasound of the heart (an echocardiogram), and a series of blood tests. Once the diagnosis has been made, a neonatologist will design a treatment plan to maximize the amount of oxygen delivered to the baby’s lungs, and subsequently, delivered to the entire body. Oxygen will be given through a tube inserted directly into the baby’s trachea. The oxygen is administered by a ventilator to improve delivery to the lungs and helps relax the blood vessels leading into the lungs.
“As a level three ICN, we are equipped to treat a newborn with PPHN quickly once the diagnosis has been made. PPHN isn’t something you can predetermine, and having nitric oxide as a treatment option allows the medical team to provide immediate care to the newborn,” Ecker says. “We have been very successful with this form of treatment and are pleased that we have this technology in the ICN to provide to our babies.”
Crozer-Keystone Health System boasts two state-certified Intensive Care Nurseries that are fully equipped to care for virtually all high-risk infants: a Level III-A Intensive Care Nursery (ICN) at Crozer and a Level II-A Neonatal Intensive Care Unit at Delaware County Memorial Hospital. Crozer’s Level III ICN holds the second-highest level of certification in Pennsylvania and is the only Level III nursery in Delaware County.
Visit http://4ubaby.crozer.org or call the maternity provider appointment line at 1-855-CK-BABIES (1-855-252-2243) for more information.