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Methemoglobin to cumulative nitric oxide ratio and response to inhaled nitric oxide in PPHN
Journal of Perinatology, 06/26/09

Pabalan MJ et al. - Inadequate oxygenation response to iNO is associated with lower MHb/ Sigma NO, suggesting suboptimal delivery of iNO to the pulmonary vasculature.

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Dr S Lakshminrusimha, 06/26/09

Methemoglobin levels are routinely evaluated in the neonatal intensive care unit during the management of infants with persistent pulmonary hypertension of the newborn (PPHN) with inhaled nitric oxide (iNO). Parenchymal lung disease is an important cause of PPHN. Inhaled NO is not effective in approximately one-third of patients with PPHN. One of the common reasons for failure to respond to iNO is inadequate delivery of iNO to the pulmonary vasculature. If iNO is not delivered to the pulmonary vasculature, it cannot interact with Hb to form methemoglobin. We have shown that infants with parenchymal lung disease that do not respond to iNO have lower methemoglobin to cumulative NO exposure ratio suggesting that suboptimal delivery of NO is an important cause of treatment failure. Optimal lung recruitment prior to administering iNO is of critical importance.

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