Abstract
INTRODUCTION
The management of newborns with persistent pulmonary hypertension has critical importance. These infants require immediate on-site intensive care, which must be continued during transport until arrival at a tertiary regional center. Inhaled nitric oxide is an effective pulmonary vasodilator, and its use during transport may support the treatment of pulmonary hypertension and ensure adequate gas exchange until handover in the intensive care unit. Since March 2018, the Neonatal Transport Service of the Peter Cerny Foundation has been the only provider in Hungary to administer inhaled nitric oxide during neonatal transport.
OBJECTIVE
To evaluate the use of inhaled nitric oxide during definitive on-site management and neonatal transport.
METHOD
In this retrospective cohort study, we analyzed data from newborn infants born between March 2018 and March 2025 who were transported by the Neonatal Transport Service of the Peter Cerny Foundation and received inhaled nitric oxide therapy. 5 patients were excluded due to postnatal age over one week or postmenstrual age exceeding 46 weeks, and 3 additional patients were excluded because of incomplete ventilation data.
RESULTS
A total of 41 cases were included in the analysis. The mean gestational age was 38 weeks (range: 28-41). The most common primary diagnosis was meconium aspiration syndrome (n = 19), followed by congenital diaphragmatic hernia (n = 7). Prior to transport, 21 infants (51%) received surfactant therapy. 8 transports originated from outside the service's primary catchment area. In 9 cases, inhaled nitric oxide therapy was initiated by the local care team; in the remaining cases, treatment was started by the neonatal transport team, in more than one-third of patients before 6 hours of life. In 24 cases (58%), infants were transported using high-frequency oscillatory ventilation. 14 newborns (43.7%) showed a response to inhaled nitric oxide, defined as at least a 20% reduction in oxygen requirement by the end of transport. Extracorporeal membrane oxygenation therapy was initiated after transport in 3 cases.
DISCUSSION AND CONCLUSION
The administration of inhaled nitric oxide during neonatal transport is feasible and safe, and provides effective support for the initiation and maintenance of definitive intensive care in critically ill newborns until transfer to a regional tertiary center. Orv Hetil. 2026; 167(21): 824-832.