PPHN – inhaled nitric oxide — RACP Paediatrics MCQ

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ModerateNeonatalPPHN – inhaled nitric oxideRACP Paediatrics

A term neonate with meconium aspiration syndrome has severe PPHN (pre-post ductal SpO2 difference 15%, oxygenation index >25) despite optimal ventilation. What is the most appropriate first-line pulmonary vasodilator?

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Correct answer: D — Inhaled nitric oxide

Inhaled nitric oxide (iNO) at 20 ppm is the first-line selective pulmonary vasodilator for PPHN in term/near-term neonates. It acts directly on pulmonary vascular smooth muscle causing vasodilation without systemic hypotension. Response is assessed within 30-60 minutes. If oxygenation index remains >25 despite iNO and optimal ventilation, ECMO should be considered.

Reference: RCH Melbourne – 2023 – PPHN CPG; ANZCOR – 2024 – Neonatal Guidelines