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iNO weaning — RACP Paediatrics MCQ

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ModerateNeonataliNO weaningRACP Paediatrics

A term neonate with mild PPHN (pre-post ductal difference 8%, FiO2 0.5) has been started on iNO with good response (SpO2 improved to 95%, FiO2 reduced to 0.3). How should iNO be weaned?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: B — Inhaled nitric oxide

iNO should be weaned gradually (in steps of 5 ppm every 2-4 hours, then 1 ppm decrements below 5 ppm) to avoid rebound pulmonary hypertension. Abrupt discontinuation can cause severe rebound vasoconstriction. Weaning should be guided by oxygenation parameters. Some centres use sildenafil to facilitate iNO weaning.

Reference: RCH Melbourne – 2023 – PPHN CPG; RACP Paediatric Curriculum – Neonatology