Controversies in the use of inhaled nitric oxide therapy in the newborn.
Kinsella JP. Abman SH.
Section of Neonatology, Children's Hospital, Denver, Colorado, USA.
Inhaled nitric oxide (NO) causes sustained improvement in oxygenation in near-term and term newborns with persistent pulmonary hypertension of the newborn (PPHN), and reduces the need for extracorporeal membrane oxygenation (ECMO). However, many questions remain concerning the application of inhaled NO to less severely ill infants, its use in units without immediate access to adjuvant therapies for hypoxemic respiratory failure, and in centers without ECMO. Particular vigilance must be given to the potential impact of widespread dissemination on inhaled NO therapy on time ECMO initiation, and the inappropriate use of inhaled NO in premature neonates.
Contemporary controversies in the management of congenital diaphragmatic hernia.
Katz AL. Wiswell TE. Baumgart S.
Department of Surgery, Thomas Jefferson University, Jefferson Medical College, Philadelphia, Pennsylvania, USA.
Congenital diaphragmatic hernia (CDH) has remained the most frustrating of the major birth defects to manage successfully. Despite the earlier detection of severe diaphragmatic defects by prenatal ultrasound, and the early recognition of CDH as a cause for respiratory distress presenting at birth, current mortality has improved little from the original series presented in 1940 by Ladd and Gross. This article discusses the difficulty in defining population with congenital diaphragmatic hernia, current controversies in the medical and surgical management of these patients, appropriate timing and usage of ECMO, a review of current, experimental therapies, and short-term and long-term outcomes of these patients.