Background and aims Inhaled nitric oxide (iNO) decreases pulmonary vascular resistance, thereby diminishing extrapulmonary shunt and improving ventilation perfusion mismatch. Hence iNO is used to treat PPHN in term and near-term neonates. My aim was to determine the effectiveness of iNO as rescue therapy in preterms with PPHN.

Method A 3 year retrospective case series was reviewed at a single hospital from January 2011 to February 2014. Data was collected from electronic discharge summaries.

Results iNO was used in 7 preterm babies as rescue therapy. The average gestational age (GA) of infants was 30 weeks with the youngest being 27 weeks. iNO was commenced before 24 h in all babies, earliest being at 3 h of age. The average duration iNO was administered was 37 h, shortest being 5 h. The baby for whom iNO was administered for the longest duration required it for RDS but PPHN improved rapidly within a few hours. Hence inhaled nitric oxide as rescue therapy for PPHN was effective in all 7 infants (100%). RDS improved in all the babies. Two babies died- one had severe intrauterine hypoxia (cord gas pH6.8) and another had bilateral pneumothoracis. Three infants (42%) had bilateral grade 3–4 intraventricular haemorrhage. Two babies (28%)developed chronic lung disease.

Conclusions Although iNO as rescue therapy for PPHN was 100% effective, the side effects of IVH cannot be ignored. Further clinical studies involving more hospitals are essential in evaluating the role of iNO as rescue therapy in preterm infants.