Physiology Series
Preterm PH isn't one disease
Why inhaled nitric oxide can rescue one hypoxic preemie with pulmonary hypertension and not the next.
Source: Nevarez Gilbert AB, Bischoff AR. NeoReviews. 2026;27(3):e144–e156.
The question
Inhaled nitric oxide is a cornerstone pulmonary vasodilator. So why does it help some preterm infants with pulmonary hypertension (PH) and not others?
The study
A narrative review from the University of Iowa, published in NeoReviews. It proposes a physiology-based framework for diagnosing, phenotyping and managing PH in infants born preterm.
What they found
- PH in preterm infants is a spectrum of mechanisms, not a single disease defined by high pulmonary vascular resistance.
- The review groups it into three phenotypes: precapillary, postcapillary and flow driven. Each has distinct hemodynamic features and clinical implications.
- Pulmonary vasodilators such as inhaled nitric oxide remain a cornerstone of therapy, but their efficacy and safety vary significantly with the underlying phenotype and cause.
- The practical message: identify the phenotype first, then individualize treatment.
Where the evidence stops
- This is a narrative review. The phenotype framework is a proposal grounded in physiology. It has not been tested as a management strategy in a randomized trial.
- Phenotyping relies on bedside assessment and imaging that may not be equally available in every unit.
References
- Nevarez Gilbert AB, Bischoff AR. Pulmonary Hypertension in Infants Who Are Premature. NeoReviews. 2026;27(3):e144–e156. doi:10.1542/neo.27-3-102 · PubMed 41763572
Independent educational content, not medical advice. Not affiliated with or endorsed by the AAP. Summaries reflect the published papers; read the originals before changing practice.
