Children Support
Basic research on NO derived from in vitro and in vivo experimental models has started to have an impact on pediatrics. Accumulating evidence suggest that the NO signaling pathway is abnormal in a number of pediatric conditions including primary pulmonary hypertension,[2] childhood essential hypertension[3], and cerebral malaria[4] and markedly increased in others such as septic shock,[5] gastroenteritis,[6,7] bronchial asthma,[8] type 1 diabetes mellitus,[9] and autoimmune and inflammatory
diseases.[10] Accurate and reliable determination of NO synthesis in vivo is essential to understand the pathophysiologic and therapeutic roles of this biologic pathway.[1]
Determination of nitric oxide (NO) synthesis in vivo is essential to understand the pathophysiologic role and therapeutic implications of the L-arginine/NO pathway in pediatric diseases. The aim of this study was to establish a noninvasive, sensitive, specific, and reliable approach to determine whole-body NO synthesis in healthy children.[1]
Inhalation of nitric oxide has made the journey from the bench to the bedside more rapidly than any other drug. Inhaled NO is a selective vasodilator for the constricted pulmonary vascular bed and improves ventilation perfusion matching in respiratory failure. In pediatrics, the use of iNO in term neonates with hypoxaemic respiratory failure, in the assessment of pulmonary vascular reactivity and in the treatment of postoperative pulmonary hypertension in congenital heart disease is well recognised and accepted.[11] Several other applications have been described but caution must be the rule with a drug that shows potential adverse and toxic effects.[11] Stimulating natural NO production is a much safer alternative to inhalation.
References:
Children Support:
[1] Forte, P., Ogborn, M. & Lilley-Chan, T. A Noninvasive, Sensitive, Specific, and Reliable Approach to Assess Whole-Body Nitric Oxide Synthesis in Children. Pediatr Res 59, 736–741 (2006). https://doi.org/10.1203/01.pdr.0000214880.15623.84
[2] Castillo L, DeRojas-Walker T, Yu YM, Sanchez M, Chapman TE, Shannon D, Tannenbaum S, Burke JF, Young VR 1995 Whole body arginine metabolism and nitric oxide synthesis in newborns with persistent pulmonary hypertension. Pediatr Res 38: 17–24
[3] Goonasekera CD, Shah V, Rees DD, Dillon MJ 1997 Nitric oxide activity in childhood hypertension. Arch Dis Child 77: 11–16
[4] Lopansri BK, Anstey NM, Weinberg JB, Stoddard GJ, Hobbs MR, Levesque MC, Mwaikambo ED, Granger DL 2003 Low plasma arginine concentrations in children with cerebral malaria and decreased nitric oxide production. Lancet 361: 676–678
[5] Duke T, South M, Stewart A 1997 Activation of the L-arginine nitric oxide pathway in severe sepsis. Arch Dis Child 76: 203–209
[6] Hegesh E, Shiloah J 1982 Blood nitrates and infantile methemoglobinemia. Clin Chim Acta 125: 107–115
[7] Forte P 2001 Plasma nitrate concentrations: a new diagnostic test in young infants with infectious gastroenteritis?. J Pediatr Gastroenterol Nutr 32: 418–420
[8] Kharitonov SA, Yates D, Robbins RA, Logan-Sinclair R, Shinebourne EA, Barnes PJ 1994 Increased nitric oxide in exhaled air of asthmatic patients. Lancet 343: 133–135
[9] Hoeldtke RD, Bryner KD, McNeill DR, Hobbs GR, Riggs JE, Warehime SS, Christie I, Ganser G, Van Dyke K 2002 Nitrosative stress, uric acid, and peripheral nerve function in early type 1 diabetes. Diabetes 51: 2817–2825
[10] Ljung T, Beijer E, Herulf M, Weitzberg E, Lundberg JO, Finkel Y, Hellstrom PM 2002 Increased rectal nitric oxide in children with active inflammatory bowel disease. J Pediatr Gastroenterol Nutr 34: 302–306
[11] A Bernasconi, M Beghetti. Inhaled nitric oxide applications in paediatric practice. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3232511/
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