Division of Respiratory Medicine & Children's Research Centre, University Children's Hospital Zurich.
University Children's Hospital Basel, Basel, Switzerland.
Pediatr Pulmonol. 2022 Jan;57(1):231-238. doi: 10.1002/ppul.25702. Epub 2021 Oct 1.
Nasal nitric oxide (nNO) measurement is recommended as a first line screening test for primary ciliary dyskinesia (PCD). While reliable velum- and non-velum-closure techniques exist for preschool children and older individuals, no data are available for neonates.
To determine feasibility of nNO screening and nNO concentration in healthy newborns in the first week of life.
Nasal NO was analyzed in tidal breathing during natural sleep using a CLD-88 sp NO analyzer (chemoluminescence sensor) and a NIOX MINO (electrochemical sensor). Test success and nNO concentration were determined and compared between the two devices.
Nasal NO was measured in 62 healthy neonates within the first week of life. Feasibility of nNO measurement was 100% for at least one nostril and 85.5% for both nostrils using the chemoluminescence device, but significantly lower with the electrochemical device (85.5% and 53.2%; p < .001). Median nNO concentration was 38 ppb (interquartile range, 27-55; range, 9-100) with the ECOMEDICS device and 23 (15-33, 8-59) with the NIOX MINO (p < .001), with a trend towards higher values for older subjects. None of the subjects exceeded nNO levels of 100 ppb.
Measurement of nNO using a chemoluminescence device is highly feasible in newborns during natural sleep. However, nNO levels are considerably lower compared to the published data for older individuals and in the range of a PCD reference group of infants between 4 and 8 weeks of age, potentially resulting in a great overlap with subjects with PCD in this age group. Therefore, screening for PCD using nasal NO might not be useful in the first week of life. Upon clinical suspicion, other diagnostic tests such as high-speed video analysis of the cilia should be applied.
鼻一氧化氮（nNO）测量被推荐作为原发性纤毛运动障碍（PCD）的一线筛查试验。虽然对于学龄前儿童和年长个体存在可靠的软腭和非软腭闭合技术，但对于新生儿尚无数据。
确定在生命的第一周内对健康新生儿进行 nNO 筛查和 nNO 浓度的可行性。
使用 CLD-88 sp NO 分析仪（化学发光传感器）和 NIOX MINO（电化学传感器）在自然睡眠期间进行潮气呼吸时分析鼻一氧化氮。确定两种设备的测试成功率和 nNO 浓度，并进行比较。
在生命的第一周内，对 62 名健康新生儿进行了鼻一氧化氮测量。使用化学发光设备，至少一个鼻孔的 nNO 测量成功率为 100%，两个鼻孔的成功率为 85.5%，而电化学设备的成功率明显较低（85.5%和 53.2%；p<0.001）。使用 ECOMEDICS 设备的中位数 nNO 浓度为 38 ppb（四分位距，27-55；范围，9-100），使用 NIOX MINO 的中位数 nNO 浓度为 23（15-33，8-59）（p<0.001），随着年龄的增长，数值呈上升趋势。没有一个研究对象的 nNO 水平超过 100 ppb。
在自然睡眠期间，使用化学发光设备测量新生儿的 nNO 具有高度可行性。然而，与发表的年长个体的数据相比，nNO 水平要低得多，并且在 4 至 8 周龄婴儿的 PCD 参考组范围内，这可能导致与该年龄段的 PCD 患者有很大的重叠。因此，在生命的第一周内，使用鼻一氧化氮进行 PCD 筛查可能没有用。在临床怀疑时，应应用其他诊断测试，如纤毛高速视频分析。
