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hypothermia, hypoglycemia, anemia, hypovolemia, metabolic acidosis, and sepsis

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Cycle of Hypoxia

Treatment

Correct reversible factors
Hemodynamic support
Oxygenation targets: preductal SpO₂ 91–95%
Ventilation: optimize lung recruitment with conventional or HFOV, Surfactant if indicated, Avoid alkalosis
Inhaled Nitric Oxide (iNO) — First-Line Vasodilator (OI > 25)
- iNO at 20 ppm is indicated when the oxygenation index (OI) exceeds 25
  - Approximately 30–40% of infants are non responders.
Adjunctive Pharmacotherapy
**ECMO — Rescue Therapy (**OI > 40)

Therapy	Indication / Trigger	Dosing	Class/LOE
iNO	OI >25	20 ppm (wean to 5 ppm → 1 ppm)	I / A
Sildenafil (oral)	iNO-refractory, OI >25	1–3 mg/kg/dose q6–8h	IIa / B
Milrinone (IV)	LV dysfunction ± iNO-refractory	50 mcg/kg load → 0.25–0.75 mcg/kg/min	IIa / B
Inhaled PGI₂	iNO-refractory, OI >25	Variable (nebulized)	IIb / B
ECMO	Refractory to all medical therapy	OI >40	I / A