**11. Additional supportive therapies for neonatal respiratory distress**

For treating pulmonary hypertension in different pulmonary diseases of the neonate the inhaled nitric oxide, pulmonary artery dilator, has been shown to have some beneficial effects [55]. On the other hand it has not been shown to be beneficial in preterm neonates with RD in reducing BPD or mortality [56]; though most NICUs are using it nowadays when hypoxic respiratory failure in extreme premature cannot be solved by other means [57].

The ECMO pumps the blood through an artificial lung back into the bloodstream, providing heart-lung bypass support outside of the neonatal body. ECMO is applied in neonates with severe RD due to congenital diaphragmatic hernia (CDH), meconium aspiration syndrome (MAS), pneumonia, air leak problems or PPHN [58]. Veno-venous ECMO is preferred to be used in infants with hypoxic respiratory failure unless an arterio-venous ECMO is needed due to combined cardio-respiratory failure. ECMO support should be used only in neonates weighing ≥2 kg of body mass.

General supportive care of a neonate with RD encompasses optimization of thermal neutral environment, fluid and nutritional management and a stable hemodynamic state ensuring adequate oxygenation and perfusion of neonatal organs.
