Neonatal persistent pulmonary hypertension treated with milrinone: four case reports.
Current standard therapy for persistent pulmonary hypertension of the newborn (PPHN) consists of optimal lung inflation, hemodynamic support and selective vasodilation with inhaled nitric oxide (iNO). However, not all infants will respond. Milrinone, a phosphodiesterase (PDE) III inhibitor, is routinely used in pediatric cardiac intensive care units to improve inotropy and reduce afterload. Although its use in post-operative cardiac failure has been proven in a randomized trial, it has not been reported to be beneficial in PPHN. We report four cases with severe PPHN treated with a combination of iNO and Milrinone. All four cases were unresponsive to therapy including iNO, with a mean oxygenation index (OI) of 40 (standard deviation (SD) 12)) before Milrinone. Substantial improvement in OI (mean of 28; SD 16) was followed by extubation and survival. However, of 4 patients, 2 developed serious intraventricular hemorrhages (IVHs), and 1 had a small IVH. To clarify the risk benefit ratio, of death versus survival with impairment, a randomized controlled trial is needed.
Bassler
Dirk
D
Division of Neonatology, Department of Paediatrics, McMaster University Medical Centre, Hamilton, Ont., Canada.
Choong
Karen
K
McNamara
Patrick
P
Kirpalani
Haresh
H
D000280:Administration, Inhalation; D000818:Animals; D005260:Female; D005865:Gestational Age; D006801:Humans; D000860:Hypoxia / Q000150:complications; D007231:Infant, Newborn; D007234:Infant, Premature; D008297:Male; D008471:Meconium Aspiration Syndrome; D020105:Milrinone / Q000627:therapeutic use*; D009569:Nitric Oxide / Q000008:administration & dosage*; D016104:Oligohydramnios; D010547:Persistent Fetal Circulation Syndrome / Q000188:drug therapy*; D010726:Phosphodiesterase Inhibitors / Q000627:therapeutic use*; D011247:Pregnancy
D010726:Phosphodiesterase Inhibitors; D009569:Nitric Oxide; D020105:Milrinone