title: Milrinone improves oxygenation in neonates with severe persistent pulmonary hypertension of the newborn.
abstract: BACKGROUND
  Many neonates with severe persistent pulmonary hypertension of the newborn (PPHN) are nonresponders to inhaled nitric oxide (iNO). Milrinone is a promising adjunctive therapy because of its pulmonary vasodilator properties and cardiotropic effects.
  
  
  METHODS
  Case series of neonates with severe PPHN (defined as oxygenation index [OI] >20, failure of iNO therapy, and echocardiographic confirmation of PPHN).
  
  
  METHODS
  Tertiary neonatal intensive care unit.
  
  
  METHODS
  Full-term (> or =37 weeks) neonates with severe PPHN who received intravenous milrinone.
  
  
  METHODS
  The primary end point was the effect of intravenous milrinone on OI and hemodynamic stability over a 72-hour study period. Secondary end points examined included duration of iNO and degree of cardiorespiratory support.
  
  
  RESULTS
  Nine neonates at a mean gestation of 39.25 +/- 2.76 weeks, birth weight of 3668 +/- 649.1 g, and baseline OI of 28.1 +/- 5.9 received milrinone treatment after a poor initial response to iNO treatment. Intravenous milrinone was commenced at a median age of 21 hours (range, 18-49 hours), and patients were treated for median of 70 hours (range, 23-136). Oxygenation index was significantly reduced after milrinone treatment, particularly in the immediate 24 hours of treatment (8.0 +/- 6.6, P < .001). There was a significant improvement in heart rate (179 +/- 15.2 vs 149.6 +/- 22.4, P < .001) over the same period. Infants who received milrinone did not develop systemic hypotension; in fact, there was a nonsignificant trend toward improved blood pressure.
  
  
  CONCLUSIONS
  Intravenous milrinone produces early improvements in oxygenation without compromising systemic blood pressure.
authors.affiliation: Division of Neonatology, Department of Pediatrics, University of Toronto, Hospital for Sick Children, Toronto, Ontario, Canada M5G 1X8. patrick.mcnamara@sickkids.ca
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: McNamara
authors.forename: Firdous
authors.initials: F
authors.lastname: Laique
authors.forename: Sataporn
authors.initials: S
authors.lastname: Muang-In
authors.forename: Hilary E
authors.initials: HE
authors.lastname: Whyte
mesh_terms: D000242:Cyclic AMP / Q000502:physiology; D006152:Cyclic GMP / Q000502:physiology; D006801:Humans; D006976:Hypertension, Pulmonary / Q000151:congenital* / Q000188:drug therapy* / Q000503:physiopathology; D007231:Infant, Newborn; D020105:Milrinone / Q000627:therapeutic use*; D010100:Oxygen / Q000097:blood*; D010726:Phosphodiesterase Inhibitors / Q000627:therapeutic use; D015398:Signal Transduction; D014665:Vasodilator Agents / Q000627:therapeutic use
chemical_list: D010726:Phosphodiesterase Inhibitors; D014665:Vasodilator Agents; D000242:Cyclic AMP; D006152:Cyclic GMP; D020105:Milrinone; D010100:Oxygen