title: Treatment of premature infants with pulmonary hypertension and right ventricular dysfunction with milrinone: a case series.
abstract: OBJECTIVE
  Milrinone has been proposed as an effective treatment for pulmonary hypertension (PH) and right ventricular (RV) dysfunction. We aimed to determine the effect of milrinone therapy on clinical and echocardiography parameters of PH in preterm infants with elevated pulmonary pressures.
  
  
  METHODS
  A retrospective case review was conducted on infants <32 weeks gestation who received milrinone for the treatment of PH and reduced RV function. Echocardiographic data were collected before and after treatment with milrinone, and serial clinical parameters were recorded over a 72h  period.
  
  
  RESULTS
  Seven infants met the inclusion criteria with a median gestation and birth weight of 27.3 weeks and 1140 g, respectively. Four infants had a diagnosis of pulmonary hypoplasia with PH, and three infants were recipients in twin-to-twin transfusion syndrome who also developed PH. Nitric oxide was used in six infants before commencement of milrinone. Milrinone was commenced at a dose of 0.33 μg kg(-1) min(-1) to 0.5 μg kg(-1) min(-1) and continued for a median duration of 70 h. Use of milrinone was associated with a fall in oxygenation index and inhaled nitric oxide dose. Following an initial fall in blood pressure over the first 6 h, there was an increase in blood pressure over the subsequent 72 h. Echocardiographic data demonstrated an increase in indicators of myocardial performance and PH. One infant died before discharge.
  
  
  CONCLUSIONS
  This case series suggests that milrinone may be a useful therapy for premature infants with echocardiography findings of PH and/or RH dysfunction. This data support the need for a randomised control trial to confirm its efficacy.
authors.affiliation: Department of Neonatology, The Rotunda Hospital, Dublin, Ireland.
authors.forename: A T
authors.initials: AT
authors.lastname: James
authors.affiliation: Department of Neonatology, The Rotunda Hospital, Dublin, Ireland.
authors.forename: C
authors.initials: C
authors.lastname: Bee
authors.affiliation: Department of Neonatology, The Rotunda Hospital, Dublin, Ireland.
authors.forename: J D
authors.initials: JD
authors.lastname: Corcoran
authors.affiliation: 1] Physiology and Experimental Medicine, Hospital for Sick Children, Toronto, Canada [2] Department of Neonatology, The Hospital for Sick Children, Toronto, Canada.
authors.forename: P J
authors.initials: PJ
authors.lastname: McNamara
authors.affiliation: Department of Paediatric Cardiology, Our Lady's Children's Hospital Crumlin, Dublin, Ireland.
authors.forename: O
authors.initials: O
authors.lastname: Franklin
authors.affiliation: 1] Department of Neonatology, The Rotunda Hospital, Dublin, Ireland [2] Department of Paediatrics, Royal College of Surgeons in Ireland, Dublin, Ireland.
authors.forename: A F
authors.initials: AF
authors.lastname: El-Khuffash
mesh_terms: D001794:Blood Pressure / Q000187:drug effects; D004452:Echocardiography; D005260:Female; D005330:Fetofetal Transfusion; D006801:Humans; D006976:Hypertension, Pulmonary / Q000188:drug therapy*; D007223:Infant; D062071:Infant, Extremely Premature; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight; D008297:Male; D020105:Milrinone / Q000008:administration & dosage*; D009569:Nitric Oxide / Q000627:therapeutic use; D011247:Pregnancy; D012189:Retrospective Studies; D014665:Vasodilator Agents / Q000008:administration & dosage*; D018497:Ventricular Dysfunction, Right / Q000188:drug therapy*; D016278:Ventricular Function, Right / Q000187:drug effects
chemical_list: D014665:Vasodilator Agents; D009569:Nitric Oxide; D020105:Milrinone