title: The effect of milrinone on right and left ventricular function when used as a rescue therapy for term infants with pulmonary hypertension.
abstract: BACKGROUND
  Milrinone may be an appropriate adjuvant therapy for infants with persistent pulmonary hypertension of the newborn. We aimed to describe the effect of milrinone administration on right and left ventricular function in infants with persistent pulmonary hypertension not responding to inhaled nitric oxide after 4 hours of administration.
  
  
  METHODS
  This is a retrospective review of infants born after or at 34 weeks of gestation with persistent pulmonary hypertension who received milrinone treatment. The primary endpoint was the effect of milrinone on myocardial performance and haemodynamics, including right and left ventricular outputs, tissue Doppler velocities, right ventricle and septal strain, and strain rate. Secondary endpoints examined included duration of inhaled nitric oxide and oxygen support.
  
  
  RESULTS
  A total of 17 infants with a mean (standard deviation) gestation and birth weight of 39.8 (2.0) weeks and 3.45 (0.39) kilograms, respectively, were included in the study. The first echocardiogram was performed 15 hours after the commencement of nitric oxide inhalation. Milrinone treatment was started at a median time of 1 hour after the echocardiogram and was associated with an increase in left ventricular output (p=0.04), right ventricular output (p=0.004), right ventricle strain (p=0.01) and strain rate (p=0.002), and left ventricle s` (p<0.001) and a` (p=0.02) waves. There was a reduction in nitric oxide dose and oxygen requirement over the subsequent 72 hours (all p<0.05).
  
  
  CONCLUSIONS
  The use of milrinone as an adjunct to nitric oxide is worth further exploration, with preliminary evidence suggesting an improvement in both oxygenation and myocardial performance in this group of infants.
authors.affiliation: 1Department of Paediatrics,The Rotunda Hospital,Dublin,Ireland.
authors.forename: Adam T
authors.initials: AT
authors.lastname: James
authors.affiliation: 1Department of Paediatrics,The Rotunda Hospital,Dublin,Ireland.
authors.forename: John D
authors.initials: JD
authors.lastname: Corcoran
authors.affiliation: 3Department of Physiology and Experimental Medicine,Hospital for Sick Children,Toronto,Canada.
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: McNamara
authors.affiliation: 5Department of Cardiology,Our Lady's Children's Hospital Crumlin,Dublin,Ireland.
authors.forename: Orla
authors.initials: O
authors.lastname: Franklin
authors.affiliation: 1Department of Paediatrics,The Rotunda Hospital,Dublin,Ireland.
authors.forename: Afif F
authors.initials: AF
authors.lastname: El-Khuffash
mesh_terms: D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000188:drug therapy* / Q000503:physiopathology*; D007223:Infant; D008297:Male; D020105:Milrinone / Q000627:therapeutic use*; D058987:Phosphodiesterase 3 Inhibitors / Q000627:therapeutic use*; D012189:Retrospective Studies; D047929:Term Birth; D016276:Ventricular Function / Q000187:drug effects*
chemical_list: D058987:Phosphodiesterase 3 Inhibitors; D020105:Milrinone
keywords: Milrinone; myocardial function; neonates; pulmonary hypertension; strain