title: The Effect of Milrinone on Splanchnic and Cerebral Perfusion in Infants With Congenital Heart Disease Prior to Surgery: An Observational Study.
abstract: Despite the advancement in the postoperative care of neonates with congenital heart disease (CHD), there is little information on preoperative management of systemic and regional hemodynamics, which may be related to outcomes. We aimed to determine the preoperative effect of milrinone, a phosphodiesterase III inhibitor, on cardiac output and splanchnic and cerebral perfusion in neonates with CHD. Neonates with CHD requiring cardiac surgery were enrolled in a prospective, single-blinded study once a clinical decision of starting milrinone (0.75 μg/kg per minute intravenously) using institutional criteria was made. Demographic and clinical variables and outcomes were recorded. Combined cardiac output and measures of splanchnic (superior mesenteric and celiac arteries) and cerebral (anterior and middle cerebral arteries) perfusion were determined by Doppler studies at 0, 6, 24, and 48 h after milrinone infusion. Investigators were unaware of intervention time points and patients in analyzing blood flow measurements. Seventeen term (39.2 ± 1.3 weeks) neonates were included with hypoplastic left-sided heart syndrome (78.5%) as the most common diagnosis. Combined cardiac output increased by 28% within 48 h (613 ± 154 vs. 479 ± 147 mL/kg per minute at baseline, P < 0.05). Superior mesenteric artery mean velocity increased at 6 h and throughout 48 h of milrinone infusion (P < 0.05). Peak and mean velocities at cerebral arteries increased with milrinone infusion (P < 0.05~0.08), and the corresponding changes at celiac artery were modest. There were no significant changes in splanchnic and cerebral resistive and pulsatility indices during milrinone infusion. Milrinone increases cardiac output with concurrent effects on splanchnic and cerebral blood flows during the short-term preoperative use in neonates with CHD.
authors.affiliation: *Division of Neonatalogy, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada; and †Department of Pediatrics, UNICAMP, Universidade Estadual de Campinas, São Paulo, Brazil.
authors.forename: Maria Otilia
authors.initials: MO
authors.lastname: Bianchi
authors.forename: Po-Yin
authors.initials: PY
authors.lastname: Cheung
authors.forename: Ernest
authors.initials: E
authors.lastname: Phillipos
authors.forename: Abimael
authors.initials: A
authors.lastname: Aranha-Netto
authors.forename: Chloe
authors.initials: C
authors.lastname: Joynt
mesh_terms: D001783:Blood Flow Velocity; D002302:Cardiac Output; D002316:Cardiotonic Agents / Q000627:therapeutic use; D002445:Celiac Artery / Q000000981:diagnostic imaging / Q000187:drug effects; D002560:Cerebrovascular Circulation / Q000187:drug effects*; D015150:Echocardiography, Doppler; D005260:Female; D006330:Heart Defects, Congenital / Q000188:drug therapy*; D006439:Hemodynamics; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D008638:Mesenteric Arteries / Q000000981:diagnostic imaging / Q000187:drug effects; D020105:Milrinone / Q000627:therapeutic use*; D010477:Perfusion; D010726:Phosphodiesterase Inhibitors / Q000627:therapeutic use; D057234:Preoperative Period; D011446:Prospective Studies; D016037:Single-Blind Method; D013152:Splanchnic Circulation / Q000187:drug effects; D013997:Time Factors
chemical_list: D002316:Cardiotonic Agents; D010726:Phosphodiesterase Inhibitors; D020105:Milrinone