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Neonatal persistent pulmonary hypertension treated with milrinone: four case reports
Dirk Bassler1, Karen Choong, Patrick McNamara
1Division of Neonatology, Department of Paediatrics, McMaster University Medical Centre, Hamilton, Ont., Canada.
Biology of the Neonate
|September 13, 2005
Summary
Adding Milrinone to inhaled nitric oxide (iNO) therapy improved oxygenation in infants with severe persistent pulmonary hypertension of the newborn (PPHN) unresponsive to iNO alone. However, this combination therapy increased the risk of intraventricular hemorrhage (IVH).
Area of Science:
- Neonatal Medicine
- Pediatric Cardiology
- Pharmacology
Background:
- Persistent pulmonary hypertension of the newborn (PPHN) is a critical condition often managed with inhaled nitric oxide (iNO).
- Some infants with PPHN do not respond adequately to standard therapies, including iNO.
- Milrinone, a phosphodiesterase (PDE) III inhibitor, is used for inotropic support and afterload reduction in pediatric cardiac care.
Observation:
- This study reports on four neonates with severe PPHN refractory to iNO therapy.
- These infants had a high mean oxygenation index (OI) of 40 (SD 12) prior to Milrinone administration.
- The combination of iNO and Milrinone was administered to these non-responsive cases.
Findings:
- A significant improvement in OI was observed after adding Milrinone, with the mean OI decreasing to 28 (SD 16).
- All four infants treated with the iNO and Milrinone combination showed improved oxygenation, leading to extubation and survival.
- However, a notable adverse event was the occurrence of intraventricular hemorrhage (IVH) in three out of the four patients (two serious, one small).
Implications:
- The combination of iNO and Milrinone may offer a survival benefit for neonates with severe PPHN unresponsive to iNO alone.
- The observed increased risk of intraventricular hemorrhage (IVH) necessitates careful consideration of the risk-benefit ratio.
- Further investigation through a randomized controlled trial is crucial to definitively establish the efficacy and safety of this combined therapeutic approach in PPHN.