Treatment of premature infants with pulmonary hypertension and right ventricular dysfunction with milrinone: a case series
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Published on: May 13, 2019
A T James1, C Bee1, J D Corcoran1
1Department of Neonatology, The Rotunda Hospital, Dublin, Ireland.
Insights
Milrinone therapy showed potential benefits for preterm infants with pulmonary hypertension (PH) and right ventricular (RV) dysfunction, improving clinical and echocardiographic markers. Further randomized trials are needed to confirm its efficacy in this vulnerable population.
Area of Science:
- Neonatal Medicine
- Pediatric Cardiology
- Pharmacology
Background:
- Pulmonary hypertension (PH) and right ventricular (RV) dysfunction are serious conditions in preterm infants.
- Milrinone is a phosphodiesterase-3 inhibitor with inotropic and vasodilatory properties, proposed for treating PH and RV dysfunction.
Purpose of the Study:
- To evaluate the effect of milrinone on clinical and echocardiographic parameters in preterm infants with PH and elevated pulmonary pressures.
- To assess the safety and efficacy of milrinone in this specific patient group.
Main Methods:
- Retrospective case review of preterm infants (<32 weeks gestation) treated with milrinone for PH and reduced RV function.
- Collection of echocardiographic data and serial clinical parameters over 72 hours before and after milrinone initiation.
Main Results:
- Seven infants met inclusion criteria; four with pulmonary hypoplasia-PH, three with twin-to-twin transfusion syndrome-associated PH.
- Milrinone use was associated with decreased oxygenation index and inhaled nitric oxide requirements.
- Echocardiography indicated improved myocardial performance and PH, despite an initial transient drop in blood pressure.
Conclusions:
- Milrinone may be a beneficial therapy for preterm infants experiencing PH and/or RV dysfunction.
- The findings support the need for a randomized controlled trial to definitively establish milrinone's efficacy in this population.
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.
Study Design:
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.
Result:
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.
Conclusion:
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.
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