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Response to pulmonary vasodilators in infants with congenital diaphragmatic hernia

Vasantha H S Kumar1,2, Rita Dadiz3, Jamie Koumoundouros4

  • 1Department of Pediatrics, University at Buffalo, Buffalo, NY, USA. vkumar3@buffalo.edu.

Pediatric Surgery International
|May 30, 2018
PubMed

Insights

Inhaled nitric oxide (iNO) and milrinone are pulmonary vasodilators for congenital diaphragmatic hernia (CDH). Response to iNO with milrinone may improve oxygenation and survival in CDH infants after ECMO.

Area of Science:

  • Neonatalogy
  • Pediatric Cardiology
  • Pulmonology

Background:

  • Congenital diaphragmatic hernia (CDH) causes lung hypoplasia, cardiac dysfunction, and pulmonary hypertension.
  • Inhaled nitric oxide (iNO) and milrinone are common pulmonary vasodilators for CDH.
  • This study investigated the hemodynamic effects of iNO and milrinone in infants with CDH.

Purpose of the Study:

  • To evaluate the hemodynamic and oxygenation effects of iNO and milrinone in infants with CDH.
  • To determine if response to iNO influences outcomes with milrinone therapy.
  • To assess the impact of these vasodilators on survival in CDH patients.

Main Methods:

  • Retrospective chart review of CDH infants from two perinatal centers.
  • Infants categorized into No-iNO, iNO-responder, and iNO-nonresponder groups.
  • Assessment of oxygenation via blood gases and hemodynamics via echocardiography.

Main Results:

  • 54% of CDH infants received iNO; 31% showed a complete oxygenation response.
  • iNO response did not correlate with reduced right ventricular pressures (RVP) or ECMO use.
  • Milrinone, used in both iNO groups, lowered RVP and improved ejection fraction (EF).
  • iNO responders receiving milrinone had improved oxygenation and higher survival post-ECMO (67% vs. 20% in nonresponders).

Conclusions:

  • Response to iNO in CDH infants may predict improved outcomes with milrinone.
  • Combined iNO and milrinone therapy shows potential for enhancing oxygenation.
  • This combination therapy might be associated with better survival rates following ECMO in CDH patients.
Abstract

Keywords:
CDHInfantsInhaled nitric oxideMilrinonePulmonary hypertension

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