Experience with phosphodiesterase inhibitors in paediatric cardiac surgery

Area of Science:

• Pediatric Cardiology
• Neonatal Intensive Care
• Pharmacology

Background:

• Refractory low-output states in newborns pose a significant mortality risk.
• Limited effective pharmacological interventions are available for this critical condition.

Purpose of the Study:

• To evaluate the efficacy and safety of enoximone in neonates with refractory low-output states.
• To assess the routine use of enoximone in post-operative pediatric surgical patients.

Main Methods:

• A controlled study administered a bolus dose of enoximone (1 mg kg-1min-1) to 16 newborns with refractory low-output states.
• A subsequent observational study administered enoximone to 84 pediatric surgical patients post-operatively.

Main Results:

• In newborns, 12 of 16 'responders' showed dramatic hemodynamic improvement, with 9 surviving. All 'non-responders' died.
• Enoximone reduced filling pressures (P < 0.005) and improved cardiac index (0.96 to 3.05 L min-1 m-2; P < 0.001).
• In pediatric surgical patients, 69% (58 of 84) experienced clinical improvement with no significant side effects.

Conclusions:

• Enoximone is an effective treatment for improving hemodynamics and survival in neonates with low-output states.
• Enoximone demonstrates a safe and effective profile for managing cardiac low-output states in pediatric surgical patients.
• Enoximone represents a valuable pharmacological option for pediatric cardiac critical care.