Milrinone in pediatric heart failure

Abstract

Introduction. Heart failure is one of the most dangerous life-threatening conditions in children, requiring complex pathogenetically based treatment aimed at increasing cardiac output.The objective was to analyze publications devoted to assessing the effectiveness and safety of the use of milrinone in critical conditions in children.Materials and methods. The analysis included 60 publications from the PubMed and e-library abstract databases for the period from 2018 to 2023. The search was carried out using the keywords: milrinone, pediatric, neonate, heart failure, acute renal injury, and outcome. After the initial review of the abstracts, 18 articles were excluded from the analysis, if full text was not available or if they did not contain relevant information from a clinical perspective.Results. A significant part of the work is devoted to a comparative analysis of the therapeutic effects of milrinone and levosimendan in the early postoperative period after cardiac surgery in children, the authors of which in most cases believe that these drugs are comparable both in terms of treatment outcomes and side effects. At the same time, the results of a number of studies indicate significant advantages of milrinone, the use of which helps to reduce the level of lactate in the blood, is not accompanied by hypervolemia of the pulmonary circulation, helps to maintain optimal values of average blood pressure and reduce the duration of treatment in the ICU. On the other hand, there is evidence that the use of milrinone in the perioperative period may be associated with an increased need for additional fluid supplementation and an increase in the frequency of deaths after surgery in young children with complex congenital heart defects (CHD). Conclusion. Milrinone is the drug of choice for the treatment of acute heart failure in children with CHD in the early postoperative period and in newborns with persistent pulmonary hypertension.