Treatment of premature infants with pulmonary hypertension and right ventricular dysfunction with milrinone: a case series

James, Adam; Bee, Carson R.; Corcoran, J D; McNamara, Patrick J.; Franklin, Orla; El-Khuffash, Afif

doi:10.1038/jp.2014.208

Cited by 40 publications

(32 citation statements)

References 37 publications

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“…Treatment of persistent pulmonary hypertension of newborn (PPHN) with milrinone requires further investigation although there are some case series papers that have found some benefits (fall in oxygenation index, decrease in the inhaled nitric oxide dose, an increase in blood pressure or an increase in indicators of myocardial performance) after milrinone infusion in newborn (term and preterm) infants with pulmonary hypertension [70][71][72][73][74].…”

Section: Discussionmentioning

confidence: 99%

Cardiovascular Drug Therapy for Human Newborn: Review of Pharmacodynamic Data

Ergenekon

Rojas-Anaya

Bravo

et al. 2018

CPD

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Background: Circulatory failure in preterm and term newborn infants is commonly treated with inotropes or vasoactive medications. In this structured literature review the available data on pharmacodynamic effects of the inotropes adrenaline, dobutamine, dopamine, levosimendan, milrinone, noradrenaline, and the vasoactive drugs vasopressin and hydrocortisone are presented. Methods: Structured searches were conducted to identify relevant articles according to pre-defined inclusion criteria which were human clinical trials published after 2000.Results: Out of 101 identified eligible studies only 22 studies met the criteria for evidence based practice guidelines level I to IV. The most prevalent pharmacodynamic effects were increase in blood pressure and/or heart rate, which were also the most frequently studied circulatory parameters. Conclusion: This review demonstrates the need for further systematic studies on all reviewed drugs with incorporation of novel noninvasive biomarkers in this vulnerable patient group, for more timely and appropriate treatment for clinical efficacy.

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Section: Discussionmentioning

confidence: 99%

Cardiovascular Drug Therapy for Human Newborn: Review of Pharmacodynamic Data

Ergenekon

Rojas-Anaya

Bravo

et al. 2018

CPD

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“…There is limited data specific to the impact of PVR on preterm myocardial function, though a similar decline in RV performance as in term neonates is reported (25). An understanding of the impact of PVR on the myocardium is important because it may significantly modify disease pathophysiology and in term neonates may be a predictor of poor outcome (26).…”

Section: Implications Of High Pvr On Myocardial Functionmentioning

confidence: 99%

Controversies in the identification and management of acute pulmonary hypertension in preterm neonates

Giesinger

Odame

et al. 2017

Pediatr Res

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It is increasingly recognized that the abnormal physiologic consequences of pulmonary hypertension (PH) may contribute to poor cardiopulmonary health in premature babies. Conflicting literature has led to clinical uncertainty, pathological misinterpretation, and variability in treatment approaches among practitioners. There are several disorders with overlapping and interrelated presentations, and other disorders with a similar clinical phenotype but diverse pathophysiological contributors. In this review, we provide a diagnostic approach for acute hypoxemic respiratory failure in the preterm neonate, outline the pathophysiological conditions that may present as acute PH, and discuss the implications of high pulmonary vascular resistance (PVR) on the cardiovascular system. Although PVR and respiratory management are highly interrelated, there may be a population of preterm neonates in whom inhaled nitric oxide may improve illness severity and may relate to outcomes. A management approach based on physiology that considers common clinical conundrums is provided. A more comprehensive understanding of the physiology may help in informed decision-making in clinical situations where conclusive scientific evidence is lacking. Regardless, high-quality research is required, and appropriate definition of the target population is paramount. A thoughtful approach to cardiovascular therapy may also provide an avenue to improve neurodevelopmental outcomes while awaiting more clear answers.

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“…In vascular smooth muscle, PDE 3A is an important enzyme that breaks down cAMP and this enzyme is inhibited by milrinone (Primacor ® ). Exposure to NO appears to enhance PDE 3A in animal studies 32, 33 and may explain the increased efficacy of milrinone in iNO-resistant PPHN 34–38 .…”

Section: Pulmonary Vasodilators Acting Via the Camp Pathwaymentioning

confidence: 99%

Pharmacologic strategies in neonatal pulmonary hypertension other than nitric oxide

Lakshminrusimha

Mathew

Leach

2016

Seminars in Perinatology

177

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Inhaled nitric oxide (iNO) is approved for use in persistent pulmonary hypertension of the newborn (PPHN) but does not lead to sustained improvement in oxygenation in a third of patients with PPHN. Inhaled NO is less effective in the management of PPHN secondary to congenital diaphragmatic hernia (CDH), extreme prematurity and bronchopulmonary dysplasia (BPD). Intravenous pulmonary vasodilators such as prostacyclin, alprostadil, sildenafil and milrinone have been successfully used in PPHN resistant to iNO. Oral pulmonary vasodilators such as endothelin-receptor antagonist bosentan and phosphodiesterase-5 inhibitors such as sildenafil and tadalafil are used both during acute and chronic phase of PPHN. In the absence of infection, glucocorticoids may also be effective in PPHN. Many of these pharmacologic agents are not approved for use in PPHN and our knowledge is based on case reports and small trials. Large multicenter randomized controlled trials with long-term follow-up are required to evaluate pharmacologic strategies in PPHN.

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Treatment of premature infants with pulmonary hypertension and right ventricular dysfunction with milrinone: a case series

Abstract: 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.

Cited by 40 publications

References 37 publications

Cardiovascular Drug Therapy for Human Newborn: Review of Pharmacodynamic Data

Cardiovascular Drug Therapy for Human Newborn: Review of Pharmacodynamic Data

Controversies in the identification and management of acute pulmonary hypertension in preterm neonates

Pharmacologic strategies in neonatal pulmonary hypertension other than nitric oxide

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