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The effect of milrinone on right and left ventricular function when used as a rescue therapy for term infants with pulmonary hypertension

Published online by Cambridge University Press:  20 January 2015

Adam T. James ,
John D. Corcoran ,
Patrick J. McNamara ,
Orla Franklin  and
Afif F. El-Khuffash
Adam T. James
Affiliation:
Department of Paediatrics, The Rotunda Hospital, Dublin, Ireland
John D. Corcoran
Affiliation:
Department of Paediatrics, The Rotunda Hospital, Dublin, Ireland
Patrick J. McNamara
Affiliation:
Department of Physiology and Experimental Medicine, Hospital for Sick Children, Toronto, Canada Department of Neonatology, The Hospital for Sick Children, Toronto, Canada
Orla Franklin
Affiliation:
Department of Cardiology, Our Lady’s Children’s Hospital Crumlin, Dublin, Ireland
Afif F. El-Khuffash*
Affiliation:
Department of Paediatrics, The Rotunda Hospital, Dublin, Ireland Department of Paediatrics, Royal College of Surgeons in Ireland, Dublin, Ireland
*
Correspondence to: Dr A. El-Khuffash FRCPI, MD, DCE, Consultant Neonatologist, The Rotunda Hospital, Parnell Street, Dublin 1, Ireland. Tel: +353 1 873 0700; Fax: +353 1 872 6523; E-mail: afif@physicians.ie
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Abstract

Introduction

Milrinone may be an appropriate adjuvant therapy for infants with persistent pulmonary hypertension of the newborn. We aimed to describe the effect of milrinone administration on right and left ventricular function in infants with persistent pulmonary hypertension not responding to inhaled nitric oxide after 4 hours of administration.

Materials and methods

This is a retrospective review of infants born after or at 34 weeks of gestation with persistent pulmonary hypertension who received milrinone treatment. The primary endpoint was the effect of milrinone on myocardial performance and haemodynamics, including right and left ventricular outputs, tissue Doppler velocities, right ventricle and septal strain, and strain rate. Secondary endpoints examined included duration of inhaled nitric oxide and oxygen support.

Results

A total of 17 infants with a mean (standard deviation) gestation and birth weight of 39.8 (2.0) weeks and 3.45 (0.39) kilograms, respectively, were included in the study. The first echocardiogram was performed 15 hours after the commencement of nitric oxide inhalation. Milrinone treatment was started at a median time of 1 hour after the echocardiogram and was associated with an increase in left ventricular output (p=0.04), right ventricular output (p=0.004), right ventricle strain (p=0.01) and strain rate (p=0.002), and left ventricle s` (p<0.001) and a` (p=0.02) waves. There was a reduction in nitric oxide dose and oxygen requirement over the subsequent 72 hours (all p<0.05).

Conclusion

The use of milrinone as an adjunct to nitric oxide is worth further exploration, with preliminary evidence suggesting an improvement in both oxygenation and myocardial performance in this group of infants.

Keywords

Milrinonepulmonary hypertensionmyocardial functionneonatesstrain
Type
Original Articles
Information
Cardiology in the Young , Volume 26 , Issue 1 , January 2016 , pp. 90 - 99
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Copyright
© Cambridge University Press 2015 

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