Milrinone Use in Persistent Pulmonary Hypertension of the Newborn

Abstract

Failure of the normal transition from in utero to ex utero physiology leads to “persistent” pulmonary hypertension of the newborn (PPHN). PPHN is frequently associated with low systemic blood pressure and low cardiac output because of increased right ventricular afterload and myocardial dysfunction. The general management of newborns with PPHN is geared toward maintenance of normothermia, normal serum electrolytes, normal intravascular volume, correction of acidosis, adequate sedation/analgesia, adequate ventilation and oxygenation with optimal lung recruitment, and avoidance of hyperoxia. Inotropic and vasoactive agents are commonly initiated early to increase cardiac output, maintain adequate systemic blood pressure, and enhance oxygen delivery to the tissue. Unfortunately, there is not much evidence on the choice, timing of initiation, dosing, monitoring, and titrating of vasoactive agents in this patient population. In this review, we will discuss the pathophysiology of PPHN and review the use of inotropic, lusitropic, and vasoactive agents in the management of PPHN, with particular attention to milrinone.

Comparison of the Efficacy of Inhaled Versus Infused Milrinone in the Management of Persistent Pulmonary Hypertension in Infants in Resource-Limited Settings A Randomized Clinical Trial

“…Therapeutic effects of injectable milrinone as an adjuvant to other therapies (including iNO) have been reviewed and validated in previous studies. In a review article, Qasim et al (4) .reviewed six studies on the effect of injectable milrinone in the management of PPHN, in which all reported a positive effect of injectable milrinone in the treatment of PPHN. The dose of milrinone in three of the studies was 50 µg / kg bolus and then 0.33 µg / kg/min infusion, while in three studies without bolus and with an infusion rate of 0.99 − 0.33 µg / kg.…”

“…PPHN is usually associated with systemic hypotension and decreased cardiac output due to increased right ventricular afterload and myocardial insu ciency (2,3) . Management of neonates with PPHN includes maintenance therapy to maintain normal body temperature, serum electrolytes, intravascular volume, acid-base balance, analgesia, ventilation, and oxygenation (4) . Timely administration of inotropic and vasoactive drugs can increase cardiac output, maintain adequate blood pressure, and improve oxygen delivery (4) .…”

“…Management of neonates with PPHN includes maintenance therapy to maintain normal body temperature, serum electrolytes, intravascular volume, acid-base balance, analgesia, ventilation, and oxygenation (4) . Timely administration of inotropic and vasoactive drugs can increase cardiac output, maintain adequate blood pressure, and improve oxygen delivery (4) . The standard routine treatment for PPHN in reference books is inhaled nitric oxide (iNO) (5,6) , which unfortunately is not available in Iran; Therefore, other treatments are used in different medical centers, depending on the condition of the neonate and the decision of the treating physician.…”

Milrinone Ameliorates the Neuroinflammation and Memory Function of Alzheimer’s Disease in an APP/PS1 Mouse Model

“…Milrinone is a kind of bipyridine with vasodilator properties, which is generally used in the therapies for cardiopulmonary diseases. 16 , 17 For instance, Qasim and Jain revealed that milrinone can ameliorate persistent pulmonary hypertension in newborn through the great improvement for cardiac function and the reduction for pulmonary vascular resistance. 16 Tang et al performed a meta-analysis for the function of milrinone on patients with acute heart failure (AHF) or acute myocardial infarction (AMI); they uncovered that milrinone may be an effectively clinical drug for the treatment of AHF and AMI.…”

“… 16 , 17 For instance, Qasim and Jain revealed that milrinone can ameliorate persistent pulmonary hypertension in newborn through the great improvement for cardiac function and the reduction for pulmonary vascular resistance. 16 Tang et al performed a meta-analysis for the function of milrinone on patients with acute heart failure (AHF) or acute myocardial infarction (AMI); they uncovered that milrinone may be an effectively clinical drug for the treatment of AHF and AMI. 17 More importantly, growing evidences uncovered the clinical use of milrinone in neurological and neurocritical care patients, including subarachnoid hemorrhage (SAH) and stroke.…”