Response to pulmonary vasodilators in infants with congenital diaphragmatic hernia

Response to pulmonary vasodilators in infants with congenital diaphragmatic hernia Background Congenital diaphragmatic hernia (CDH) is associated with lung hypoplasia, cardiac dysfunction and pulmonary hypertension. Inhaled nitric oxide (iNO) and milrinone are commonly used pulmonary vasodilators in CDH. We studied the hemodynamic effects of iNO and milrinone in infants with CDH. Methods A retrospective chart review was performed of all CDH infants admitted to two regional perinatal centers and infants classified into three groups: No-iNO group; iNO-responders and iNO-nonresponders. Oxygenation and hemodynamic effects of iNO and milrinone were assessed by blood gases and echocardiography. Results Fifty-four percent (39/72) of infants with CDH received iNO and 31% of these infants (12/39) had complete oxygena- tion response to iNO. Oxygenation response to iNO was not associated with a decrease in right ventricular pressures (RVP) or ECMO use. Four infants (33%) in the iNO-responder group and eight infants (30%) in the iNO-nonresponder group received milrinone. Milrinone lowered RVP and improved ejection fraction (EF). Response to iNO was associated with improved oxygenation to milrinone and increased survival following ECMO (67 vs. 20% among nonresponders). Conclusions Response to inhaled nitric oxide in combination with milrinone may be associated with improved oxygenation and better survival after ECMO in infants with CDH. Keywords CDH · Pulmonary hypertension · http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Pediatric Surgery International Springer Journals

Response to pulmonary vasodilators in infants with congenital diaphragmatic hernia

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Publisher
Springer Berlin Heidelberg
Copyright
Copyright © 2018 by Springer-Verlag GmbH Germany, part of Springer Nature
Subject
Medicine & Public Health; Pediatrics; Surgery; Pediatric Surgery
ISSN
0179-0358
eISSN
1437-9813
D.O.I.
10.1007/s00383-018-4286-5
Publisher site
See Article on Publisher Site

Abstract

Background Congenital diaphragmatic hernia (CDH) is associated with lung hypoplasia, cardiac dysfunction and pulmonary hypertension. Inhaled nitric oxide (iNO) and milrinone are commonly used pulmonary vasodilators in CDH. We studied the hemodynamic effects of iNO and milrinone in infants with CDH. Methods A retrospective chart review was performed of all CDH infants admitted to two regional perinatal centers and infants classified into three groups: No-iNO group; iNO-responders and iNO-nonresponders. Oxygenation and hemodynamic effects of iNO and milrinone were assessed by blood gases and echocardiography. Results Fifty-four percent (39/72) of infants with CDH received iNO and 31% of these infants (12/39) had complete oxygena- tion response to iNO. Oxygenation response to iNO was not associated with a decrease in right ventricular pressures (RVP) or ECMO use. Four infants (33%) in the iNO-responder group and eight infants (30%) in the iNO-nonresponder group received milrinone. Milrinone lowered RVP and improved ejection fraction (EF). Response to iNO was associated with improved oxygenation to milrinone and increased survival following ECMO (67 vs. 20% among nonresponders). Conclusions Response to inhaled nitric oxide in combination with milrinone may be associated with improved oxygenation and better survival after ECMO in infants with CDH. Keywords CDH · Pulmonary hypertension ·

Journal

Pediatric Surgery InternationalSpringer Journals

Published: May 28, 2018

References

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