Amer J Perinatol
DOI: 10.1055/s-0039-1678558
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Is Milrinone Effective for Infants with Mild-to-Moderate Congenital Diaphragmatic Hernia?

Michelle Mears
1  School of Nursing, University of Utah School of Medicine, Salt Lake City, Utah
2  Division of Neonatology, Primary Children's Hospital, Salt Lake City, Utah
,
Michelle Yang
2  Division of Neonatology, Primary Children's Hospital, Salt Lake City, Utah
3  Division of Neonatology, University of Utah School of Medicine, Salt Lake City, Utah
,
Bradley A. Yoder
2  Division of Neonatology, Primary Children's Hospital, Salt Lake City, Utah
3  Division of Neonatology, University of Utah School of Medicine, Salt Lake City, Utah
› Author Affiliations
Funding None.
Further Information

Publication History

06 August 2018

20 December 2018

Publication Date:
01 February 2019 (eFirst)

Abstract

Background Pulmonary hypertension with left ventricular dysfunction commonly occurs in congenital diaphragmatic hernia (CDH). Milrinone, a phosphodiesterase-III inhibitor with lusitropic and vasodilator effects, is used in up to 30% of CDH infants across the United States. No randomized trials have tested the efficacy or safety of milrinone in CDH neonates.

Study Design We performed a paired retrospective analysis of CDH infants to assess the efficacy of milrinone treatment (N = 24 pairs). Efficacy was assessed by change in oxygenation index (OI) and calculated pulmonary artery pressure (PAP). We evaluated safety on the basis of risks factors such as nonoperative bleeding, dysrhythmia, hypokalemia, and thrombocytopenia.

Results The median age of milrinone initiation was 18 hours (interquartile range [IQR]: 9–38) and the median duration was 127 hours (IQR: 95–194). PAP did not change from the baseline of 49 ± 11 mm Hg (milrinone) and 53 ± 11 mm Hg (No milrinone; p = 0.327). Baseline OI was 9.6 ± 6.5. There was a similar decrease in OI (median [IQR]; milrinone: 58% [16–74]; vs. no milrinone: 65% [50–71]; p = 0.221 between groups; p < 0.005 within groups). Baseline left ventricle measurements were similar. Both groups showed significant improvement over time. No adverse events were noted.

Conclusion In OI-matched untreated neonates with mild-to-moderate CDH, milrinone use was associated with neither improved OI, PAP, or left ventricular measurements, nor adverse events. Study limitations warrant prospective randomized controlled trials.

Authors' Contributions

Drs Yoder and Mears contributed to the conception and design of the study, data collection and analysis, and manuscript preparation; Dr Yang contributed to data analysis and manuscript preparation. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.