Response to pulmonary vasodilators in infants with congenital diaphragmatic hernia

Vasantha H.S. Kumar, Rita Dadiz, Jamie Koumoundouros, Stephanie Guilford, Satyanarayana Lakshminrusimha

Research output: Contribution to journalArticle

5 Citations (Scopus)

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 oxygenation 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.

Original languageEnglish (US)
Pages (from-to)1-8
Number of pages8
JournalPediatric Surgery International
DOIs
StateAccepted/In press - May 28 2018

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Vasodilator Agents
Nitric Oxide
Milrinone
Lung
Ventricular Pressure
Congenital Diaphragmatic Hernias
Hemodynamics
Pulmonary Hypertension
Echocardiography
Gases

Keywords

  • CDH
  • Infants
  • Inhaled nitric oxide
  • Milrinone
  • Pulmonary hypertension

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Surgery

Cite this

Response to pulmonary vasodilators in infants with congenital diaphragmatic hernia. / Kumar, Vasantha H.S.; Dadiz, Rita; Koumoundouros, Jamie; Guilford, Stephanie; Lakshminrusimha, Satyanarayana.

In: Pediatric Surgery International, 28.05.2018, p. 1-8.

Research output: Contribution to journalArticle

Kumar, Vasantha H.S. ; Dadiz, Rita ; Koumoundouros, Jamie ; Guilford, Stephanie ; Lakshminrusimha, Satyanarayana. / Response to pulmonary vasodilators in infants with congenital diaphragmatic hernia. In: Pediatric Surgery International. 2018 ; pp. 1-8.
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AU - Lakshminrusimha, Satyanarayana

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N2 - 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 oxygenation 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.

AB - 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 oxygenation 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.

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