Response to pulmonary vasodilators in infants with congenital diaphragmatic hernia
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.
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.
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).
Response to inhaled nitric oxide in combination with milrinone may be associated with improved oxygenation and better survival after ECMO in infants with CDH.
KeywordsCDH Pulmonary hypertension Inhaled nitric oxide Milrinone Infants
This research work was performed without any support from external funding or grants. No funds were received for covering the costs to publish in open access.
HSVK and SL conceived and designed the project; RD and SG provided help with IRB approval; RD, JK and SG substantially contributed to acquisition, analysis and interpretation of data; all the authors (VK, RD, JK, SG and SL) played a critical role in drafting and revising the manuscript for intellectual content.
Compliance with ethical standards
Conflict of interest
The authors have no conflict of interests to declare.
This article does not contain any studies with animals performed by any of the authors.
Research involving human participants
This is a retrospective case–control study. The University at Buffalo Institutional Review Board of the State University of New York, Buffalo (MODCR00001406), and the Research Subjects Review Board at the University of Rochester, Rochester (RSRB0006718), approved the study protocol for data collection in study patients.
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