신생아 지속성 폐고혈압증에서의 Milrinone 치료 경험
Experience of Milrinone Treatment for Persistent Pulmonary Hypertension of the Newborn
인두교, 선용한, 홍희주, 조강호, 손동우, 전인상, 차한, 양성완, 최덕영, 류일, 정미진, 심소연,
소속 상세정보
인두교 ( In Doo-Kyo )
가천의과학대학교 소아과학교실
선용한 ( Sun Yong-Han )
가천의과학대학교 소아과학교실
홍희주 ( Hong Hee-Joo )
가천의과학대학교 소아과학교실
조강호 ( Cho Kang-Ho )
가천의과학대학교 소아과학교실
손동우 ( Son Dong-Woo )
가천의과학대학교 소아과학교실
전인상 ( Jeon In-Sang )
가천의과학대학교 소아과학교실
차한 ( Tchah Hann )
가천의과학대학교 소아과학교실
양성완 ( Yang Sung-Wan )
가천의과학대학교 소아과학교실
최덕영 ( Choi Deok-Young )
가천의과학대학교 소아과학교실
류일 ( Ryoo Eell )
가천의과학대학교 소아과학교실
정미진 ( Jung Mi-Jin )
가천의과학대학교 소아과학교실
심소연 ( Shim So-Yeon )
가천의과학대학교 소아과학교실
KMID : 0438520060130020201
Abstract
Purpose: Persistent pulmonary hypertension of the newborn (PPHN) is life threatening neonatal disease. Nitric oxide (NO) has been proven to improve oxygenation, however its usage is limited and 30% of patients with PPHN are NO nonresponders. Milrinone decreases right ventricular afterload and has selective pulmonary vasodilator effect. We studied the effects of milrinone on neonates with respiratory failure originated in PPHN.
Methods: Six neonates, who had oxygen index above 20 and responded poorly to other management, were treated with intravenous milrinone after confirming pulmonary hypertension with echocardiography. We reviewed their medical records retrospectively. Intravenous milrinone was started at a dose of 0.375 microgram/kg/min. Respiratory indices (Oxygenation index [OI], ventilation settings, and arterial blood gas) and cardiovascular stability (mean arterial pressure and heart rate) were documented just before; and at 6, 12, 24, 36, 48, and 72 hours after commencement of milrinone therapy. The primary outcome was the effect of milrinone on oxygenation, which was 40% reduction in OI.
Results: Primary cause of PPHN was meconium aspiration syndrome in three infants, respiratory distress syndrome (RDS) in the other three. Milrinone was commenced at a median age of 22.3+/-6.1 hours with a dose of 0.375 microgram/kg/min except one infant (0.5 microgram/kg/min) and infants were treated for median 58.3+/-16.7 hours. OI of all infants showed 40% reduction within 24 hours. There were no mortality, and no infants with hypotension, and intraventricular hemorrhage.
Conclusion: Milrinone proved to be effective for PPHN by improving oxygenation. It did not cause any complications in clinical trials for newborns. It is suggested that Milrinone can replace NO or can be used as adjunct to NO in the treatment of PPHN.
키워드
Milrinone;Oxygenation index;Pulmonary hypertension of the newborn(PPHN)
원문 및 링크아웃 정보
등재저널 정보