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Response to pulmonary vasodilators in infants with congenital diaphragmatic hernia

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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.

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Acknowledgements

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.

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Authors and Affiliations

  1. Department of Pediatrics, University at Buffalo, Buffalo, NY, USA

    Vasantha H. S. Kumar, Jamie Koumoundouros & Stephanie Guilford

  2. University of Rochester Medical Center, Rochester, NY, USA

    Rita Dadiz

  3. Department of Pediatrics, University of California Davis Children’s Hospital, Sacramento, CA, USA

    Satyan Lakshminrusimha

  4. Division of Neonatology, Department of Pediatrics, John R Oishei Children’s Hospital, University at Buffalo, 1001 5th Floor Main Street, Buffalo, NY, 14203, USA

    Vasantha H. S. Kumar

Authors
  1. Vasantha H. S. Kumar
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  2. Rita Dadiz
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  4. Stephanie Guilford
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  5. Satyan Lakshminrusimha
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Contributions

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.

Corresponding author

Correspondence to Vasantha H. S. Kumar.

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The authors have no conflict of interests to declare.

Ethical approval

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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Kumar, V.H.S., Dadiz, R., Koumoundouros, J. et al. Response to pulmonary vasodilators in infants with congenital diaphragmatic hernia. Pediatr Surg Int 34, 735–742 (2018). https://doi.org/10.1007/s00383-018-4286-5

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  • DOI: https://doi.org/10.1007/s00383-018-4286-5

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