Evidence summary
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Efficacy
Treatment of pulmonary hypertension in near term infants: Case series report improvements in, pulmonary and systemic haemodynamics and oxygenation in infants with pulmonary hypertension, treated with nitric oxide. 1, 6, 7 (LOE IV GOR C), Treatment of very pre-term infants: An RCT found no difference in measures of systemic blood flow, when used preventatively in extremely premature infants. 8 Case series reported improvement in, oxygenation and a fall in blood pressure in pre-term infants with pulmonary hypertension treated, with nitric oxide. 9 There are insufficient data to determine the efficacy and safety of milrinone in, pre-term infants with pulmonary hypertension and/or myocardial dysfunction.10 (LOE II 8, GOR C), Neonates and infants undergoing cardiac surgery: A single RCT found high dose milrinone reduced the risk of LCOS post cardiac surgery. 2, 3 (LOE II, GOR B) An historical control study reported use of milrinone post ductal ligation improved ventilation and reduced inotrope use 11 (LOE IV, GOR C). Infants and children with shock associated with myocardial dysfunction: An RCT found milrinone 0.5 microgram/kg/min reduced mortality in children with enterovirus 71-induced pulmonary oedema and/or shock. A loading dose was not used. 4 (LOE II, GOR B).
Safety
Reports of arrhythmias, tachycardia, hypotension and hypokalaemia, bronchospasm, headaches, thrombocytopenia, anaemia and elevated serum liver enzymes. In neonates treated with milrinone, hypotension and intraventricular haemorrhage have been observed. 2, 6 (LOE IV)
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