The use of milrinone in neonates with persistent pulmonary hypertension of the newborn - a randomised controlled trial pilot study (MINT 1): study protocol and review of literature
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Date
2018-12-03
Authors
El-Khuffash, Afif
McNamara, Patrick J.
Breatnach, Colm
Bussmann, Neidin
Smith, Aisling
Feeney, Oliver
Tully, Elizabeth
Griffin, Joanna
de Boode, Willem P.
Cleary, Brian
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Volume Title
Publisher
BMC
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Abstract
Persistent pulmonary hypertension of the newborn (PPHN) is a relatively common condition which results in a mortality of up to 33%. Up to 40% of infants treated with nitric oxide (iNO) either have a transient response or fail to demonstrate an improvement in oxygenation. Milrinone, a selective phosphodiesterase 3 (PDE3) inhibitor with inotropic and lusitropic properties may have potential benefit in PPHN. This pilot study was developed to assess the impact of milrinone administration on time spent on iNO in infants with PPHN. This is a multicentre, randomized, double-blind, two arm pilot study, with a balanced (1:1) allocation of 20 infants. In this pilot study, we hypothesise that infants ≥34 weeks gestation and ≥ 2000 g with a clinical and echocardiography diagnosis of PPHN, intravenous milrinone used in conjunction with iNO will result in a reduction in the time spent on iNO. In addition, we hypothesise that milrinone treatment will lead to an improvement in myocardial performance and global hemodynamics when compared to iNO alone. We will also compare the rate of adverse events associated with the milrinone, and the pre-discharge outcomes of both groups. The purpose of this pilot study is to assess the feasibility of performing the trial and to obtain preliminary data to calculate a sample size for a definitive multi-centre trial of milrinone therapy in PPHN.
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Keywords
Nitric oxide , Pulmonary hypertension , Milrinone , Phosphodiesterase , Neonates
Citation
Afif, E.K., McNamara, P.J., Breatnach, C., Bussmann, N., Smith, A., Feeney, O., Tully, E., Griffin, J., de Boode, W.P., Cleary, B. and Franklin, O., 2018. The use of milrinone in neonates with persistent pulmonary hypertension of the newborn-a randomised controlled trial pilot study (MINT 1): study protocol and review of literature. Maternal health, neonatology and perinatology, 4(1): 24 (12pp) DOI: 10.1186/s40748-018-0093-1