Dopamine increase SVR while milrinon decrease it so both had different action

So wen compensated shock we like to maintain vaso construction and wen thing worse due to vasoconstrition due to un compansation den milrinon act adjuvant ..... Both have also similar action of also..... increase heart contractility ...wen dopa receptor tired milrinone receptor still work for help...

Its simple.just find out cause of shock by echo.if IVC small/ underfilled, use fluid and dopamine.if cardiac contractility poor but still BP at higher side use milrinone.u can not use milrinone in any type of hypotention if BP low.

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Ya obviously if echo available...

Milrinone is a vasodilator. Useful in PPHN. If 2-D Echo is not available then it will be dangerous to use it in hypotension. Dopamine or epinephrine is better bet. Now epinephrine is increasingly preferred to Dopamine

We used milrinone with dopamine IV and sildenafil for PPHN.

Unfortunately this study (http://clinicaltrials.gov/ct2/show/NCT01088997?term=milrinone+neonates&rank=1) has been terminated prematurely.

Would have been interesting to find out more about the drugs effects in neonates.

In our Center, we re-evaluate PPHN treatment in newborn and we introduced Milrinone (I used once with good result).

For milrinone use is mandatory a cardiac echography: cardiologist or experienced neonatologist in cardiac echo

 

Here some information about Milrinone that I took from Literature

Milrinone actually is a off-label drugs for PPHN in Italy but several times it is used with good results (parents' consensus necessary)

Milrinone has a duble effects:

- inotropic effect on cardiac output

- pulmonary and systemic vasodilatatory effect, with possibile synergic effect with iNO

Indication: PPHN  NON-responder to iNO with cardiac echo showing left ventricular disfunction. We associate Milrinone plus Adrenalin (Dopamine increases pulmonary resistences thus incerasing afterload of right ventricule; Dobutamine worses cardiac performances during left ventricole disfunction)

Dosing (based on literature):

- gestazional age < 30 weeks: loading dose 50-75 microgr/kg in 60 min, manteinance dose 0,375-0,75 microgr/kg/min

- gestazional age > 30 weeks: loading dose 135 microgr/kg in 180 min, maintenance dose 0,2-0,75 microgr/kg/min

In case of severe systemic hypotension (with total amine dose > 10 microgr/kg/min) the LOADING dose should be reduced to 25 microgr/kg or omitted

Maximal duration: 3 days (even if in Literature some authors used milrinone for several days)

Since milrinone is metabolized by kidney, reduce loading dose and maintenance dose in case of severe renal impairment

REMEMBER: milrinone infusion is NOT compatible with Furosemide (precipitaion of drugs)

Milrinone preparation: VIAL: 10 ml e.v.  (1 mL=1 mg); diluite 1 ml/kg of Milrinone up to 50 mL of Saline or 5%Glucose (velocity 1mL/h=0,33 microgr/kg/min)

Side effets: hypotension (2.9%), supraventricular aritmic pulse (3.8%) or ventricular (12% even if these cardiac efefct are present very rare in pediatric and neonatal population), hyokaliemia (0.6%), trombocitopenia (0.4%)

Some Literature:

- Carina Teixeira-Mendonc¸aa, Tiago Henriques-Coelhob, Pathophysiology of pulmonary hypertension in newborns: Therapeutic indications Rev Port Cardiol. 2013;32(12):1005-12

- Marcia L. Buck, The Use of Milrinone in Infants and Children PEDIATRIC PHARMACOTHERAPY Volume 9 Number 2 February 2003

- Chryssoula Tzialla, Rosa Maria Cerbo, Gianfranco Perotti, Mauro Stronati Persistent pulmonary hypertension of the newborn refractoryto inhaled nitric oxide treated with milrinone: a case report The Turkish Journal of Pediatrics 2010; 52: 78-80

- Patrick J. McNamara; Sandesh P. Shivananda; Mohit Sahni; David Freeman; Anna Taddio,  Pharmacology of Milrinone in Neonates With Persistent Pulmonary Hypertension of the Newborn and Suboptimal Response to Inhaled Nitric Oxide Pediatr Crit Care Med 2013; 14:74–84

- Sanchez Luna , Franco ML, Bernardo B. Therapeutic strategies in pulmonary hypertension of the newborn: where are we now? Curr Med Chem. 2012;19(27):4640-53

- Cabral JE, Belik J. Persistent pulmonary hypertension of the newborn: recent advances in pathophysiology and treatment. J Pediatr (Rio J). 2013 May-Jun;89(3):226-42