Exploratory Assessment of Levosimendan in Infants With Congenital Diaphragmatic Hernia
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Read the article on pubmed.ncbi.nlm.nih.gov ↗Article · Apr 2021 · 1 min read
In brief
In brief
Retrospective study of 24 infants with congenital diaphragmatic hernia treated with levosimendan showed improvement in pulmonary hypertension and biventricular dysfunction within 7 days. The inodilator was associated with reduced ventilatory support needs and vasoactive medication requirements, with minimal adverse effects.
Written by the GCMD Library team from the article.
Objectives: Infants with congenital diaphragmatic hernia frequently suffer from cardiac dysfunction and pulmonary hypertension during the postnatal course. With the use of the inodilator levosimendan, a therapeutic approach is available in situations with catecholamine-refractory low-cardiac-output failure and severe pulmonary hypertension.
Design: Retrospective single-center cohort study.
Setting: University-based, tertiary-care children's hospital neonatal ICU.
Patients: Cohort of 24 infants with congenital diaphragmatic hernia and levosimendan therapy, without underlying major cardiac defect, treated at the University Children´s Hospital Bonn, Germany, between January 2017 and December 2018.
Interventions: None.
Measurements and main results: Twenty-four infants with congenital diaphragmatic hernia were treated with levosimendan (41% of hospitalized congenital diaphragmatic hernia infants in the study period). In 88%, the congenital diaphragmatic hernia was left-sided. The median observed-to-expected lung-to-head ratio was 36%. About 60% of the infants were supported with venovenous extracorporeal membrane oxygenation and the mortality was 38% (9/24 infants). Levosimendan administration was associated with improvement of pulmonary hypertension severity (p = 0.013 and p = 0.000) and right ventricular dysfunction (p = 0.011 and p = 0.000) at 24 hours and 7 days after treatment. Similarly, the prevalence of left ventricular dysfunction decreased from 50% at baseline to 10% after 7 days (p = 0.026). A significant reduction in the peak inspiratory pressure was observed after drug application (p = 0.038) and a significant decrease of the Vasoactive-Inotropic Score was apparent (p = 0.022). A relevant arterial hypotension as a drug-related adverse event occurred in one patient.
Conclusions: This is the first study exploring clinical and hemodynamic changes after levosimendan treatment in a cohort of infants with congenital diaphragmatic hernia. An association of levosimendan application and an improvement in pulmonary hypertension, right ventricular, and left ventricular dysfunction were observed within 7 days after drug infusion. However, due to the retrospective design of this study, the results should be interpreted carefully.
DOI: 10.1097/PCC.0000000000002665