Korean Circ J.  2014 Sep;44(5):320-327. 10.4070/kcj.2014.44.5.320.

Safety and Efficacy of the Off-Label Use of Milrinone in Pediatric Patients with Heart Diseases

• Lee J
• Kim GB
• Kwon HW
• Kwon BS
• Bae EJ
• Noh CI
• Lim HG
• Kim WH
• Lee JR
• Kim YJ

• KMID: 2223871
• DOI: http://doi.org/10.4070/kcj.2014.44.5.320

Abstract

BACKGROUND AND OBJECTIVES
Milrinone is often used in children to treat acute heart failure and prevent low cardiac output syndrome after cardiac surgery. Due to the lack of studies on the long-term milrinone use in children, the objective of this study was to assess the safety and efficacy of the current patterns of milrinone use for > or =3 days in infants and children with heart diseases.
SUBJECTS AND METHODS
We retrospectively reviewed the medical records of patients aged <13 years who received milrinone for > or =3 days from January 2005 to December 2012. Patients' characteristics including age, sex, height, weight, and body surface area were recorded. The following parameters were analyzed to identify the clinical application of milrinone: initial infusion rate, maintenance continuous infusion rate, total duration of milrinone therapy, and concomitantly infused inotropes. The safety of milrinone was determined based on the occurrence of adverse events such as hypotension, arrhythmia, chest pain, headache, hypokalemia, and thrombocytopenia.
RESULTS
We assessed 730 admissions (684 patients) during this period. Ventricular septal defects were the most common diagnosis (42.4%) in these patients. Milrinone was primarily used after cardiac surgery in 715 admissions (97.9%). The duration of milrinone treatment varied from 3 to 64.4 days (> or =7 days in 149 admissions). Ejection fraction and fractional shortening of the left ventricle improved in patients receiving milrinone after cardiac surgery. Dose reduction of milrinone due to hypotension occurred in only 4 admissions (0.5%). Although diverse arrhythmias occurred in 75 admissions (10.3%), modification of milrinone infusion to manage arrhythmia occurred in only 3 admissions (0.4%). Multivariate analysis indicated that the development of arrhythmia was not influenced by the pattern of milrinone use.
CONCLUSION
Milrinone was generally administered for > or =3 days in children with heart diseases. The use of milrinone for > or =3 days was effective in preventing low cardiac output after cardiac surgery when combined with other inotropes, suggesting that milrinone could be safely employed in pediatric patients with heart diseases.

Keyword

Milrinone; Heart disease; Child; Safety

MeSH Terms

Arrhythmias, Cardiac
Body Surface Area
Cardiac Output, Low
Chest Pain
Child
Diagnosis
Headache
Heart Diseases*
Heart Failure
Heart Septal Defects, Ventricular
Heart Ventricles
Humans
Hypokalemia
Hypotension
Infant
Medical Records
Milrinone*
Multivariate Analysis
Off-Label Use*
Retrospective Studies
Thoracic Surgery
Thrombocytopenia
Milrinone

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