What is the role of inotropic drugs in the treatment of persistent pulmonary hypertension of the newborn (PPHN)?

Updated: Sep 03, 2019
  • Author: Kate A Tauber, MD; Chief Editor: Howard S Weber, MD, FSCAI  more...
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Optimal circulatory support is important to maintain adequate perfusion and maximize tissue oxygenation. Rapid infusion of colloid or crystalloid solutions, unless there is evidence of intravascular depletion, should be avoided as it results in a further increase in right atrial pressure which could lead to worsening of both the right-to-left shunting at the level of the foramen ovale and right ventricular systolic function.

Inotropic support with dopamine, dobutamine, and/or milrinone is frequently helpful in maintaining adequate cardiac output and systemic blood pressure while avoiding excessive volume administration. Although dopamine is frequently used as a first-line agent, other agents, such as dobutamine and milrinone, are helpful when myocardial contractility is poor.

Placement of a venous catheter into the umbilical vein (or other central vein) will allow for the administration of inotropic agents or hypertonic solutions (eg, calcium gluconate solution).

Avoid catheter placement into the neck vessels, which should be saved for extracorporeal support, if needed.

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