Background and Aims To report the successful use of the new inodilator levosimendan in 4 critically ill neonates with refractory heart failure. At present, no data are available on the use of levosimendan in newborns outside the cardiosurgical setting.
Methods Clinical chart review.
Results Neonates described in Table 1 were given LS due to severe refractory heart failure when standard treatment was ineffective and/or complications occurred. LS was administered as a continuous i.v. infusion (0.2 mcg/kg/min over the first 24 hrs). LS addition resulted in an improvement and/or stabilisation of hemodynamic status, with nearly normal restoration of heart function in 2/4 infants. Patients with PH and RV enlargement could be weaned off from pulmonary vasodilators.
Conclusions In these full-term neonates with post-ischaemic low cardiac output/pulmonary hypertension and heart failure of infectious or metabolic origin, refractory to first line inotropic drugs, LS was a potent inotropic agent and a possible add-on therapy. As suggested, in the neonatal period LS may represent an ideal drug for immature myocardium characterized by a much more calcium dependent contractility than adults. Further studies are needed to evaluate the role of LS in refractory HF.
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