Defining the Typical Course of Persistent Pulmonary Hypertension of the Newborn: When to Think Beyond Reversible Causes.

OBJECTIVES: To describe the typical clinical course of reversible persistent pulmonary hypertension of the newborn (PPHN) from perinatal etiologies and compare that with the clinical course of PPHN due to underlying fetal developmental etiologies. STUDY DESIGN: This was a single-center, retrospective cohort study of liveborn newborns either born or transferred to our facility for higher level of care between 2015 and 2020 with gestational age ≥35 weeks and a clinical diagnosis of PPHN in the electronic health record. Newborns with complex congenital heart disease and congenital diaphragmatic hernia were excluded. Using all data available at time of collection, newborns were stratified into 2 groups by PPHN etiology - perinatal and fetal developmental causes. Primary outcomes were age at initiation, discontinuation, and total duration of extracorporeal life support, mechanical ventilation, supplemental oxygen, inhaled nitric oxide, inotropic support, and prostaglandin E1. Our secondary outcome was age at echocardiographic resolution of pulmonary hypertension. Groups were compared by t-test. Time-to-event Kaplan Meier curves described and compared (log-rank test) discontinuation of each therapy. RESULTS: Sixty-four (72%) newborns had perinatal etiologies whereas 24 (28%) had fetal developmental etiologies. The resolution of perinatal PPHN was more rapid compared with fetal developmental PPHN. By 10 days of age, more neonates were off inotropes (98% vs 29%, P < .01), decannulated from extracorporeal life support (100% vs 0%, P < .01), extubated (75% vs 37%, P < .01), and had echocardiographic resolution of PH (35% vs 7%, P = .02). CONCLUSIONS: An atypical PPHN course, characterized by persistent targeted therapies in the second week of life, warrants further work-up for fetal developmental causes.

Presumed normal hemodynamic values of the arteries in the final third period of gestation in bitches

Background: Doppler ultrasonography enables the investigation of vascular blood flow indexes in gestational assessment,being able to detect vascular resistances that can affect fetal and maternal circulation, such as cases of placental insufficiency, associated with fetal cerebral oxygenation deficit and fetal distress. The study aims to assume hemodynamicallynormal values in the final third of gestation in bitches, of the umbilical, uteroplacental, middle cerebral and internal carotidarteries, correlating the obtained Doppler velocimetric indexes, for the assessment of the feto-placental circulation, andprediction of fetal viability indexes, fetal centralization and probable date of delivery.Materials, Methods & Results: Thirty healthy bitches were examined in the final third of gestation (40-60 days). Thesewere evaluated by Doppler ultrasonography at 2 times (T): T1: between 40-50 days; T2: between 51-60 of gestation.At each time point, the peak systolic velocities (PSV) and end-diastolic velocities (EDV) used to obtain the pulsatility(IP) and resistivity (IR) indexes of the umbilical, uteroplacental, middle cerebral and internal carotid arteries of fetuseswere evaluated. Also, the systole/diastole (S/D) ratio of these vessels was evaluated. The data obtained were subjected toanalysis of variance and Tukey test, using a P value equal to 5%. A significant difference was observed between velocitiesand Doppler velocimetric indexes between the 2 phases of the gestational final third in all studied vessels. There was anincrease in the values of PSV and EDV and a decrease in the indexes, as the probable date of delivery approached. Theanalysis of the umbilical cord IR showed an increase from P1 to P2 (P < 0.05), while the IP decreased at the same time.For all studied variables there was a statistically significant difference (P < 0.05). In the uteroplacental...(AU)

Presumed normal hemodynamic values of the arteries in the final third period of gestation in bitches

Background: Doppler ultrasonography enables the investigation of vascular blood flow indexes in gestational assessment,being able to detect vascular resistances that can affect fetal and maternal circulation, such as cases of placental insufficiency, associated with fetal cerebral oxygenation deficit and fetal distress. The study aims to assume hemodynamicallynormal values in the final third of gestation in bitches, of the umbilical, uteroplacental, middle cerebral and internal carotidarteries, correlating the obtained Doppler velocimetric indexes, for the assessment of the feto-placental circulation, andprediction of fetal viability indexes, fetal centralization and probable date of delivery.Materials, Methods & Results: Thirty healthy bitches were examined in the final third of gestation (40-60 days). Thesewere evaluated by Doppler ultrasonography at 2 times (T): T1: between 40-50 days; T2: between 51-60 of gestation.At each time point, the peak systolic velocities (PSV) and end-diastolic velocities (EDV) used to obtain the pulsatility(IP) and resistivity (IR) indexes of the umbilical, uteroplacental, middle cerebral and internal carotid arteries of fetuseswere evaluated. Also, the systole/diastole (S/D) ratio of these vessels was evaluated. The data obtained were subjected toanalysis of variance and Tukey test, using a P value equal to 5%. A significant difference was observed between velocitiesand Doppler velocimetric indexes between the 2 phases of the gestational final third in all studied vessels. There was anincrease in the values of PSV and EDV and a decrease in the indexes, as the probable date of delivery approached. Theanalysis of the umbilical cord IR showed an increase from P1 to P2 (P < 0.05), while the IP decreased at the same time.For all studied variables there was a statistically significant difference (P < 0.05). In the uteroplacental...

Pacientes con corazón univentricular sometidos a cirugía de Glenn / Patients with univentricular heart submitted to Glenn surgery

Resumen Objetivo: Describir las características clínicas, quirúrgicas y posquirúrgicas de pacientes univentriculares sometidos a cirugía de Glenn en un centro de referencia cardiovascular. Método: Estudio descriptivo, retrospectivo, llevado a cabo entre enero de 2012 y diciembre de 2016, en pacientes menores de 18 años que consultaron a una clínica de cuarto nivel, con cardiopatías de fisiología univentricular, definidos por ecocardiografía institucional, presentados en junta médico-quirúrgica, operados o no como primer estadio de paliación y seguidos en el programa de ventrículo único de la institución, posterior a un cateterismo cardiaco para ser presentado en junta médica que definió la realización de cirugía de Glenn. De la historia clínica se recolectaron datos de ecocardiogramas diagnósticos, cateterismos cardiacos, descripciones quirúrgicas y evoluciones. Resultados: Se analizaron 88 pacientes univentriculares, de los cuales el 63% eran hombres y el 36% eran mujeres. La anatomía del ventrículo funcional univentricular derecho estuvo presente en el 38.6% y la morfología funcional izquierda en el 61.4%. Entre las características asociadas con la mortalidad se verificó que el 1.1% tuviera insuficiencia moderada de la válvula atrioventricular y que el 3.4% tuviera insuficiencia grave de la válvula atrioventricular. El 38.6% presentó cifras de presión pulmonar elevadas, medidas por cateterismo cardiaco, y el 46% tenían resistencia vascular pulmonar aumentada. Se usó terapia vasopresora antes de la cirugía de Glenn en nueve pacientes; todos recibieron milrinona. La mortalidad posquirúrgica fue del 18%. Conclusiones: Este estudio evidencia que el diagnóstico y la intervención temprana contribuyen a reducir la morbimortalidad en los pacientes con diagnóstico de corazón univentricular, puesto que sin intervención de segundo estadio de paliación sería mortal para la mayoría de ellos. Así mismo, evidencia la importancia de la implementación de un programa integral para la atención de enfermedades cardiovasculares complejas.

Abstract Objective: To describe the clinical, surgical and post-surgical characteristics of univentricular patients undergoing Glenn’s surgery in a cardiovascular reference center. Method: Descriptive, retrospective study from January 2012 to December 2016, in patients under 18 who consulted a fourth level clinic with cardiopathies of univentricular physiology defined by institutional echocardiography, presented at the surgical medical board, operated or not as the first stage of palliation, followed in the single ventricle program of the institution, later performed a cardiac catheterization to be presented at the medical board that defined the performance of Glenn’s surgery. From the clinical history, data of diagnostic echocardiograms, cardiac catheterizations, surgical descriptions, and evolutions were collected. Results: A total of 88 univentricular patients were analyzed, of which 63% were men and 36% women. The anatomy of the right univentricular functional ventricle was present in 38.6% and 61.4% of left functional morphology. Among the characteristics associated with mortality, it was verified that 1.1% had moderate atrioventricular valve insufficiency and 3.4% had severe atrioventricular valve insufficiency in the patients who participated in the study. 38.6% had pulmonary arterial hypertension detected by cardiac catheterization and 46% had increased pulmonary vascular resistance. The use of vasopressor therapy before Glenn’s surgery was present in 9 patients and of them, the whole had milrinone. The postoperative mortality was 18%. Conclusions: This study shows that diagnosis and early intervention reduce morbidity and mortality in patients with a diagnosis of univentricular heart since without intervention of the second stage of palliation would be fatal for the vast majority of patients. It also demonstrates the importance of a comprehensive program for the care of complex cardiovascular pathologies.

Restricción del crecimiento intrauterino: una aproximación al diagnóstico, seguimiento y manejo / Intrauterine growth restriction: an approach to diagnosis, monitoring and management

ANTECEDENTES: La restricción del crecimiento intrauterino (RCIU) es una entidad de origen multifactorial que puede ser causada por una gran variedad de patologías a nivel materno, fetal o placentario, y que representa altas tasas de morbimortalidad materna y perinatal. Es importante realizar un diagnóstico certero de esta patología con el fin de llevar a cabo un enfoque de seguimiento y de manejo que pueda disminuir todas las complicaciones asociadas a la enfermedad. OBJETIVO: Realizar una revisión detallada y actualizada de la etiopatogenia, criterios diagnósticos, seguimiento con ecografía Doppler y manejo de la restricción del crecimiento intrauterino. MÉTODO: Se realizó una búsqueda de literatura publicada en inglés y español en bases de datos como PubMed/MEDLINE, Ovid, MDconsult utilizando las palabras clave: restricción del crecimiento intrauterino, feto pequeño para la edad gestacional, circulación fetal, ecografía Doppler, además de la búsqueda de estadísticas relacionadas con RCIU, de los resultados obtenidos se seleccionaron 61 artículos. La información obtenida fue clasificada y utilizada como soporte para la realización de esta revisión. RESULTADOS: Se presentan los estudios disponibles, las revisiones y artículos recomendados para la evaluación de pacientes con RCIU, adicionalmente aquellos que brindan nueva información con respecto al diagnóstico, evaluación de circulación fetal, seguimiento y manejo de esta entidad clínica. CONCLUSIÓN: La restricción del crecimiento intrauterino es una patología que presenta altas tasas de morbimortalidad perinatal. La identificación temprana de estos fetos y el seguimiento adecuado mediante la evalución Doppler permiten disminuir los resultados adversos y las secuelas a corto y largo plazo.

BACKGROUND: Intrauterine growth restriction has a multifactorial origin and can be caused by a variety of pathologies in the mother, fetus or placenta, representing high rates of maternal and perinatal morbidity and mortality. Therefore, it is important to accurately diagnose this condition in order to focus in the follow and management, which can reduce the complications associated with the disease. OBJECTIVE: To perform a detailed and up to date review of the etiology, diagnostic criteria, follow up with Doppler ultrasonography and management of intrauterine growth restriction. METHODS: A literature search was done in English and Spanish in databases such us PubMed/MEDLINE, Ovid, MDconsult using the following key words: intrauterine growth restriction, small for gestational age fetus, fetal circulation, Doppler ultrasonography. Also national statistics for intrauterine growth restriction were used, obtaining 61 documents. The information obtained was classified and used in the development of this review. RESULTS: The available studies are presented, and recommended revisions to the evaluation of patients with IUGR, additionally those that provide new information regarding the diagnosis, evaluation of fetal circulation, monitoring and management of this clinical entity. CONCLUSION: Intrauterine growth restriction is a pathology with a frequent diagnosis an represents high rates of perinatal morbidity and mortality. Early identification of these fetuses and adequate monitoring by Doppler evaluation allow reducing adverse outcomes and consequences in the short and long term.

Pediatric cataracts: clinical aspects, frequency of strabismus and chronological, etiological, and morphological features / Catarata pediátrica: aspectos clínicos, frequência de estrabismo e características cronológicas, etiológicas e morfológicas

Purpose: This study aimed to evaluate the frequency of strabismus and chronological, etiological, and morphological features in patients with pediatric cataracts. Methods: Medical records of pediatric patients were evaluated at the Congenital Cataract Section, Department of Ophthalmology, Federal University of São Paulo, from 2001 to 2011. Patients with congenital cataract or developmental cataract were included. The patients with traumatic cataract, cataract secondary to uveitis, radiation or drugs, aphakic or pseudophakic patients who underwent surgery in another hospital, patients with glaucoma, non-lenticular leukocorias (retinoblastoma, retinopathy of prematurity, prelenticular leukocorias), and lens subluxation were excluded from the study. The following outcomes were evaluated: frequency of chronological, etiological, and morphological features, laterality, and occurrence of associated strabismus. Results: A total of 207 patients were included. One hundred and seventeen patients (56.5%) had congenital cataract and 90 patients (43.5%) had developmental cataract. One hundred and nine patients (52.6%) had unilateral cataract. In terms of morphology, 72 children (33.8%) had zonular cataract and 66 (31.9%) had total cataract. Idiopathic cataract affected 150 patients (72.5%). There were 108 patients (52.2%) with strabismus, mainly secondary esotropia. Conclusion: Idiopathic etiology was the most frequent cause in this group of patients. Zonular cataract was the main morphological type of cataract in the study. Unilateral cataract occurred more frequently in patients with persistent fetal vasculature (PFV). Strabismus presented in 52% of the patients. The current analysis may help establish an earlier and more accurate diagnosis of pediatric cataracts. .

Objetivos: Avaliar as frequências do estrabismo e as características cronológica, etiológica e morfológica das cataratas pediátricas. Método: Estudo retrospectivo dos prontuários de crianças atendidas no Ambulatório de Catarata Congênita do Departamento de Oftalmologia da Universidade Federal de São Paulo no período entre 2001 e 2011. Foram incluídos pacientes com diagnóstico de catarata congênita ou de desenvolvimento. Foram excluídos os pacientes com catarata traumática; secundárias a uveíte, radiação ou medicamentos; pacientes operados em outro serviço; pacientes com glaucoma; leucocorias não cristalinianas (retinoblastoma, retinopatia da prematuridade, leucocorias pré-cristalinianas), e com sub-luxação do cristalino. Foram avaliadas: as frequências cronológicas, etiológicas e morfológicas das cataratas; a lateralidade e a ocorrência de estrabismo associado nestes pacientes. Resultados: Foram incluídos 207 pacientes. Cento e dezessete (56,5%) apresentavam catarata congênita e 90 (43,5%) apresentavam catarata de desenvolvimento. Cento e nove (52,6%) pacientes eram portadores de catarata unilateral. Quanto à morfologia, 72 crianças (33,8%) apresentavam catarata zonular e 66 (31,9%) apresentavam catarata total. A etiologia idiopática foi a mais frequente (72,5%) afetando 150 pacientes. Foram observados 108 pacientes (52,2%) com estrabismo associado, especialmente endotropias secundárias. Conclusões: A etiologia idiopática foi a mais frequente neste estudo. O tipo morfológico zonular foi o mais frequentemente diagnosticado. Cataratas unilaterais ocorreram mais frequentemente em pacientes com persistência da vasculatura fetal. O estrabismo associado ocorreu em 52% dos pacientes. A análise dos resultados deste estudo pode ...

Manejo anestésico en un recién nacido portador de hernia diafragmática derecha bajo soporte ventilatorio de alta frecuencia oscilatoria.: Reporte de un caso clínico

RESUMEN El manejo anestésico para reparación de hernia diafragmática en recién nacidos (RN) es un desafío, que obliga a establecer estrategias en el pre, intra y postoperatorio. Actualmente se pospone el procedimiento hasta obtener las mejores condiciones con especial relevancia en los cuidados preoperatorios. Objetivo: analizar el manejo anestesiológico utilizando un modo ventilatorio de alta frecuencia oscilatoria (VOAF) en unidad de cuidados intensivos neonatales (UCIN). Estamos frente a un RN con grandes alteraciones en lo respiratorio y cardiovascular, un procedimiento en un área fuera de block quirúrgico, que requiere mayor planificación, y un modo ventilatorio nuevo en el país. La técnica anestésica a elegir debe cumplir con los objetivos anestésicos. Optamos por una total intravenosa por la estabilidad hemodinámica, la imposibilidad de conectar un vaporizador al ventilador porque perderíamos los beneficios de la VOAF. Es importante el trabajo multidisciplinario, sopesar el riesgo-beneficio de realizar el procedimiento en UCIN, formar un equipo especializado en neonatología, y fundamentalmente contar con un área especializada para procedimientos quirúrgicos en neonatos, en UCIN o cercano a la unidad. En este caso clínico se tuvo en cuenta todos estos puntos y aun así vemos que la mortalidad de esta patología es muy alta.

SUMMARY The anesthetic management of diaphragmatic hernia repair in newborns is a challenge that requires to define strategies during pre, intra and postoperative periods. At present, the procedure is postponed until obtaining the best conditions possible, placing special emphasis in preoperative care. Objective: to analyze the anesthetic management using the high-frequency oscillatory ventilation (HFOV) method in the neonatal intensive unit (NICU). We are in the presence of: a newborn with significant respiratory and cardiovascular alterations, a procedure outside the operating room that requires more planning, and a ventilation method that is being used for the first time in the country. The anesthetic technique must comply with the anesthetic objectives. We opted for a total intravenous anesthesia due to the hemodynamic stability, and the impossibility of connecting a humidifier to the ventilator as we would lose the HFOV benefits. It is important to implement a multidisciplinary work, to consider the risk-benefit of performing a procedure in the NICU, to set a team specialized in neonatology, and mainly, to have a specialized area for surgical procedures in neonates in the NICU or near the Unit. We took into account all these elements in this clinical case and yet the mortality rate of this pathology is very high.

RESUMO O manejo anestésico para reparação de hérnia em recém nascidos (RN) é um desafio, exige estabelecer estratégias no pre, intra e pós-operatório. Atualmente se adia o procedimento ate obter as melhores condições, com especial relevância aos cuidados pré-operatórios. Objetivo: Analisar o manejo anestesiológico utilizando um modo ventilatorio de alta frequência oscilatória (VOAF) em unidades de cuidados intensivos neonatais (UCIN). Enfrentamo-nos com um RN com grandes alterações respiratórias e cardiovasculares, procedimento em área fora de bloco cirúrgico, que requer maior planificação e um modo ventilatorio novo no País. A técnica anestésica a ser escolhida deve cumprir com os objetivos anestésicos. Optamos por uma técnica intravenosa total devido a estabilidade hemodinâmica, a impossibilidade de conectar um vaporizador ao ventilador porque perderíamos os benefícios da (VOAF). É importante o trabalho multidisciplinar, avaliar o risco - beneficio de realizar o procedimento na UCIN, formar uma equipe especializada em neonatalogia e fundamentalmente contar com uma área especializada para procedimentos cirúrgicos em recém nascidos na UCIN ou perto da unidade. Neste caso clinico levou-se em conta todos estes aspectos, ainda assim notamos que a mortalidade desta patologia é muito alta.

Estudo morfométrico do coração fetal: sua utilização como parâmetro para análise ecocardiográfica / Morphometric study of the fetal heart: a parameter for echocardiographic analysis", "_i": "en

OBJETIVO: Avaliar o diâmetro, o perímetro e a área das valvas atrioventriculares do coração fetal, bem como a espessura das paredes ventriculares e os diâmetros das cavidades ventriculares. MATERIAIS E MÉTODOS: Foram dissecados 20 corações de fetos com idade gestacional entre 28 e 36 semanas. Em seguida foram medidos os diâmetros ântero-posterior e transverso e aferidos as áreas e os perímetros das valvas mitral e tricúspide, bem como foram medidas as espessuras das paredes ventriculares e os diâmetros de suas cavidades, utilizando-se um paquímetro com acurácia de1/10 mm. RESULTADOS: Os diâmetros ântero-posterior e transverso da valva atrioventricular esquerda mediram, em média, 10,35 ± 1,62 mm e 9,90 ± 1,79 mm, respectivamente, e os diâmetros ântero-posterior e transverso da valva atrioventricular direita, 10,98 ± 1,90 mm e 9,51 ± 1,81 mm, respectivamente. A área e o perímetro da valva mitral foram de 84,06 ± 25,09 mm² e 29,87 ± 3,96 mm, respectivamente. A área e o perímetro da valva tricúspide mediram, respectivamente, 84,49 ± 26,79 mm² e 28,44 ± 3,85 mm. No ventrículo direito a espessura da parede anterior foi de 5,00 ± 1,70 mm e a da parede posterior foi de 3,83 ± 0,91 mm; no ventrículo esquerdo a espessura da parede anterior foi de 4,25 ± 0,87 mm e a da parede posterior foi de 4,14 ± 0,89 mm. O septo interventricular teve espessura de 4,10 ± 1,13 mm. O ventrículo direito teve como diâmetro ântero-posterior 9,25 ± 0,85 mm, e como diâmetro transverso 8,24 ± 0,42 mm. O ventrículo esquerdo mediu 9,95 ± 0,37 mm para o diâmetro ântero-posterior e 9,20 ± 0,40 mm para o diâmetro transverso. CONCLUSÃO: O conhecimento dos dados morfométricos do coração do feto é de grande importância para o diagnóstico ecocardiográfico de possíveis malformações cardíacas.

OBJECTIVE: To evaluate the diameter, perimeter and area of atrioventricular valves as well thickness of ventricular walls and diameter of ventricular cavity of fetal hearts. MATERIALS AND METHODS: Twenty fetal hearts at gestational age between 28 and 36 weeks were dissected. A paquimeter with 1/10 mm accuracy was utilized for the following morphological measurements: anteroposterior and transverse diameters, mitral and tricuspid valves areas and perimeters. RESULTS: Anteroposterior and transverse diameters of the left atrioventricular valve measured 10.35 ± 1.62 mm and 9.90 ± 1.79 mm, respectively; and anteroposterior and transverse diameters of the right atrioventricular valve measured 10.98 ± 1.90 mm and 9.51 ± 1.81 mm, respectively. Mitral valve area and perimeter were, respectively, 84.06 ± 25.09 mm² and 29.87 ± 3.96 mm. Tricuspid valve area and perimeter were, respectively, 84.49 ± 26.79 mm² and 28.44 ± 3.85 mm. The thicknesses of the anterior and posterior right ventricular walls were, respectively, 5.00 ± 1.70 mm and 3.83 ± 0.91 mm. The thicknesses of the anterior and posterior left ventricular walls were, respectively, 4.25 ±0.87 mm and 4.14 ± 0.89 mm. The thickness of the interventricular septum measured 4.10 ± 1.13 mm. The anteroposterior diameter of the right ventricle was 9.25 ± 0.85 mm, and the transverse diameter was 8.24 ± 0.42 mm. The anteroposterior diameter of the left ventricle measured 9.95 ± 0.37 mm, and transverse diameter measured 9.20 ± 0.40 mm. CONCLUSION: The role of morphometric data of fetal atrioventricular valves is highly significant in the echocardiographic diagnosis of possible congenital cardiac malformations.

Uso de milrinona no tratamento da hipertensão pulmonar persistente do recém-nascido / Milrinone for persistent pulmonary hypertension of the newborn treatment

OBJETIVO: Descrever uma série de casos de recém-nascidos com hipertensão pulmonar persistente grave, que receberam milrinona para promover a vasodilatação pulmonar. MÉTODOS: Análise retrospectiva de prontuários de 28 pacientes com diagnóstico de hipertensão pulmonar persistente do recém-nascido (HPPRN). Após o diagnóstico, todos os pacientes receberam uma dose de ataque de 50mcg/kg de milrinona, seguida por 0,75mcg/kg/min. O índice de oxigenação (IO) foi calculado no início da infusão e 72 horas após o início da medicação. RESULTADOS: Todos os neonatos receberam milrinona e o sildenafil foi associado em 54 por cento. O uso de dopamina assegurou a manutenção da pressão arterial em nível adequado em todos os casos. Sedação contínua, alcalinização e surfactante foram medidas coadjuvantes no tratamento. Durante a internação, sete pacientes (25 por cento) evoluíram a óbito e todos eles apresentaram aumento do IO, com elevação da média de 25 para 38 com a milrinona. Os sobreviventes, com exceção de um neonato, apresentaram redução do IO em uso de milrinona, com queda da média de 19 para 7. CONCLUSÕES: O uso da milrinona parece ser uma alternativa para o tratamento da HPPRN, na ausência do óxido nítrico. A redução do IO com a medicação foi fator determinante da boa evolução dos pacientes. O índice de falha no tratamento com a milrinona nesta casuística foi semelhante ao encontrado na literatura para o uso de óxido nítrico.

OBJECTIVE: To describe a series of neonates with severe persistent pulmonary hypertension, who received milrinone as the main treatment for pulmonary vasodilatation. METHODS: Retrospective analysis by chart review of 28 neonates with persistent pulmonary hypertension. A dose of 0.75µg/kg/min of milrinone was given, after a loading dose of 50µg/kg. The oxygenation index (OI) was calculated before and 72 hours after the medication. RESULTS: All infants received milrinone and sildenafil was associated to milrinone in 54 percent. The use of dopamine assured normal blood pressure during milrinone treatment in all patients. Continuous sedation, alcalinization and surfactant were additional measures in the treatment. During the hospitalization period, seven (25 percent) patients died and all of them presented an OI increase after milrinone (the average OI rose from 25 to 38). All but one of the 21 surviving patients presented improvement of the OI with milrinone, with a reduction of the mean index from 19 to 7. CONCLUSIONS: Milrinone can be used to treat persistent pulmonary hypertension of the newborn, in the absence of nitric oxide. The reduction of the OI during treatment was associated with clinical improvement. The failure rate for milrinone treatment in this series of cases was similar to that found in the literature regarding nitric oxide.