Levosmindan: A new step up in Management in Neonatal Cardiogenic shock
Abstract We report the use of Levosimendan, calcium sensitizer, inodilator in a neonate with post-operative refractory cardiogenic shock. Currently, no data are available on the use of levosimendan in newborns outside the cardiosurgical setting. A 38-week neonate -with isolated exomphalos major-presented post-operatively with pulmonary hypertension, refractory cardiogenic shock (inspite of receiving, a bolus of 10ml/kg, Dopamine and Dobutamine 15µg/kg/min, Adrenaline up to 1mg/Kg/min, Noradrenaline 0.5mg/Kg/min, Terlipressin 20µg/Kg/hour, Milrinone 25µg/Kg/min) and arrhythmia (supraventricular tachycardia). Levosimendan was introduced as an intravenous infusion with an initial rate of 0.1 up to 0.2µg/Kg/min in addition to Noradrenaline 1µg/Kg/min, Dopamine 15µg/Kg/min and Furosemide infusion 0.1mg/Kg/hour. The patient improved evidenced by normalization of vital signs and restoration of perfusion with better cardiac functions by echocardiography. Conclusion: Levosimendan has positive inotropic, lusitropic and vasodilating effects for the treatment of heart failure yet further studies in neonates are still required.
