New Inotropic Pharmacologic Strategies Targeting the Failing Myocardiumin the Newborn and Infant

Pharmacologic support of the failing neonatal heart to maintain cardiac output, which is vital for sufficient end organ perfusion, is a challenging task for the pediatric intensivist, especially since strategies which have been proven to be effective in adults cannot necessarily be extrapolated to neonates. The unique biochemical properties and structure of the neonatal heart, including the increased non-contractile tissue mass, a lower responsiveness to beta adrenergic agents and the heart rate dependent cardiac output with a limited ability toincrease stroke volume, favor some of the new inotropes of the Ca+ sensitizer family. Focusing on the after loadreduction, inodilators as phosphodiesterase inhibitors and human brain natriuretic peptide offer treatment optionsfor the neonatal myocardium. Additionally, thyroxine and steroids have been investigated in neonates with lowcardiac output after surgery for congenital heart disease. Gene therapy, in particular cardiac-selective gene transfer,might offer perspectives for future support for the neonatal heart. This text reviews some of the most recentpharmacologic strategies targeting the failing myocardium in the critically ill newborn and infant