Evaluation of levosimendan as treatment option in preterm infants with cardiac dysfunction and pulmonary hypertension

Abstract Objectives Levosimendan as a calcium-sensitizer is a promising innovative therapeutical option for the treatment of severe cardiac dysfunction (CD) and pulmonary hypertension (PH) in preterm infants, but no data are available analyzing levosimendan in cohorts of preterm infants. Design/ Setting Retrospective single-center cohort study. Patients and Methods Retrospective single-center cohort study. Data of all preterm infants (gestational age (GA) <37 weeks) with levosimendan treatment and CD and/or PH in the echocardiographic assessment between 01/2018 and 06/2021 were screened for analysis. Main outcome measures The primary clinical endpoint was defined as echocardiographic response to levosimendan. Results 105 preterm infants were finally enrolled for further analysis. 48% of the preterm infants were classified as extremely low for GA newborns (ELGANs, <28 weeks of GA) and 73% as extremely low birth weight infants (<1500g, ELBW). The primary endpoint was reached in 71%, without difference regarding GA or BW. The incidence of moderate or severe PH decreased from baseline to follow-up (24h) in about 30%, with a significant decrease in the Responder-group (p<0.001). The incidence of left-ventricular dysfunction and bi-ventricular dysfunction decreased significantly from baseline to follow-up (24h) in the Responder-group (p=0.007, and p<0.001, respectively). The arterial lactate level decreased significantly from baseline (4.7 mmol/l) to 12h (3.6 mmol/l, p<0.05), and 24h (3.1 mmol/l, p<0.01). Conclusion Levosimendan treatment is associated with an improvement of both CD and PH in preterm infants, with a stabilization of the MAP during the treatment and a significant decrease of arterial lactate levels. Future prospective trials are highly warranted.