Levosimendan in pediatric and neonatal practice – Pro and Contra

Abstract

The problem of intensive shock therapy of various etiologies in neonatology remains relevant. Anatomical and physiological features of the cardiovascular system and changes that occur during the first weeks of life in children affect the choice and dose of drugs to resolve a critical condition. The shortcomings of medications available in neonatology for the correction of arterial hypotension and shock led to the search for new drugs for the treatment of such patients.Levosimendan is a cardiotonic agent that increases the sensitivity of the heart to calcium, has a positive inotropic and vasodilatory effect, reducing preload and postload of the heart. Levosimendan has been used in neonatal practice for more than 15 years, but the lack of major studies to date evaluating its effectiveness and safety in newborns significantly limits its use. Several studies have demonstrated a positive effect of the drug on cerebral, systemic perfusion and oxygenation in newborns with low cardiac output syndrome, safety, low frequency of side effects and reduced time spent in the intensive care unit for newborns after correction of heart defects and in newborns who have suffered asphyxia. However, most of the published results of the clinical use of levosimendan in neonatology are limited to a few observations or poor quality of the study design.The available literature data indicate a good potential of the drug as a means of inotropic support, however, there is no convincing data on the effect of levosimendan on the survival of newborns in critical condition.