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Background <p>Neonatal myocardial infarction is a rare and often life-threatening condition, particularly in preterm neonates, with nonspecific clinical presentations that complicate diagnosis. While diagnosis relies on ECG changes, elevated cardiac markers, and echocardiographic abnormalities, management guidelines and validated biomarker cut-offs for neonates are lacking. Conventional inotropic support is often necessary, but its efficacy in immature myocardium can be limited. Levosimendan, a calcium sensitizer with inotropic, lusitropic, and vasodilatory effects, offers potential advantages by improving contractility without increasing myocardial oxygen consumption, but evidence in neonates, especially preterm infants, remains scarce.</p> Case presentation <p>We report the case of an extremely preterm neonate (26 + 6 weeks gestation) who developed severe myocardial ischemic injury and refractory cardiogenic shock following perinatal hypoxic-ischemic insult. Despite aggressive resuscitation and conventional inotropic support with Dobutamine, Noradrenaline, and Milrinone, the infant’s condition remained critical with persistent severe left ventricular dysfunction. Given the lack of response to conventional therapy, off-label levosimendan was initiated. Within 48&#xa0;h, significant clinical and echocardiographic improvement was observed, including shock resolution and recovery of left ventricular ejection fraction.</p> Conclusions <p>This case highlights the successful use of Levosimendan in a preterm neonate with severe myocardial ischemic injury and refractory cardiogenic shock, where conventional inotropes failed to improve cardiac function. Levosimendan’s unique mechanism of action, which enhances contractility without increasing myocardial oxygen demand, proved beneficial in the context of an immature myocardium. While further studies are needed to standardize its application and establish clear guidelines, this case suggests that Levosimendan may be a valuable therapeutic option for acute heart failure in preterm neonates, particularly in cases unresponsive to traditional treatments.</p>

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Use of Levosimendan in a preterm neonate with myocardial ischemic injury: a case report

  • 期刊论文

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  • 发表日期：

    2025年11月19日

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  • Chiara Araneo,
  • Martino Landi,
  • Caterina Coradeschi,
  • Sara Cecchi,
  • Marco Colombo,
  • Silvia Maffei,
  • Giacomo Mugnai,
  • Barbara Tomasini

摘要

Background

Neonatal myocardial infarction is a rare and often life-threatening condition, particularly in preterm neonates, with nonspecific clinical presentations that complicate diagnosis. While diagnosis relies on ECG changes, elevated cardiac markers, and echocardiographic abnormalities, management guidelines and validated biomarker cut-offs for neonates are lacking. Conventional inotropic support is often necessary, but its efficacy in immature myocardium can be limited. Levosimendan, a calcium sensitizer with inotropic, lusitropic, and vasodilatory effects, offers potential advantages by improving contractility without increasing myocardial oxygen consumption, but evidence in neonates, especially preterm infants, remains scarce.

Case presentation

We report the case of an extremely preterm neonate (26 + 6 weeks gestation) who developed severe myocardial ischemic injury and refractory cardiogenic shock following perinatal hypoxic-ischemic insult. Despite aggressive resuscitation and conventional inotropic support with Dobutamine, Noradrenaline, and Milrinone, the infant’s condition remained critical with persistent severe left ventricular dysfunction. Given the lack of response to conventional therapy, off-label levosimendan was initiated. Within 48 h, significant clinical and echocardiographic improvement was observed, including shock resolution and recovery of left ventricular ejection fraction.

Conclusions

This case highlights the successful use of Levosimendan in a preterm neonate with severe myocardial ischemic injury and refractory cardiogenic shock, where conventional inotropes failed to improve cardiac function. Levosimendan’s unique mechanism of action, which enhances contractility without increasing myocardial oxygen demand, proved beneficial in the context of an immature myocardium. While further studies are needed to standardize its application and establish clear guidelines, this case suggests that Levosimendan may be a valuable therapeutic option for acute heart failure in preterm neonates, particularly in cases unresponsive to traditional treatments.