Hemodynamic instability in the critically ill neonate: An approach to cardiovascular support based on disease pathophysiology

Giesinger, Regan E.; McNamara, Patrick J.

doi:10.1053/j.semperi.2015.12.005

Cited by 103 publications

(103 citation statements)

References 80 publications

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“…Echocardiography provides an objective assessment of cardiac function and allows assessment of the response to therapeutic interventions. Recent reviews describe a pathophysiology-based approach with functional echo as the primary assessment tool used to define the underlying problem and direct therapeutic interventions [24,25]. However, the exact role functional echocardiography has to play is most likely disease specific and evidence that it improves outcome in preterm infants with low blood pressure in the first days needs to be determined.…”

Section: Has Management Changed?mentioning

confidence: 99%

What Should We Do about Low Blood Pressure in Preterm Infants

Dempsey¹

2017

Neonatology

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The management of preterm infants with low blood pressure soon after birth remains unresolved. The definition of what constitutes low blood pressure is uncertain. At birth, mean blood pressure appears to be gestation specific and increases in the first few days of life. Antenatal steroids, delayed cord clamping, and the avoidance of mechanical ventilation are all associated with higher mean blood pressure and less hypotension after birth. Rates of hypotension of 15-50% have been reported in various studies of extremely preterm infants. However, only about 10% of all extremely preterm infants receive inotropes, suggesting that clinicians take into account other factors such as clinical, biochemical, and echocardiographic findings before deciding to intervene. The exact role of functional echocardiography in assessing the need for treatment of low blood pressure in extremely preterm infants remains to be determined. Near- infrared spectroscopy to assess cerebral perfusion may also have a role to play. Volume expansion (usually 10 mL/kg of saline) remains the most commonly used intervention for low blood pressure but evidence of benefit is lacking and there may be safety concerns. Whilst dopamine is the most commonly used inotropic drug, dobutamine, epinephrine, corticosteroids, milrinone, and vasopressin have also been utilised in preterm infants with low blood pressure. Clinical trials with long-term outcomes are needed to determine the most suitable inotrope and when to use it. Early hypotension differs from late hypotension with regard to cause, treatment, and outcome. A number of recent studies aimed at improving the evidence base for the treatment of early hypotension in extremely preterm infants have been terminated early because of poor recruitment. Currently, the answer to the question of what to do about low blood pressure in preterm infants remains unclear.

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Section: Has Management Changed?mentioning

confidence: 99%

What Should We Do about Low Blood Pressure in Preterm Infants

Dempsey¹

2017

Neonatology

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“…Неонатальный миокард характери-зуется высокой концентрацией несократительных элементов. Мио фибриллы короче, имеют большее количество митохондрий, относительно хуже орга-низованы [16,27].…”

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“…Реакция на стимуляцию катехоламина-ми у новорожденных преимущественно выражает-ся в виде спазма периферических сосудов, приводя-щего к увеличению постнагрузки. Симпатическая иннервация незрелого миокарда весьма ограниче-на [27]. Эта особенность характерна для новорож-денных меньшего срока гестации.…”

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“…Его реакция на дополнительный стресс, который создается увели-ченными метаболическими потребностями, -напри-мер, в ответ на инфекцию, изменение волемической нагрузки, назначение инотропных препаратов, -мо-жет быть весьма ограниченна [27].…”

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“…Следует с большой осторожностью экстраполиро-вать результаты исследований взрослых пациентов относительно дозозависимого эффекта кардиотони-ческих и вазоактивных препаратов на популяцию новорожденных. Даже минимальная доза данных лекарственных средств может вызвать максималь-ный эффект у маленьких пациентов [27].…”

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Hemodynamic monitoring on the background of intensive therapy in newborns

et al. 2017

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The article deals with the problem of early neonatal and infant mortality. It is pointed out that recent advances in emergency and intensive care therapy have provided decline in early neonatal and infant mortality. Hemodynamic disorders are reported to be associated with any severe pathology in patients of all age groups including newborns, significantly influence quality of life of patients having experienced a critical condition. Clinical manifestations of hemodynamic disorders in infants are not considered to be specific; they are critically delayed and are not timely recognized. The article describes peculiarities of the cardio-vascular system of newborns that are responsible for the necessity of thorough hemodynamic profile monitoring in order to provide detection of vital function alterations at the early stages, ensure timely onset of intensive therapy and its qualitative performance. Special attention is paid to current methods of determination of central hemodynamic parameters, which are stated to be divided into invasive and non-invasive. The paper also highlights some peculiarities of evaluation of hemodynamic findings using specific monitoring methods and factors influencing the outcome. The article specifies increased interest towards non-invasive monitoring tools of hemodynamic profile in recent years; their relevance is stated to be doubtless in both pediatric and neonatal practice. The main task of any monitoring procedure is reported to be hemodynamic findings analysis, “trend tracking” in the process of monitoring a patient and intensive therapy performance.

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A neonate with intrauterine growth restriction and pseudo‐Bartter syndrome due to severe maternal eating disorder: A case report

Babatseva

Chatziioannidis

Tagaraki

et al. 2020

Clinical Case Reports

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Pseudo-Bartter syndrome, a rare disorder, similar to Bartter syndrome, lacks renal tubular pathology. We present the case of a term small for gestational age neonate with metabolic alkalosis since birth with gradual decline within first week of life. Similar laboratory findings were observed in baby's mother, suffered from severe eating disorders. Pseudo-Bartter syndrome is a rare disorder caused by chloride poor diet, loss of sodium or chloride in the urine/ stool, and vomit or prostaglandin infusion. 1,2 It is characterized by hypokalemic, hypochloremic metabolic alkalosis.

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Hemodynamic instability in the critically ill neonate: An approach to cardiovascular support based on disease pathophysiology

Cited by 103 publications

References 80 publications

What Should We Do about Low Blood Pressure in Preterm Infants

What Should We Do about Low Blood Pressure in Preterm Infants

Hemodynamic monitoring on the background of intensive therapy in newborns

A neonate with intrauterine growth restriction and pseudo‐Bartter syndrome due to severe maternal eating disorder: A case report

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