Recognition and management of neonatal hemodynamic compromise

Abstract

Hemodynamic compromise of the neonate can occur in various clinical situations, including but not limited to maladaptation during the early transitional period, sepsis, congenital heart anomalies, hemodynamically significant patent ductus arteriosus, persistent pulmonary hypertension of the newborn, systemic inflammatory diseases such as necrotizing enterocolitis, and dehydration. Despite the handful of advances in neonatal care through ground-breaking clinical trials, the management of neonatal shock is often dependent on the bedside clinician's experience and training without the aid of high-level evidence. However, the recognition for the importance of comprehensive and serial hemodynamic assessment is growing. There is now a wealth of literature investigating the use of functional echocardiography, nearinfrared spectroscopy, and noninvasive impedance-based cardiometry to complement common bedside hemodynamic measures such as blood pressure and heart rate measurement. In this review article, the pathophysiology of neonatal hemodynamic compromise is outlined, and concomitant best-evidence management for hemodynamic compromise in the neonate is proposed.

Efficacy and Safety of Vasopressin and Terlipressin in Preterm Neonates: A Systematic Review

“…The cause of death for these neonates is not reported. Considering this lack of data, in preterm neonates with hypotension in the immediate postnatal transitional period, where myocardial maladaptation, uncompensated decrease in preload and delayed adrenal recovery are the main known associated pathophysiology [ 44 , 45 , 46 ], the use of vasopressin cannot be recommended.…”

Engineering nano-drug biointerface to overcome biological barriers toward precision drug delivery

“…Even after vascular localization, architecture-dependent drag forces caused by blood flow may rip NPs from endothelial cell membranes if the NPs lack an adequate binding affinity for the latter [ 103 ]. As a result, in vascular pathologies, the frequently altered hemodynamics (due to stenosis and hypertension) experienced by systemically administered NPs significantly impact NPs distribution and delivery [ 104 , 105 ].…”

Hypotension and significant patent ductus arteriosus in infants born extremely preterm during the postnatal transitional period: normal adaptation?

“…However, in several clinical trials, neonates with hypotension born preterm treated with dobutamine had similar clinical outcomes (including intraventricular hemorrhage [IVH]) as those treated with dopamine. 1 Although dobutamine has demonstrated some promise in improving indices of systemic blood flow in pilot trials of neonates born preterm with low superior vena cava flow, 4,5 reducing morbidity has proven elusive, 6 and blood pressure is demonstrably unreliable in helping clinicians identify neonates with low systemic blood flow in need of treatment. 7 Alternative methods of identifying cerebral hypoxia, such as near infrared spectroscopy, are associated with cerebral injury and may represent a useful modality to guide the initiation and titration of cardiovascular treatments among hypotensive neonates.…”