A new physiologic-based integrated algorithm in the management of neonatal hemodynamic instability

Elsayed, Yasser; Wahab, Muzafar Gani Abdul

doi:10.1007/s00431-021-04307-5

Cited by 7 publications

(9 citation statements)

References 73 publications

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“…Haemodynamic instability and hypoxaemia are common and serious threats to the survival of neonates,1 which are associated with mortality, bronchopulmonary dysplasia (BPD), intraventricular haemorrhage (IVH) and long-term neurological development delay 2–8. However, the management of haemodynamic instability and hypoxaemia is challenging due to the complexity of the physiology and pathophysiology in the neonatal period 9…”

Section: Introductionmentioning

confidence: 99%

“…For example, systemic blood pressure probably does not provide precise cerebral blood flow information. A growing body of literature indicates that critical care ultrasound (CCUS) (also known as point-of-care ultrasound) has become the optimal tool for evaluation, diagnosis, monitoring and guidance for invasive procedures in sick neonates,24–27 which can help clinicians treat patients based on physiology and pathophysiology 9. It is characterised as a real-time bedside assessment tool used by frontline clinicians 28.…”

Section: Introductionmentioning

confidence: 99%

“…Therefore, a thoughtful and structured sonographic workflow in sick neonates is required. Few studies have proposed a sonographic workflow in sick neonates,1 9 24 36 but mainly focused on echocardiography (Targeted neonatal Echocardiography, TnECHO) or lung ultrasound rather than comprehensive sonographic assessment 37–42. The comprehensive sonographic characteristics in critically ill neonates remain uncertain 9 24 43 44…”

Section: Introductionmentioning

confidence: 99%

“… 2–8 However, the management of haemodynamic instability and hypoxaemia is challenging due to the complexity of the physiology and pathophysiology in the neonatal period. 9 …”

Section: Introductionmentioning

confidence: 99%

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A study protocol for investigating the sonographic characteristics of neonates with critical illness: an observational cohort study

Xiao

et al. 2023

bmjpo

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BackgroundHaemodynamic instability and hypoxaemia are common and serious threats to the survival of neonates. A growing body of literature indicates that critical care ultrasound has become the optimal evaluation tool for sick neonates. However, few studies have described sonographic characteristics of haemodynamics systematically in the neonates with critical illness. This protocol describes a prospective observational cohort study aimed at (1) characterising the sonographic characteristics of the neonates with critical diseases; and (2) assessing the mortality, significant morbidity, utility of vasoactive medications, fluid resuscitation, duration of ventilation, etc.Methods and analysisThis is a single-centre, prospective and observational study conducted in Chengdu Women’s and Children’s Central Hospital from 1 December 2022 to 31 December 2027. Neonates admitted to the neonatal intensive care unit will be recruited. After inclusion, the neonates will undergo the neonatal critical care ultrasound. The data collected via case report forms include clinical variables and sonographic measures. The primary outcome is to identify the sonographic characteristics of sick neonates with different diseases, and the secondary outcome is to describe the mortality, significant morbidity, utility of vasoactive medications, fluid resuscitation and duration of ventilation.DiscussionOur study provided an organised neonatal critical care ultrasound workflow, which can be applied in practice. Accordingly, this study will first set up large data on the sonographic description of the neonates with critical illness, which can help to understand the pathophysiology of the critical illness, potentially titrating the treatment.Trial registration numberChinese Clinical Trial Registry (ChiCTR2200065581;https://www.chictr.org.cn/com/25/showproj.aspx?proj=184095).

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“… 2–8 However, the management of haemodynamic instability and hypoxaemia is challenging due to the complexity of the physiology and pathophysiology in the neonatal period. 9 …”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

A study protocol for investigating the sonographic characteristics of neonates with critical illness: an observational cohort study

Xiao

et al. 2023

bmjpo

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“…Fluid-refractory catecholamine-resistant shock, particularly septic shock, is one of the leading causes of morbidity and mortality in the neonatal intensive care unit, with devastating consequences in preterm neonates [ 4 , 12 , 13 ]. The goal of management is to restore systemic circulation with appropriate use of fluid therapy and increase vascular tone with vasopressors [ 14 ]. However, in shock that is resistant to catecholamines, the lack of response to vasopressors is a significant challenge.…”

Section: Introductionmentioning

confidence: 99%

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

Al-Saadi

Sushko²,

Bui³

et al. 2022

IJERPH

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Introduction: The use of arginine vasopressin (AVP) and terlipressin to treat hypotension in preterm neonates is increasing. Our aim was to review the available evidence on the efficacy and safety of AVP and terlipressin for use in preterm neonates. Methods: MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, Web of Science, and Google Scholar from inception to September 2021 were searched for studies of AVP and terlipressin in the treatment of hypotension of any cause in preterm neonates. Primary outcomes were improvement in end-organ perfusion and mortality. The risk of bias assessment and certainty of the evidence were performed using appropriate tools. Results: Fifteen studies describing the use of AVP (n = 12) or terlipressin (n = 3) among 148 preterm neonates were included. Certainly, the available evidence for the primary outcome of end-organ perfusion rated as very low. AVP or terlipressin were used to treat 144 and 4 neonates, respectively. Improvement in markers of end-organ perfusion was reported in 143 (99%) neonates treated with AVP and 3 (75%) treated with terlipressin. The mortality rate was 41% (n = 59) and 50% (n = 2) for neonates who received AVP and terlipressin, respectively. Hyponatremia was the most frequently reported adverse event (n = 37, 25%). Conclusion: AVP and terlipressin may improve measured blood pressure values and possibly end-organ perfusion among neonates with refractory hypotension. However, the efficacy–safety balance of these drugs should be assessed on an individual basis and as per the underlying cause. Studies on the optimal dosing, efficacy, and safety of AVP and terlipressin in preterm neonates with variable underlying conditions are critically needed.

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Point-of-care ultrasound (POCUS) protocol for systematic assessment of the crashing neonate—expert consensus statement of the international crashing neonate working group

et al. 2022

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Sudden unexpected clinical deterioration or cardiorespiratory instability is common in neonates and is often referred as a “crashing” neonate. The established resuscitation guidelines provide an excellent framework to stabilize and evaluate these infants, but it is primarily based upon clinical assessment only. However, clinical assessment in sick neonates is limited in identifying underlying pathophysiology. The Crashing Neonate Protocol (CNP), utilizing point-of-care ultrasound (POCUS), is specifically designed for use in neonatal emergencies. It can be applied both in term and pre-term neonates in the neonatal intensive care unit (NICU). The proposed protocol involves a stepwise systematic assessment with basic ultrasound views which can be easily learnt and reproduced with focused structured training on the use of portable ultrasonography (similar to the FAST and BLUE protocols in adult clinical practice). We conducted a literature review of the evidence-based use of POCUS in neonatal practice. We then applied stepwise voting process with a modified DELPHI strategy (electronic voting) utilizing an international expert group to prioritize recommendations. We also conducted an international survey among a group of neonatologists practicing POCUS. The lead expert authors identified a specific list of recommendations to be included in the proposed CNP. This protocol involves pre-defined steps focused on identifying the underlying etiology of clinical instability and assessing the response to intervention.Conclusion: To conclude, the newly proposed POCUS-based CNP should be used as an adjunct to the current recommendations for neonatal resuscitation and not replace them, especially in infants unresponsive to standard resuscitation steps, or where the underlying cause of deterioration remains unclear. What is known? • Point-of-care ultrasound (POCUS) is helpful in evaluation of the underlying pathophysiologic mechanisms in sick infants. What is new? • The Crashing Neonate Protocol (CNP) is proposed as an adjunct to the current recommendations for neonatal resuscitation, with pre-defined steps focused on gaining information regarding the underlying pathophysiology in unexplained “crashing” neonates. • The proposed CNP can help in targeting specific and early therapy based upon the underlying pathophysiology, and it allows assessment of the response to intervention(s) in a timely fashion.

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A new physiologic-based integrated algorithm in the management of neonatal hemodynamic instability

Cited by 7 publications

References 73 publications

A study protocol for investigating the sonographic characteristics of neonates with critical illness: an observational cohort study

A study protocol for investigating the sonographic characteristics of neonates with critical illness: an observational cohort study

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

Point-of-care ultrasound (POCUS) protocol for systematic assessment of the crashing neonate—expert consensus statement of the international crashing neonate working group

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