Turkish Neonatal Society guideline on the neonatal hemodynamics and management of hypotension in newborns

Abstract

Hemodynamic instability is frequent in high-risk infants admitted to neonatal intensive care units. However, monitoring and treatment strategies of those conditions might show variations among the units. Different factors can compromise hemodynamic status in preterm/ term infants. Treatment options mostly include volume replacement, inotropes and/or vasopressors (dopamine, dobutamine, epinephrine and milrinone) and hydrocortisone. In general, these treatments are driven by predetermined protocols, which are not patient-based. According to the current knowledge, a physiology-driven approach that takes the individual characteristics of the newborn into consideration is accepted to be more suitable. In neonatal hemodynamics, important determinants are cardiac output, systemic vascular resistance, blood pressure, regional tissue perfusion and oxygenation. The novel technological methods, “targeted neonatal echocardiography” and “near-infrared spectroscopy” can help to delineate the underlying pathophysiology better, when added to the clinical assessment. In this review, strategies for the assessment of neonatal hemodynamics, as well as etiology, monitoring, and treatment of hemodynamic instability in preterm and term infants are presented.

Contemporary Trends and Risk Factors of Hemodynamic and Myocardial Mechanics Derived by the Pressure Recording Analytical Method After Pediatric Cardiopulmonary Bypass

“…β-adrenergic overstimulation may cause tachycardia and cardiac dysfunction impairing cardiac filling and contractility ( 31 ). At the same time, α-adrenergic overstimulation may cause peripheral ( 32 ) and coronary arterial vasoconstriction ( 33 ), leading to increased SVRI and cardiac afterload, and reduced myocardial oxygen delivery ( 34 ). The latter may be further compounded by tachycardia result from increased myocardial oxygen consumption.…”

Cardiovascular Pharmacological Support Among Preterm Infants in Chinese Referral Center Neonatal Intensive Care Units

“…Although a major difference was also seen in ELBW and infants with birth weight ≥1,500 infants, this was not statistically significant, which was most likely related to inadequate number of infants. The association between a high rate of cardiovascular pharmacological support in the early postnatal period and hypotension is thought to be related to impaired cardiac loading conditions due to the physiologic changes that occur in the transition environment (2,38,39). Dempsey et al found a spontaneous increase in blood pressure within 24 h after birth in ELBW infants who remained untreated (40).…”

Finger tips: A novel approach to managing life‐threatening neonatal limb ischaemia

“…The causes are multi‐factorial, inclusive of low cardiac output state, thrombus development, vasospasm secondary to inotropic support, catheter insertion related or secondary to extravasation injury. Tissue oxygenation can also be affected by excessive tissue consumption which is exacerbated with sepsis and dehydration, 1 as it is demonstrated in this case. Tissue injury can result in necrosis and subsequent loss of distal extremities and limbs.…”