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Vol. 103, No. 4, 2013
Issue release date: May 2013
Neonatology 2013;103:335-340

Common Hemodynamic Problems in the Neonate

Barrington K.J.
Département de Pédiatrie, CHU Sainte-Justine, Université de Montréal, Montréal, Qué., Canada

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Hemodynamic problems are common in neonatal intensive care. They occur in the context of incomplete myocardial and vascular development and in cardiovascular responses to interventions which are, as a result, limited and often uncertain and unpredictable. In this review, I outline the hemodynamic features of 4 neonatal conditions which often require intervention: (1) persistent pulmonary hypertension of the newborn, (2) cardiogenic shock (most commonly in the context of hypoxic ischemic injury), (3) sepsis and (4) low blood pressure in the transitional period of the extremely preterm infant. I also look at the evidence which exists for effective interventions and the most important research questions for the future. Copyright i 2013 S. Karger AG, Basel

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  1. Anderson PA: Maturation and cardiac contractility. Cardiol Clin 1989;7:209–225.
  2. Lopaschuk GD, Collins-Nakai RL, Itoi T: Developmental changes in energy substrate use by the heart. Cardiovasc Res 1992;26:1172–1180.
  3. Teitel DF, Sidi D, Chin T, Brett C, Heymann MA, Rudolph AM: Developmental changes in myocardial contractile reserve in the lamb. Pediatr Res 1985;19:948–955.
  4. Van Hare GF, Hawkins JA, Schmidt KG, Rudolph MA: The Effects of increasing mean arterial pressure on left ventricular output in newborn lambs. Circ Res 1990;67:78–83.
  5. Akita T, Joyner RW, Lu C, Kumar R, Hartzell HC: Developmental changes in modulation of calcium currents of rabbit ventricular cells by phosphodiesterase inhibitors. Circulation 1994;90:469–478.
  6. Barrington KJ, Dempsey EM: Cardiovascular support in the preterm: treatments in search of indications. J Pediatr 2006;148:289–291.
  7. Paradisis M, Evans N, Kluckow M, Osborn D: Randomized trial of milrinone versus placebo for prevention of low systemic blood flow in very preterm infants. J Pediatr 2009;154:189–195.
  8. Roze JC, Tohier C, Maingueneau C, Lefevre M, Mouzard A: Response to dobutamine and dopamine in the hypotensive very preterm infant. Arch Dis Child 1993;69:59–63.
  9. Evans N, Kluckow M: Early determinants of right and left ventricular output in ventilated preterm infants. Arch Dis Child Fetal Neonatal Ed 1996;74:F88–F94.
  10. Evans N, Kluckow M, Currie A: Range of echocardiographic findings in term neonates with high oxygen requirements. Arch Dis Child Fetal Neonatal Ed 1998;78:F105–F111.
  11. Hickey PR, Hansen DD, Wessel D, Lang, Jonas RA, Elixson EM: Blunting of stress responses in the pulmonary circulation of infants by fentanyl. Anesth Analg 1985;64:1137–1142.
  12. Finer NN, Barrington KJ: Nitric oxide for respiratory failure in infants born at or near term. Cochrane Database Syst Rev 2001:CD000399.
  13. Finer NN, Sun JW, Rich W, Knodel E, Barrington KJ: Randomized, prospective study of low-dose versus high-dose inhaled nitric oxide in the neonate with hypoxic respiratory failure. Pediatrics 2001;108:949–955.
  14. Lakshminrusimha S, Russell JA, Steinhorn RH, Ryan RM, Gugino SF, Morin FC 3rd, et al: Pulmonary arterial contractility in neonatal lambs increases with 100% oxygen resuscitation. Pediatr Res 2006;59:137–141.
  15. Lakshminrusimha S, Russell JA, Steinhorn RH, Swartz DD, Ryan RM, Gugino SF, et al: Pulmonary hemodynamics in neonatal lambs resuscitated with 21%, 50%, and 100% oxygen. Pediatr Res 2007;62:313–318.
  16. Jundi K, Barrington KJ, Henderson C, Allen RG, Finer NN: The hemodynamic effects of prolonged respiratory alkalosis in anesthetized newborn piglets. Intensive Care Med 2000;26:449–456.
  17. Walsh-Sukys MC, Tyson JE, Wright LL, Bauer CR, Korones SB, Stevenson DK: Persistent pulmonary hypertension of the newborn in the era before nitric oxide: practice variation and outcomes. Pediatrics 2000;105:14–20.
  18. Drummond WH, Webb IB, Purcell KA: Cardiopulmonary response to dopamine in chronically catheterized neonatal lambs. Pediatr Pharmacol (New York) 1981;1:347–356.
  19. Tourneux P, Rakza T, Bouissou A, Krim G, Storme L: Pulmonary circulatory effects of norepinephrine in newborn infants with persistent pulmonary hypertension. J Pediatr 2008;153:345–349.
  20. Sehgal A, Osborn D, McNamara PJ: Cardiovascular support in preterm infants: a survey of practices in Australia and New Zealand. J Paediatr Child Health 2012:48:317–323.
  21. Esch J, Joynt C, Manouchehri N, Lee TF, Li YQ, Bigam D, et al: Differential hemodynamic effects of levosimendan in a porcine model of neonatal hypoxia-reoxygenation. Neonatology 2011;101:192–200.
  22. Coe JY, Olley PM, Vella G, Coceani F: Bipyridine derivatives lower arteriolar resistance and improve left ventricular function in newborn lambs. Pediatr Res 1987;22:422–428.
  23. Barrington KJ, Etches PC, Schulz R, Talbot JA, Graham AJ, Pearson RJ, et al: The hemodynamic effects of inhaled nitric oxide and endogenous nitric oxide synthesis blockade in newborn piglets during infusion of heat-killed group B streptococci. Crit Care Med 2000;28:800–808.
  24. de Waal K, Evans N: Hemodynamics in preterm infants with late-onset sepsis. J Pediatr 2010;156:918–922.
  25. Kermorvant-Duchemin E, Laborie S, Rabilloud M, Lapillonne A, Claris O: Outcome and prognostic factors in neonates with septic shock. Pediatr Crit Care Med 2008;9:186–191.
  26. Tourneux P, Rakza T, Abazine A, Krim G, Storme L: Noradrenaline for management of septic shock refractory to fluid loading and dopamine or dobutamine in full-term newborn infants. Acta Paediatr 2008;97:177–180.
  27. Laughon M, Bose C, Allred E, O’Shea TM, Marter LJ, Bednarek F, et al: Factors associated with treatment for hypotension in extremely low gestational age newborns during the first postnatal week. Pediatrics 2007;119:273–280.
  28. Logan JW, O’Shea TM, Allred EN, Laughon MM, Bose CL, Dammann O, et al: Early postnatal hypotension and developmental delay at 24 months of age among extremely low gestational age newborns. Arch Dis Child Fetal Neonatal Ed 2011;96:F321–F328.
  29. Logan JW, O’Shea TM, Allred EN, Laughon MM, Bose CL, Dammann O, et al: Early postnatal hypotension is not associated with indicators of white matter damage or cerebral palsy in extremely low gestational age newborns. J Perinatol 2011;31:524–534.
  30. Osborn DA, Evans N, Kluckow M: Clinical detection of low upper body blood flow in very premature infants using blood pressure, capillary refill time, and central-peripheral temperature difference. Arch Dis Child Fetal Neonatal Ed 2004;89:F168–F173.
  31. Miletin J, Pichova K, Dempsey E: Bedside detection of low systemic flow in the very low birth weight infant on day 1 of life. Eur J Pediatr 2009;168:809–813.
  32. Dempsey EM, Al Hazzani F, Barrington KJ: Permissive hypotension in the extremely low birthweight infant with signs of good perfusion. Arch Dis Child Fetal Neonatal Ed 2009;94:F241–F244.

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