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Critical congenital heart disease: What should the neonatologist know?
Introduction The incidence of congenital heart disease (CHD) is estimated at approximately 8 per 1000 live births, with up to 25–30% of CHD deemed critical congenital heart disease (CCHD). CCHD includes lesions that necessitate early interventions to avoid significant morbidity…
Hemodynamic management in special circumstances
Key points 1. Neonates with hypertrophic cardiomyopathy due to diabetes who have cardiovascular instability benefit from a strategy that avoids positive inotropy and high peak end-expiratory pressure and prioritizes left heart volume loading and increased left ventricular afterload. 2. Neonates…
Hemodynamic management in resource-challenged countries
Key points Low- and middle-income countries contribute to a major portion of the global neonatal disease burden, accounting for >90% of neonatal mortality. Perinatal asphyxia, gram-negative sepsis, and prematurity are major contributors to the neonatal disease burden in LMIC countries.…
Pathophysiologically based management of pulmonary hypertension of the newborn
Key points Acute pulmonary hypertension (aPH), classically referred to as persistent pulmonary hypertension of the newborn (PPHN) when occurring during the perinatal transition period, is characterized by failure of the normal postnatal decline in pulmonary vascular resistance (PVR). Elevated pulmonary…
Chronic pulmonary hypertension
Key points Chronic pulmonary hypertension (cPH), a severe form of pulmonary vascular disease, is characterized by a sustained and progressive elevation of pulmonary vascular resistance, pulmonary artery pressures, and resultant exposure of the right ventricle to high afterload. cPH most…
Pathophysiology and assessment of acute pulmonary hypertension of the newborn
Introduction Acute pulmonary hypertension (aPH) in the neonatal period is common in sick newborn infants being treated in the neonatal intensive care unit (NICU). The causes and underlying pathophysiology are multifactorial. Acute pulmonary hypertension in the newborn is secondary to…
Hemodynamically based management of circulatory compromise in the newborn
Key points There is little outcome-based evidence to guide circulatory support in the newborn. In clinical situations of high risk for circulatory compromise, there are a range of hemodynamics. A “one size fits all” approach to neonatal circulatory support is…
Glucocorticoids and adrenal function in neonates with hypotension
Key points 1. Corticosteroids are increasingly used in the acutely ill newborn population to increase blood pressure and reduce inotrope exposure. 2. There are clinical and disease states in infants in which glucocorticoids have been studied and found to have…
Hemodynamics of the neonate following perinatal hypoxic-ischemia and the effects of therapeutic hypothermia
Introduction Globally, neonatal encephalopathy precipitated by perinatal hypoxia-ischemia remains a common cause of brain injury. The incidence varies from 1 to 3 per 1000 to up to 25 per 1000 in developed and developing countries, respectively. Therapeutic hypothermia has been…