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.…
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…
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…
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…
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…
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…
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…
Key points Sepsis can progress rapidly from mild clinical signs to full-blown septic shock with high morbidity and mortality. The clinical recognition of the onset of sepsis and the onset of neonatal septic shock can be challenging. In conjunction with…
Key points The very-low-birth-weight infant is hemodynamically vulnerable due to a unique set of risk factors, which include an immature myocardium with poor response to volume load and afterload, immature autonomic vasoregulation, and thus ineffective cardiovascular compensatory mechanisms, a propensity…
Key points The simplistic “treat all or treat none” approach to management of a patent ductus arteriosus (PDA) has been increasingly challenged in recent years as the variation in clinical and hemodynamic presentation has been realized. Spontaneous closure rates, poor…