Key points The autonomic nervous system (ANS) plays a key role in maintaining homeostasis in the critically ill preterm or term infant. Prematurity, an adverse intrauterine environment, and intrinsic fetal factors, such as congenital heart disease (CHD), may impact the…
Key points A period of systemic and cerebral hypoperfusion in the immediate postnatal period predisposes the extremely preterm infant to peri-/intraventricular hemorrhage (P/IVH). Cardiovascular immaturity and maladaptation after birth contribute to postnatal hypoperfusion. Ventilatory support, especially inappropriately high mean airway…
Key points Cardiorespiratory transition at birth is a complex series of changes in which the lungs replace the placenta as the organ of gas exchange and the main source of preload to the left side of the heart. Lung aeration,…
Key points Highlighting the importance of understanding physiology prior to prescribing medications will enable the provider to choose the preferred regimen for each particular patient. Extrapolating data from older pediatric populations and adults must be done with caution, considering the…
Introduction Cardiopulmonary interactions are crucial considerations in the intensive care management of critically ill neonates. The understanding of the impact of mechanical ventilation on the heart and lungs permits the prediction of a neonate’s response to the initiation or modification…
Key points In the context of neonatal care, invasive or noninvasive measurement of blood pressure can be accomplished with acceptable precision across all gestational age categories. Gestational and postnatal-age-dependent population-based normative blood pressure ranges are available. However, their usefulness in…
Key points Multiple mechanisms operate to regulate blood flow to organs – these are also important in the newborn. Distribution of cardiac output is actively regulated. Autoregulation may best be described as a degree of capacity rather than an on-off…
Key points 1. A successful hemodynamic transition from fetal to extrauterine life is a complex process and requires the interdependent sequential physiologic changes to take place in a timely manner 2. Immaturity- or pathophysiology-driven disturbances of the transitional process may…
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Introduction Procedural skills are an important component of care in the neonatal intensive care unit (NICU). Procedures have inherent risks and can be the source of significant morbidity and mortality if the proper techniques are not applied. Historically, the acquisition…