Intraventricular hemorrhage (IVH) is a major complication of prematurity. Despite the term referring to hemorrhage within the ventricle, it encompasses hemorrhage confined to the germinal matrix (grade I), extension to lateral ventricles without (grade II) or with (grade III) ventricular…
Introduction Hypotension of the premature newborn is a condition commonly encountered in the neonatal intensive care setting. Although no definite cut-off values exist in considering a given newborn to be hypotensive, certain blood pressure ranges will cause significant anxiety among…
KEY POINTS 1. Shock is a clinical condition marked by poor tissue perfusion resulting in inadequate oxygen delivery and tissue hypoxia. 2. Neonates with shock have hypotension or poor tissue perfusion, and there are important surrogate markers such as prolonged…
Key points Although there is no consensus on the definition of hypotension in preterm infants, up to 50% of very low birth weight (VLBW) infants are diagnosed with hypotension, and about one-third of extremely preterm infants receive at least one…
Key points The respiratory and cardiac systems are integrally related both anatomically and functionally, and as a result there are significant interactions, particularly in the newborn period. Inappropriately high airway pressure during mechanical ventilation leads to adverse hemodynamic effects including…
Key points Although presence of a patent ductus arteriosus (PDA) can easily be confirmed with echocardiography, diagnosis of a hemodynamically significant PDA is more challenging and not standardized. Evaluation of hemodynamic and clinical significance of a PDA should include assessment…
Key points Accurate assessment of the hemodynamic status in critically ill neonates requires blood pressure measurements to be interpreted in the context of indirect (clinical signs) and direct (measurements and assessments) indicators of systemic circulation (cardiac output) and regional organ…
Key points Cardiac output monitoring in preterm and term neonates is feasible but remains challenging despite the availability of different technologies. The best systems to monitor cardiac output in the clinical setting in neonatal intensive care at present are transthoracic…
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 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…