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A new physiologic-based integrated algorithm in the management of neonatal hemodynamic instability

  • Clinical Algorithm
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Abstract

Physiologic-based management of hemodynamic instability is proven to guide the logical selection of cardiovascular support and shorten the time to clinical recovery compared to an empiric approach that ignores the heterogeneity of the hemodynamic instability related mechanisms. In this report, we classified neonatal hemodynamic instability, circulatory shock, and degree of compensation into five physiologic categories, based on different phenotypes of blood pressure (BP), other clinical parameters, echocardiography markers, and oxygen indices. This approach is focused on hemodynamic instability in infants with normal cardiac anatomy.

Conclusion: The management of hemodynamic instability is challenging due to the complexity of the pathophysiology; integrating different monitoring techniques is essential to understand the underlying pathophysiologic mechanisms and formulate a physiologic-based medical recommendation and approach.

What is Known:

• Physiologic-based assessment of hemodynamics leads to targeted and pathophysiologic-based medical recommendations.

What is New:

• Hemodynamic instability in neonates can be categorized according to the underlying mechanism into five main categories, based on blood pressure phenotypes, systemic vascular resistance, and myocardial performance.

• The new classification helps with the targeted management and logical selection of cardiovascular support.

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Availability of data and material

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Code availability

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Abbreviations

BP:

Blood pressure

DBP:

Diastolic blood pressure

DO2 :

Oxygen delivery

FOE:

Fractional oxygen extraction

PDA:

Patent ductus arteriosus

PP:

Pulse pressure

PVR:

Pulmonary vascular resistance

MABP:

Mean arterial blood pressure

NIRS:

Near-infrared spectroscopy

POCUS:

Point of care ultrasound

StO2 :

Tissue oxygen saturation

VO2 :

Oxygen consumption

SBP:

Systolic blood pressure

SpO2 :

Arterial oxygen saturation

SVR:

Systemic vascular resistance

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Authors and Affiliations

  1. Division of Neonatology, Department of Pediatrics and Child Health, Rady Faculty of Health Sciences, University of Manitoba, Women’s Hospital, 820 Sherbrook Street, Winnipeg, MB, R2016, R3A0L8, Canada

    Yasser Elsayed

  2. Division of Neonatology, Department of Pediatrics and Child Health, McMaster University, Hamilton, Canada

    Muzafar Gani Abdul Wahab

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  1. Yasser Elsayed
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  2. Muzafar Gani Abdul Wahab
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YE and MA conceptualized the article. YE and MA conducted the background literature search. YE devised the manuscript, and both authors agree to the formatting and contents.

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Correspondence to Yasser Elsayed.

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Elsayed, Y., Abdul Wahab, M. A new physiologic-based integrated algorithm in the management of neonatal hemodynamic instability. Eur J Pediatr 181, 1277–1291 (2022). https://doi.org/10.1007/s00431-021-04307-5

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