cardiovascular-agents and Infant--Newborn--Diseases

Hemodynamic disturbance in the sick neonate is common, highly diverse in underlying pathophysiology and dynamic. Dysregulated systemic and cerebral blood flow is hypothesized to have a negative impact on neurodevelopmental outcome and survival. An understanding of the physiology of the normal neonate, disease pathophysiology, and the properties of vasoactive medications may improve the quality of care and lead to an improvement in survival free from disability. In this review we present a modern approach to cardiovascular therapy in the sick neonate based on a more thoughtful approach to clinical assessment and actual pathophysiology. Targeted neonatal echocardiography offers a more detailed insight into disease processes and offers longitudinal assessment, particularly response to therapeutic intervention. The pathophysiology of common neonatal conditions and the properties of cardiovascular agents are described. In addition, we outline separate treatment algorithms for various hemodynamic disturbances that are tailored to clinical features, disease characteristics and echocardiographic findings.

Topics: Algorithms; Cardiovascular Agents; Cardiovascular Diseases; Cardiovascular System; Critical Illness; Echocardiography; Hemodynamics; Humans; Infant, Newborn; Infant, Newborn, Diseases; Symptom Assessment; Treatment Outcome

Successful management of neonatal shock is driven by the etiology and pathophysiology of the cardiovascular compromise. In the clinical practice, however, we only have a limited ability to recognize the etiology of the condition (hypovolemia, myocardial dysfunction or abnormal vasoregulation). Therefore, management is based on administration of fluid boluses and vasoactive medications according to personal preference rather than to the underlying pathophysiology. In addition, although management strategies aimed at improving systemic blood pressure may have been associated with a decrease in mortality in critically ill neonates, there are no prospective data on the effect of these management strategies on morbidity, especially on long-term neurodevelopmental outcome. This paper briefly reviews some of the more frequently encountered clinical presentations of neonatal shock and describes the developmentally regulated cardiovascular responses to the pathophysiology-driven management strategies used in these clinical presentations in the critically ill preterm and term neonate.

Topics: Cardiotonic Agents; Cardiovascular Agents; Humans; Hypotension; Infant, Newborn; Infant, Newborn, Diseases; Shock

This article reviews the various cardiovascular drugs for newborns, including antiarrhythmics, antihypertensives, inotropes, and pulmonary vasodilators. Antiarrhythmic drugs are classified according to their mechanisms of action, such as effects on ion channels, duration of repolarization, and receptor interaction, which help with understanding the effects of individual antiarrhythmic drugs and selection of drugs for specific arrhythmias. Drug treatment for hypertension should start with a single drug from one of the following classes: ACE inhibitors, angiotensin-receptor antagonists, beta-receptor antagonists, calcium channel blockers, or diuretics. The inotropic drug should be selected according to its specific pharmacologic properties and the specific cardiovascular abnormality to be corrected. An effective pulmonary vasodilator must dilate the pulmonary vasculature more than the systemic vasculature.

Topics: Cardiovascular Agents; Cardiovascular Diseases; Humans; Infant, Newborn; Infant, Newborn, Diseases

Extreme prematurity exposes the neonate to a number of potential renal insults that may result in a reduced number of glomeruli and/or renal size. This may predispose these individuals to cardiovascular disease later in life. The objective was to determine using magnetic resonance imaging (MRI) whether extreme prematurity results in decreased renal volume.. Neonates <29 weeks' gestation and term infants undergoing MRI of the brain were enrolled in the study. An MRI was performed at term corrected age in the premature neonate and within the first 4 weeks of life in the term neonate.. Seventeen preterm infants and 13 term infants had MRIs performed. There was no significant difference in weight and length at the time of MRI (p = 0.76 and 0.11, respectively). There was no significant difference in total renal volume or total kidney volume to weight ratio between the preterm and term neonates (p = 0.83 and 0.6, respectively).. At term corrected age, extremely premature neonates have the same renal volume as term infants. It is unclear whether renal volume is a good indicator of glomerular number.

Topics: Cardiovascular Agents; Cardiovascular Diseases; Case-Control Studies; Female; Gestational Age; Humans; Indomethacin; Infant, Extremely Low Birth Weight; Infant, Newborn; Infant, Newborn, Diseases; Infant, Premature; Kidney; Magnetic Resonance Imaging; Male; Organ Size; Radiography

Topics: Abnormalities, Drug-Induced; Acetaminophen; Acetazolamide; Anti-Bacterial Agents; Cardiovascular Agents; Cataract; Chloramphenicol; Communicable Diseases; Female; Histamine H1 Antagonists; Humans; Infant, Newborn; Infant, Newborn, Diseases; Meclizine; Muscle Relaxants, Central; Nitrofurantoin; Oxytetracycline; Pregnancy; Pregnancy Complications; Pregnancy Complications, Infectious; Progesterone; Sulfamethoxypyridazine; Sulfisoxazole; Sympathomimetics; Tetracycline; Toxicology