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2018 ; 6
(ä): 87
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Neonatal Hemodynamics: From Developmental Physiology to Comprehensive Monitoring
#MMPMID29675404
Vrancken SL
; van Heijst AF
; de Boode WP
Front Pediatr
2018[]; 6
(ä): 87
PMID29675404
show ga
Maintenance of neonatal circulatory homeostasis is a real challenge, due to the
complex physiology during postnatal transition and the inherent immaturity of the
cardiovascular system and other relevant organs. It is known that abnormal
cardiovascular function during the neonatal period is associated with increased
risk of severe morbidity and mortality. Understanding the functional and
structural characteristics of the neonatal circulation is, therefore, essential,
as therapeutic hemodynamic interventions should be based on the assumed
underlying (patho)physiology. The clinical assessment of systemic blood flow
(SBF) by indirect parameters, such as blood pressure, capillary refill time,
heart rate, urine output, and central-peripheral temperature difference is
inaccurate. As blood pressure is no surrogate for SBF, information on cardiac
output and systemic vascular resistance should be obtained in combination with an
evaluation of end organ perfusion. Accurate and reliable hemodynamic monitoring
systems are required to detect inadequate tissue perfusion and oxygenation at an
early stage before this result in irreversible damage. Also, the hemodynamic
response to the initiated treatment should be re-evaluated regularly as changes
in cardiovascular function can occur quickly. New insights in the understanding
of neonatal cardiovascular physiology are reviewed and several methods for
current and future neonatal hemodynamic monitoring are discussed.