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• W2901673746 endingPage "27" @default.
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• W2901673746 abstract "Abstract There is growing controversy in the field of neonatal hemodynamics about the diagnosis and treatment of neonatal cardiovascular compromise in the very preterm infant. Accordingly, fundamental questions such as the timely recognition of the subpopulation of neonates at high risk for the development of hemodynamic compromise in the transitional period, the definition of individual patient-dependent blood pressure (BP) thresholds associated with inadequate tissue oxygen delivery (DO2), the role of physiologic cord clamping, the recognition of the hemodynamic antecedents of peri-intraventricular hemorrhage, and other related issues are yet to be answered. In the absence of such information, applying the principles of developmental cardiovascular physiology and pathophysiology can help in establishing the diagnosis and determining the optimal management of neonatal circulatory compromise. The past two decades have seen a growing controversy in the field of neonatal hemodynamics in general and over the diagnosis and treatment of neonatal cardiovascular insufficiency especially in the very preterm infant. The complexities and difficulties associated with the design and execution of randomized controlled trials (RCTs) targeting clinically relevant outcome measures in very preterm neonates with cardiovascular compromise are the primary reasons for the ongoing controversy. Indeed, questions such as the BP threshold associated with inadequate tissue DO2 and thus necessitating treatment in a selected patient population can be answered only by properly designed RCTs. In the absence of such information, applying the principles of developmental cardiovascular physiology and pathophysiology can aid the diagnosis and management of neonatal circulatory compromise. In addition, designing RCTs in this area also requires a thorough understanding of developmental cardiovascular physiology. Therefore this chapter first reviews the principles of fetal, transitional, and posttransitional hemodynamics, with an emphasis on the principles of developmental cardiovascular physiology. Building on the physiologic principles reviewed, the second part of the chapter then discusses the etiology and pathophysiology of neonatal cardiovascular compromise. The major goals of this chapter are to help the reader to appreciate the impact of immaturity and/or pathologic events on the physiology of neonatal cardiovascular transition and understand the primary factors leading to cardiovascular compromise in the preterm and term neonate. Using this knowledge, along with carefully selected and relevant information from clinical trials, the clinician can best assess and manage hemodynamic disturbance in the immediate transitional period and beyond and potentially reduce the end-organ damage caused by decreased DO2 to the organs, especially the immature brain in affected neonates." @default.
• W2901673746 created "2018-11-29" @default.
• W2901673746 creator A5030974797 @default.
• W2901673746 creator A5054084190 @default.
• W2901673746 date "2019-01-01" @default.
• W2901673746 modified "2023-09-25" @default.
• W2901673746 title "Principles of Developmental Cardiovascular Physiology and Pathophysiology" @default.
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