23 Cardiovascular System Hemodynamic Compromise in the Neonate

Abstract

Preamble The management of the hemodynamic status of neonates, particularly premature infants, poses many challenges. There is currently a lack of clarity on the subject of whether therapeutic intervention should be based on arterial pres-sure or systemic blood flow. What is clear, however, is that the subject of neonatal hemodynamics is highly complex and influenced by developmental, transitional, and path-ological factors. The approach to therapeutic intervention does not lend itself toward any directive or strict protocol, but must be individualized based on maturity, disease, and response to intervention. It is likely that a composite approach based on blood flow and arterial pressure is required, with careful consideration of the influence of preload, afterload, and myocardial performance in the context of individual patient. Serial echocardiography may better facilitate this decision-making process. This chapter will deal with these issues and provide a comprehensive assessment and management pathway for infants with hemodynamic instability.