Abstract
Disorders of perfusion in newborn infants are frequently observed in neonatal intensive care units. The current assessment practices are primarily based on clinical signs. Significant technologic advances have opened new avenues for continuous assessment at the bedside. Combining these devices with functional echocardiography provides an in-depth understanding of perfusion and allows targeting therapy to the pathophysiology rather than monitoring and targeting blood pressure. This change in approach is guided by the fact that perfusion disorders can result from a number of causes and a single management approach might do more harm than good. This approach has the potential to improve long term outcomes but needs to be tested in well-designed trials.
Highlights
Assessment and management of neonatal perfusion is an integral part of neonatal intensive care
The routinely used clinical signs have a limitation because of low sensitivity during early periods of impaired perfusion and are deranged only when the newborn has progressed to a state of uncompensated or irreversible shock [1]
This may or may not represent a pathological state of shock, which is derangement of perfusion. It is a condition connoting circulatory failure, where tissues cannot be provided with adequate oxygen or nutrients. This change in concept is pivotal for appropriate management of hemodynamic disturbance and assessment of neonatal perfusion is important in day to day practice
Summary
Assessment and management of neonatal perfusion is an integral part of neonatal intensive care. Clinicians have to understand the pathophysiology of the hemodynamic problems to objectively match the therapy to the cause rather than be guided by the traditional approaches to manage ment using volume, inotropes and vasopressors This requires an un derstanding of the physiologic concepts of hemodynamics and the pharmacodynamic properties of the pharmaceutical agents used for management. Hypotension is a numerical or statistical value connoting a blood pressure that is more than two standard deviations from the mean This may or may not represent a pathological state of shock, which is derangement of perfusion. It is a condition connoting circulatory failure, where tissues cannot be provided with adequate oxygen or nutrients This change in concept is pivotal for appropriate management of hemodynamic disturbance and assessment of neonatal perfusion is important in day to day practice
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