Chapter 20 - Cardiovascular compromise in the preterm infant during the first postnatal day

Abstract

The appropriate assessment and treatment of the VLBW infant with cardiovascular impairment or shock requires the clinician to obtain adequate information about the etiology and underlying physiologic determinants of the condition. The clinician should be aware of the physiologic changes that occur in areas such as myocardial function and vital organ blood supply allocation in the first postnatal days. The addition of a clinician-performed cardiac ultrasound to the assessment process provides information about the size and shunt direction of the ductus arteriosus and the function of the myocardium and its filling as well as information about the cardiac output and calculated peripheral vascular resistance. Knowledge of these parameters allows the clinician to more appropriately select therapies that are targeted at the underlying pathophysiology. Paradoxically this information may also reduce the need for treatment as infants with low numeric blood pressure, but normal cardiac function and output and organ perfusion may not require further treatment, only continued real-time comprehensive cardiorespiratory monitoring.