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Hemodynamic consequences of respiratory interventions in preterm infants
Journal article   Open access   Peer reviewed

Hemodynamic consequences of respiratory interventions in preterm infants

Arvind Sehgal, J Lauren Ruoss, Amy H Stanford, Satyan Lakshminrusimha and Patrick J McNamara
Journal of perinatology, Vol.42(9), pp.1153-1160
09/2022
DOI: 10.1038/s41372-022-01422-5
PMCID: PMC9436777
PMID: 35690691
url
https://doi.org/10.1038/s41372-022-01422-5View
Published (Version of record) Open Access

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Abstract

Advances in perinatal management have led to improvements in survival rates for premature infants. It is known that the transitional period soon after birth, and the subsequent weeks, remain periods of rapid circulatory changes. Preterm infants, especially those born at the limits of viability, are susceptible to hemodynamic effects of routine respiratory care practices. In particular, the immature myocardium and cardiovascular system is developmentally vulnerable. Standard of care (but essential) respiratory interventions, administered as part of neonatal care, may negatively impact heart function and/or pulmonary or systemic hemodynamics. The available evidence regarding the hemodynamic impact of these respiratory practices is not well elucidated. Enhanced diagnostic precision and therapeutic judiciousness are warranted. In this narrative, we outline (1) the vulnerability of preterm infants to hemodynamic disturbances (2) the hemodynamic effects of common respiratory practices; including positive pressure ventilation and surfactant therapy, and (3) identify tools to assess cardiopulmonary interactions and guide management.
 Hemodynamics Humans Infant Infant, Newborn Infant, Premature Infant, Premature, Diseases - drug therapy Intermittent Positive-Pressure Ventilation Pulmonary Surfactants - therapeutic use Respiratory Distress Syndrome, Newborn - drug therapy

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