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Neonatal hypotension

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https://www.readbyqxmd.com/read/28719038/static-cerebrovascular-pressure-autoregulation-remains-intact-during-deep-hypothermia
#1
Dheeraj Goswami, Katherine McLeod, Samantha Leonard, Kathleen Kibler, Ronald Blaine Easley, Charles D Fraser, Dean Andropoulos, Ken Brady
BACKGROUND: Clinical studies measuring cerebral blood flow in infants during deep hypothermia have demonstrated diminished cerebrovascular pressure autoregulation. The coexistence of hypotension in these cohorts confounds the conclusion that deep hypothermia impairs cerebrovascular pressure autoregulation. AIM: We sought to compare the lower limit of autoregulation and the static rate of autoregulation between normothermic and hypothermic piglets. METHODS: Twenty anesthetized neonatal piglets (5-7 days old; 10 normothermic and 10 hypothermic to 20°C) had continuous measurements of cortical red cell flux using laser Doppler flowmetry, while hemorrhagic hypotension was induced without cardiopulmonary bypass...
July 18, 2017: Paediatric Anaesthesia
https://www.readbyqxmd.com/read/28701597/randomized-comparative-study-of-intravenous-infusion-of-three-different-fixed-doses-of-milrinone-in-pediatric-patients-with-pulmonary-hypertension-undergoing-open-heart-surgery
#2
Neeraj Kumar Barnwal, Sanjeeta Rajendra Umbarkar, Manjula Sudeep Sarkar, Raylene J Dias
BACKGROUND: Pulmonary hypertension secondary to congenital heart disease is a common problem in pediatric patients presenting for open heart surgery. Milrinone has been shown to reduce pulmonary vascular resistance and pulmonary artery pressure in pediatric patients and neonates postcardiac surgery. We aimed to evaluate the postoperative outcome in such patients with three different fixed maintenance doses of milrinone. METHODOLOGY: Patients were randomized into three groups...
July 2017: Annals of Cardiac Anaesthesia
https://www.readbyqxmd.com/read/28684143/what-s-new-in-clinical-obstetric-anesthesia-in-2015
#3
REVIEW
P E Hess
Each calendar year the Society for Obstetric Anesthesia and Perinatology invites an individual to conduct a review of the medical literature, identifying clinically relevant publications of interest to the obstetric anesthesia provider. This report of that effort covers the publications from 2015 and includes the categories of anesthesia and analgesia, complications of neuraxial procedures, and the effects of anesthesia on the fetus. Neuraxial procedures represent the foundation of obstetric anesthesia; advances in anesthesia and analgesia include novel modes of administration, and refinements in care of the medically complex patient...
March 18, 2017: International Journal of Obstetric Anesthesia
https://www.readbyqxmd.com/read/28678073/prophylactic-norepinephrine-infusion-for-preventing-hypotension-during-spinal-anesthesia-for-cesarean-delivery
#4
Warwick D Ngan Kee, Shara W Y Lee, Floria F Ng, Kim S Khaw
BACKGROUND: The use of norepinephrine for maintaining blood pressure (BP) during spinal anesthesia for cesarean delivery has been described recently. However, its administration by titrated manually controlled infusion in this context has not been evaluated. METHODS: In a double-blinded, randomized controlled trial, 110 healthy women having spinal anesthesia for elective cesarean delivery were randomly allocated to 1 of 2 groups. In group 1, patients received an infusion of 5 μg/mL norepinephrine that was started at 30 mL/h (2...
July 1, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28656602/rapid-response-team-calls-to-obstetric-patients-in-a-busy-quaternary-maternity-hospital
#5
Timothy M Crozier, Pauline Galt, Stuart J Wilson, Euan M Wallace
AIMS: There is limited published information regarding intensive care unit (ICU) led rapid response team (RRT) calls to obstetric patients. We examined the characteristics of RRT calls to obstetric patients at a tertiary teaching hospital. METHODS: Details of calls to pregnant and postpartum patients between October 2010 and June 2014 were obtained from the hospital RRT database. Each was retrospectively examined for data on patient demographics, call trigger, interventions and outcomes...
June 28, 2017: Australian & New Zealand Journal of Obstetrics & Gynaecology
https://www.readbyqxmd.com/read/28653463/does-hypothermia-impair-cerebrovascular-autoregulation-in-neonates-during-cardiopulmonary-bypass
#6
Brendan Smith, Eric Vu, Kathleen Kibler, Craig Rusin, Ronald B Easley, Dean Andropoulos, Jeffrey Heinle, Marek Czosnyka, Daniel Licht, Jennifer Lynch, Ken Brady
BACKGROUND: Autoregulation monitoring has been proposed as a means to identify optimal arterial blood pressure goals during cardiopulmonary bypass, but it has been observed that cerebral blood flow is pressure passive during hypothermic bypass. When neonates cooled during cardiopulmonary bypass are managed with vasodilators and controlled hypotension, it is not clear whether hypothermia or hypotension were the cause of impaired autoregulation. AIM: We sought to measure the effect of both arterial blood pressure and hypothermia on autoregulation in a cohort of infants cooled for bypass, hypothesizing a collinear relationship between hypothermia, hypotension, and dysautoregulation...
June 27, 2017: Paediatric Anaesthesia
https://www.readbyqxmd.com/read/28629239/cortisol-precursors-in-neonates-with-vasopressor-resistant-hypotension-in-relationship-to-demographic-characteristics
#7
Abdelmoneim Khashana, Hoda Ahmed, Amal Ahmed, Amina Abdelwahab, Timo Saarela, Mika Rämet, Mikko Hallman
OBJECTIVE: To correlate between cortisol precursors in neonates with vasopressor resistant hypotension and demographic characteristics. METHODS: We investigated 48 neonates with vasopressor-resistant hypotension. Gestation at birth ranged from 34 to 42 weeks and postnatal age from 4 to 14 days. Cortisol and precursor steroids were measured soon after the onset of volume expansion and inotropes for treatment of shock. Their concentrations were determined using liquid chromatography-mass spectrometry...
June 19, 2017: Journal of Maternal-fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/28625306/spinal-induced-hypotension-incidence-mechanisms-prophylaxis-and-management-summarizing-20-years-of-research
#8
REVIEW
Jennifer E Lee, Ronald B George, Ashraf S Habib
Hypotension commonly occurs in parturients undergoing cesarean delivery under spinal anesthesia. This leads to maternal and neonatal adverse outcomes, including maternal nausea and vomiting and fetal acidosis, and might even lead to cardiovascular collapse if not treated. Arterial dilatation and reduction in systemic vascular resistance are the major contributors to spinal-induced hypotension. Therefore, strategies aimed at expanding the intravascular volume with fluid loading or increasing venous return with lower extremities mechanical compression and lateral tilt have had limited effectiveness in the management of spinal-induced hypotension...
March 2017: Best Practice & Research. Clinical Anaesthesiology
https://www.readbyqxmd.com/read/28591973/-the-application-of-internal-iliac-artery-balloon-occlusion-in-pernicious-placenta-previa
#9
Xiao-Rong Qi, Xing-Hui Liu, Yong You, Xiao-Dong Wang, Rong Zhou, Ai-Yun Xing, Li Zhang, Gang Ning, Fu-Min Zhao, Kai-Ming Li
OBJECTIVES: To evaluate the clinical application value of internal iliac artery balloon occlusion in pernicious placenta previa. METHODS: We retrospectively reviewed the medical records of the patients of pernicious placenta previa in a single center from Jan, 2010 to Jan, 2015. The patients were divided into two groups, internal iliac artery balloon occlusion group and the control group without endovascular intervention. Blood loss in operation, volume of transfused blood products, caesarean hysterectomy, operating time, hospital days after operation and postoperative morbidity were compared between the two groups...
July 2016: Sichuan da Xue Xue Bao. Yi Xue Ban, Journal of Sichuan University. Medical Science Edition
https://www.readbyqxmd.com/read/28518133/an-evaluation-of-hydrocortisone-dosing-for-neonatal-refractory-hypotension
#10
E S Peeples
OBJECTIVE: The objective of the study was to compare blood pressure, vasoactive medication requirements and adverse outcomes after administration of high- versus low-dose hydrocortisone (HC) in preterm infants. STUDY DESIGN: This is a retrospective analysis of 106 infants ⩽28 weeks gestational age with hypotension requiring vasoactive infusions and high-dose (4 mg kg(-1) per day, n=50), low-dose (1 to 3 mg kg(-1) per day, n=20) or no HC (n=36) from 2011 to 2015...
May 18, 2017: Journal of Perinatology: Official Journal of the California Perinatal Association
https://www.readbyqxmd.com/read/28515969/application-of-selective-bronchial-intubation-versus-neurally-adjusted-ventilatory-assist-in-the-management-of-unilateral-pulmonary-interstitial-emphysema-an-illustrative-case-and-the-literature-review
#11
Shing-Yan Robert Lee
In the treatment of left-sided pulmonary interstitial emphysema (PIE) in a 23-week neonate, we used two ventilatory strategies: selective bronchial intubation from day 10 to 15 and neurally adjusted ventilatory assist (NAVA) from day 18 to 26. We compared the effects and adverse effects of these two strategies. On selective bronchial intubation, desaturation was frequent. Fentanyl infusion was required. There was an episode of carbon dioxide retention coupled with hypotension. On NAVA, the neonate was clinically stable without the requirement of sedation...
April 2017: American Journal of Perinatology Reports
https://www.readbyqxmd.com/read/28473717/safety-and-tolerance-of-propranolol-in-neonates-with-severe-infantile-hemangiomas-a-prospective-study
#12
Yi Ji, Siyuan Chen, Bo Xiang, Yang Yang, Liqing Qiu
Although the efficacy of propranolol for the treatment of infantile hemangiomas (IHs) has been well documented, there is a paucity of clinical data regarding the safety and tolerance of propranolol in neonates. A prospective study of 51 patients less than 30 days of age with severe IH was conducted. All patients were admitted to the hospital for monitoring during initial propranolol treatment at day 0 with dose adjustments at days 7 and 28. Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), blood glucose (BG) levels and potential side effects were evaluated during treatment...
May 4, 2017: Scientific Reports
https://www.readbyqxmd.com/read/28462900/hyperdehydroepiandrosterone-in-neonates-with-hypoxic-ischemic-encephalopathy-and-circulatory-collapse
#13
Abdelmoneim Khashana, Engy Ahmed
BACKGROUND: Circulatory collapse is a very common complication of the critical illnesses in neonates including neonates with hypoxic ischemic encephalopathy; it can be the end result and cause of death of several conditions. Often, despite treatment with fluid resuscitation and vasopressor agents, circulatory collapse persist, and blood pressure can remain critically low, compromising adequate blood flow to vital organs and brain. Low blood pressure has been associated with increased mortality...
April 12, 2017: Pediatrics and Neonatology
https://www.readbyqxmd.com/read/28452098/impact-of-bradycardia-or-asystole-on-neonatal-cardiopulmonary-resuscitation-at-birth
#14
Vasantha H S Kumar, Annie Skrobacz, Changxing Ma
BACKGROUND: Fetal hypoxia from intrapartum events can lead to absent heart rate (HR) or bradycardia (BC) at birth requiring aggressive neonatal resuscitation. Neonatal resuscitation guidelines do not differentiate infants with bradycardia (HR<100/min) from absent HR at birth. As HR is the primary determinant of resuscitation, we hypothesize that infants with no HR at 1 minute would require more extensive resuscitation with worse clinical outcomes compared to infants with bradycardia at 1minute...
April 28, 2017: Pediatrics International: Official Journal of the Japan Pediatric Society
https://www.readbyqxmd.com/read/28451389/effect-of-ephedrine-combined-with-bupivacaine-on-maternal-hemodynamic-and-spinal-nerve-block-in-cesarean-delivery
#15
Mingyue Ge, Sheng Wang, Zhigang Dai, Yan Li, Liping Xie, Xuejao Liu, Jiangwen Yin
The aim of the study was to investigate the effects of ephedrine intrathecal injection on maternal thermodynamics and spinal nerve block in cesarean section. A total of 107 patients undergoing elective cesarean section under combined spinal epidural anesthesia were randomly divided into two groups: group E: Bupivacaine (6 mg) combined with ephedrine (15 mg) and group C: Bupivacaine (6 mg). Systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), the incidence of hypotension, hypertension, tachycardia, nausea and vomiting were all recorded...
March 2017: Biomedical Reports
https://www.readbyqxmd.com/read/28410573/risk-factors-for-necrotizing-enterocolitis-in-neonates-a-systematic-review-of-prognostic-studies
#16
Noor Samuels, Rob A van de Graaf, Rogier C J de Jonge, Irwin K M Reiss, Marijn J Vermeulen
BACKGROUND: Necrotizing enterocolitis (NEC) is a severe multifactorial disease in preterm neonates associated with high morbidity and mortality. Better insight into prognostic values of the many reported factors associated with NEC is needed to enable identification of neonates at risk for NEC. The aim was to systematically review the literature to identify independent risk factors for NEC from the literature. METHODS: Medline, Cochrane, Embase, Pubmed and Google Scholar were searched systematically for cohort studies reporting prognostic factors for NEC in neonates using multivariable analysis...
April 14, 2017: BMC Pediatrics
https://www.readbyqxmd.com/read/28399330/arginine-supplementation-for-prevention-of-necrotising-enterocolitis-in-preterm-infants
#17
REVIEW
Prakeshkumar S Shah, Vibhuti S Shah, Lauren E Kelly
BACKGROUND: Decreased concentration of nitric oxide has been proposed as one of the possible cellular mechanisms of necrotising enterocolitis (NEC). Arginine can act as a substrate for production of nitric oxide in the tissues, and arginine supplementation may help to prevent NEC. OBJECTIVES: To examine the effect of arginine supplementation (administered by any route) on the incidence of NEC in preterm neonates. To conduct subgroup analyses based on the dose of arginine and the gestational age of participants (≤ 32 weeks, > 32 weeks)...
April 11, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28397438/intraventricular-hemorrhage-in-neonates-born-from-23-to-26-weeks-of-gestation-retrospective-analysis-of-risk-factors
#18
Dawid Szpecht, Irmina Nowak, Paulina Kwiatkowska, Marta Szymankiewicz, Janusz Gadzinowski
BACKGROUND: The study aim was to determine the incidence and analyze risk factors of IVH stage 3 and 4 in infants born before 26 weeks of gestation. OBJECTIVES: A retrospective analysis of 110 preterm babies (23-26 weeks of gestation) hospitalized from 2009 to 2014 at the Department of Neonatology of Poznan University of Medical Sciences was performed. MATERIAL AND METHODS: In the study group there were 29 (26.4%) children in the 23rd-24th weeks of pregnancy and 81 (73...
January 2017: Advances in Clinical and Experimental Medicine: Official Organ Wroclaw Medical University
https://www.readbyqxmd.com/read/28360439/baricity-of-bupivacaine-on-maternal-hemodynamics-after-spinal-anesthesia-for-cesarean-section-a-randomized-controlled-trial
#19
Simin Atashkhoei, Naghi Abedini, Hojjat Pourfathi, Ali Bahrami Znoz, Pouya Hatami Marandi
BACKGROUND: After spinal anesthesia, patients undergoing cesarean section are more likely to develop hemodynamic changes. The baricity of local anesthetic has an important role on spinal blockade effects. The aim of this study was to compare the isobar and hyperbaric bupivacaine 0.5% plus fentanyl on maternal hemodynamics after spinal anesthesia for C/S. METHODS: In this double-blind study, 84 healthy pregnant women undergoing C/S using bupivacaine 0.5% isobar (study group, n=42) or hyperbaric (control group, n=42) for spinal anesthesia were scheduled...
March 2017: Iranian Journal of Medical Sciences
https://www.readbyqxmd.com/read/28330506/clonidine-for-sedation-in-the-critically-ill-a-systematic-review-and-meta-analysis
#20
Jing Gennie Wang, Emilie Belley-Coté, Lisa Burry, Mark Duffett, Timothy Karachi, Dan Perri, Waleed Alhazzani, Frederick D'Aragon, Hannah Wunsch, Bram Rochwerg
BACKGROUND: This systematic review and meta-analysis investigates the efficacy and safety of clonidine as a sedative in critically ill patients requiring invasive mechanical ventilation. METHODS: We performed a comprehensive search of MEDLINE, EMBASE, CINAHL and the Cochrane trial registry. We identified RCTs that compared clonidine to any non-clonidine regimen in critically ill patients, excluding neonates, requiring mechanical ventilation. The GRADE method was used to assess certainty of evidence...
February 25, 2017: Critical Care: the Official Journal of the Critical Care Forum
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