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Hemodynamic consequences of respiratory interventions in preterm infants

Journal

JOURNAL OF PERINATOLOGY
Volume 42, Issue 9, Pages 1153-1160

Publisher

SPRINGERNATURE
DOI: 10.1038/s41372-022-01422-5

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Funding

  1. CAUL

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Advancements in perinatal management have improved survival rates for premature infants, but the transitional period after birth and subsequent weeks are still characterized by rapid circulatory changes. Routine respiratory care practices can have negative effects on heart function and hemodynamics in preterm infants, especially those born at the limits of viability. It is important to have tools to assess cardiopulmonary interactions and guide management in order to mitigate these potential impacts.
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.

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