Support of the preterm circulation: keynote address to the Fifth Evidence vs Experience Conference, Chicago, June 2008.
Hemodynamics is an area of neonatology that is marked more by what we do not know than what we do. What is clear is that it is much more complex than just measuring blood pressure (BP). Early postnatal preterm hemodynamic pathophysiology is characterized by low systemic blood flow (SBF), possibly relating to a mix of afterload compromise, left-to-right shunting through the unconstricted ductus and to the circulatory effects of ventilation. After approximately 24 h of age, vasodilatation seems to be the dominant pathology. In the face of this complexity, a one-size-fits-all approach to treatment that will be applicable in a large clinical trial may prove elusive. The possibility of using a measure of both BP and SBF to target an appropriate treatment needs to be explored.
Evans
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Department of Newborn Care, Royal Prince Alfred Hospital and University of Sydney, Sydney, NSW, Australia. nevans@med.usyd.edu.au
D001783:Blood Flow Velocity / Q000187:drug effects / Q000502:physiology; D001794:Blood Pressure / Q000187:drug effects / Q000502:physiology; D002545:Brain Ischemia / Q000503:physiopathology / Q000628:therapy; D002303:Cardiac Output, Low / Q000503:physiopathology / Q000628:therapy; D002316:Cardiotonic Agents / Q000627:therapeutic use; D003131:Combined Modality Therapy; D004280:Dobutamine / Q000627:therapeutic use; D004298:Dopamine / Q000627:therapeutic use; D004374:Ductus Arteriosus, Patent / Q000503:physiopathology / Q000628:therapy; D019317:Evidence-Based Medicine; D006439:Hemodynamics / Q000187:drug effects / Q000502:physiology*; D006706:Homeostasis / Q000187:drug effects / Q000502:physiology; D006801:Humans; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000503:physiopathology* / Q000628:therapy*; D015931:Intensive Care, Neonatal; D008297:Male; D011175:Positive-Pressure Respiration / Q000379:methods; D016032:Randomized Controlled Trials as Topic; D012039:Regional Blood Flow / Q000187:drug effects / Q000502:physiology; D018608:Ultrasonography, Doppler; D017585:Ultrasonography, Doppler, Transcranial
D002316:Cardiotonic Agents; D004280:Dobutamine; D004298:Dopamine