title: Evidence-based versus pathophysiology-based approach to diagnosis and treatment of neonatal cardiovascular compromise.
abstract: With the advances in biomedical research and neonatal intensive care, our understanding of cardiovascular developmental physiology and pathophysiology has significantly improved during the last few decades. Despite this progress, the current management of circulatory compromise depends primarily on experts' opinions rather than high level of evidence. The lack of reliable, accurate, continuous and preferably non-invasive monitoring techniques has further limited our ability to collect the information needed for the design and execution of more sophisticated clinical trials with a better chance to provide the evidence we need. Given the lack of randomized, placebo-controlled trials investigating clinically relevant outcomes of novel treatments of neonatal cardiovascular compromise, we must now use the available lower level of evidence and our present understanding of developmental physiology and pathophysiology when providing cardiovascular supportive care to critically ill neonates. However, with recent advances in cardiovascular monitoring capabilities, direct and more objective assessment of the changes in cardiovascular function, organ blood flow, and tissue oxygenation have become possible. These advances have helped in our clinical assessment and enabled us to start designing more sophisticated interventional clinical trials using clinically relevant endpoints.
authors.affiliation: Division of Neonatology and the Center for Fetal and Neonatal Medicine, Department of Pediatrics, Children's Hospital Los Angeles and the LAC+USC Medical Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA. Electronic address: snoori@chla.usc.edu.
authors.forename: Shahab
authors.initials: S
authors.lastname: Noori
authors.affiliation: Sidra Medical and Research Center, Doha, Qatar.
authors.forename: Istvan
authors.initials: I
authors.lastname: Seri
mesh_terms: D001794:Blood Pressure / Q000502:physiology; D002318:Cardiovascular Diseases / Q000503:physiopathology*; D002319:Cardiovascular System / Q000503:physiopathology*; D006439:Hemodynamics; D006801:Humans; D007022:Hypotension / Q000503:physiopathology; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000503:physiopathology*; D008991:Monitoring, Physiologic; D012039:Regional Blood Flow / Q000502:physiology*
keywords: Cardiac function; Echocardiography; Hypotension; Myocardial dysfunction; Sepsis; Vascular resistance