Transitional Hemodynamics in Preterm Neonates: Clinical Relevance.
BACKGROUND
Each newborn enters this world facing tremendous respiratory, hemodynamic and neuroendocrine challenges while going through drastic physiological changes during the process of adaption from fetal to postnatal life. Even though the vast majority of term infants transition smoothly without apparent consequences, this task becomes increasingly arduous for the extremely preterm infant.


RESULTS
This article reviews the physiology and pathophysiology of cardiovascular adaptation of the very preterm neonate. In particular it describes the physiology of fetal circulation, summarizes the hemodynamic changes occurring during preterm births and discusses the impact of the most frequently seen clinical scenarios that place additional burden on the premature infant during immediate transition. Finally an emphasis is placed on discussing common clinical dilemmas and practical aspects of developmental hemodynamics such as neonatal hypotension and patent ductus arteriosus; clinical presentations the neonatologist encounters on a daily basis.


CONCLUSIONS
The review provides a physiology-based view on the hemodynamics of the immediate postnatal transitional period.
Division of Neonatology, Department of Pediatrics, Chang Gung Children's Hospital and Chang Gung Memorial Hospital, Chang Gung College of Medicine, Taoyuan, Taiwan.
Tai-Wei
TW
Wu
Division of Neonatology, Department of Pediatrics, Children's Hospital Los Angeles, CA, USA; Center for Fetal and Neonatal Medicine LAC+USC Medical Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
Timur
T
Azhibekov
Center of Excellence in Neonatology, Department of Pediatrics, Sidra Medical and Research Center and Weill Cornell Medical College, Doha, Qatar. Electronic address: iseri@sidra.org.
Istvan
I
Seri
D002560:Cerebrovascular Circulation; D004374:Ductus Arteriosus, Patent / Q000503:physiopathology; D005260:Female; D005333:Fetus / Q000098:blood supply; D006439:Hemodynamics; D006801:Humans; D007223:Infant; D062071:Infant, Extremely Premature / Q000502:physiology*; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000503:physiopathology; D010920:Placenta / Q000098:blood supply; D011247:Pregnancy
Preterm neonate; developmental hemodynamics; fetal circulation; neonatal hypotension; persistent ductus arteriosus