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      Individualized Hemodynamic Management in Newborns

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          Abstract

          In our aim to improve patient outcome we are transitioning from a “one-size-fits-all” protocolized approach toward an individualized hemodynamic management, that is tailored to the cardiovascular (patho-)physiology and the specific clinical characteristics of each individual patient. In this narrative review an overview is provided about an individualized approach toward various neonatal hemodynamic conditions.

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          Most cited references 37

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          Towards rational management of the patent ductus arteriosus: the need for disease staging.

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            Early and long-term outcome of infants born extremely preterm.

            There is no question that birth at extremely low gestational ages presents a significant threat to an infant's survival, health and development. Growing evidence suggests that gestational age may be conceptualised as a continuum in which births before 28 weeks of gestation (extremely preterm: EP) represent the severe end of a spectrum of health and developmental adversity. Although comprising just 1%-2% of all births, EP deliveries pose the greatest challenge to neonatal medicine and to health, education and social services for the provision of ongoing support for survivors with additional needs. Studying the outcomes of these infants remains critical for evaluating and enhancing clinical care, planning long-term support and for advancing our understanding of the life-course consequences of immaturity at birth. Here we review literature relating to early and long-term neurodevelopmental, cognitive, behavioural and educational outcomes following EP birth focusing on key themes and considering implications for intervention.
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              Clinicians' abilities to estimate cardiac index in ventilated children and infants.

              To evaluate the ability of clinicians involved in the provision of paediatric intensive care to estimate cardiac index in ventilated children, based on physical examination and clinical and bedside laboratory data. Clinicians were exposed to all available haemodynamic and laboratory data for each patient, allowed to make a physical examination, and asked to first categorize cardiac index as high, high to normal, low to normal, or low, and then to quantify this further with a numerical estimate. Cardiac index was measured simultaneously by femoral artery thermodilution (coefficient of variation 5.37%). One hundred and twelve estimates were made by 27 clinicians on 36 patients (median age 34.5 months). Measured cardiac index ranged from 1.39 to 6.84 1/min/m2. Overall, there was poor correlation categorically (kappa statistic 0.09, weighted kappa 0.169) and numerically (r = 0.24, 95% confidence interval 0.06 to 0.41), although some variation was seen among the various levels of seniority. Assuming that objective measurement, and hence manipulation, of haemodynamic variables may improve outcome, these findings support the need for a safe, accurate, and repeatable technique for measurement of cardiac index in children who are critically ill.
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                Author and article information

                Contributors
                Journal
                Front Pediatr
                Front Pediatr
                Front. Pediatr.
                Frontiers in Pediatrics
                Frontiers Media S.A.
                2296-2360
                07 October 2020
                2020
                : 8
                Affiliations
                Division of Neonatology, Department of Pediatrics, Radboud University Medical Center, Radboud Institute for Health Sciences, Amalia Children's Hospital , Nijmegen, Netherlands
                Author notes

                Edited by: Karel Allegaert, University Hospitals Leuven, Belgium

                Reviewed by: Liam Mahoney, Southmead Hospital, United Kingdom; Eugene Dempsey, University College Cork, Ireland

                *Correspondence: Willem P. de Boode willem.deboode@ 123456radboudumc.nl

                This article was submitted to Neonatology, a section of the journal Frontiers in Pediatrics

                Article
                10.3389/fped.2020.580470
                7575728
                Copyright © 2020 de Boode.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                Page count
                Figures: 1, Tables: 0, Equations: 0, References: 37, Pages: 5, Words: 4157
                Categories
                Pediatrics
                Mini Review

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