How to diagnose and treat acute pulmonary hypertension when you have no cardiology support.

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Date: Nov. 2022
From: Early Human Development(Vol. 174)
Publisher: Elsevier B.V.
Document Type: Report; Brief article
Length: 386 words

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Abstract :

Keywords Acute pulmonary hypertension; Newborn; Targeted neonatal echocardiography; Right ventricular dysfunction; Cardiovascular physiology; Systemic hypotension Highlights * Acute pulmonary hypertension (aPH) is a complex, pathophysiology-based disorder. * The hallmark physiologic characteristic of aPH is elevated pulmonary artery pressure. * Several hemodynamic phenotypes of neonatal aPH exist. * Treatment of neonatal aPH should be targeted at the underlying pathophysiology. * Targeted neonatal echocardiography is valuable for assessing hemodynamics in aPH. Abstract Acute pulmonary hypertension (aPH) is a complex, physiology-driven disorder that causes critical illness in newborns, the hallmark of which is elevated pressure in the pulmonary vascular bed. Several underlying hemodynamic phenotypes exist, including classic arterial aPH with resistance-driven elevations in pulmonary arterial pressure (PAP), alongside flow-driven aPH from left-to-right shunt lesions, and primary left ventricular dysfunction with pulmonary venous hypertension and elevated left atrial pressure. Targeted neonatal echocardiography (TnECHO) is an important tool for evaluation of hemodynamics in aPH and is highly useful for evaluating modulators of disease and targeting cardiovascular therapy. The diagnostic approach to aPH includes confirmation of elevation of PAP, evaluation of the cause and exclusion of structural cardiac disease, assessment of the response of the myocardium to adverse loading conditions, and appraisal of the adequacy of systemic blood flow. Therapeutic goals include support of right ventricular (RV) function, RV afterload reduction, and selection of cardiotropic agents that support underlying pathophysiology without adverse effects on heart rate or pulmonary vascular resistance in addition to routine supportive intensive care. Training programs for TnECHO exist across multiple jurisdictions and strong correlation with pediatric cardiology assessment has been demonstrated. Future directions include adapting TnECHO training with a greater focus on achieving competency, and further research into the role of the modality in providing individualized cardiovascular care for patients with heterogenous underlying physiology, and its effect on key neonatal outcomes. Author Affiliation: (a) Grace Centre for Newborn Intensive Care, The Children's Hospital at Westmead, Sydney, Australia (b) Faculty of Medicine and Health, The University of Sydney, Sydney, Australia (c) Division of Newborn Medicine, Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, USA (d) Division of Neonatology, Stead Family Department of Pediatrics, University of Iowa Stead Family Children's Hospital, Iowa City, USA * Corresponding author at: 200 Hawkins Drive, Iowa City, IA 52242, USA. Byline: S.M. Boyd (a,b), T. Chatmethakul (c), P.J. McNamara [] (d,*)

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Gale Document Number: GALE|A723925862