Table of Contents:
  • Front Cover
  • IFC
  • HEMODYNAMICS AND CARDIOLOGY: Neonatology Questions and Controversies
  • Series Page
  • HEMODYNAMICS AND CARDIOLOGY: Neonatology Questions and Controversies
  • Copyright
  • Contributors
  • Preface
  • Series Foreword
  • Contents
  • A
  • Developmental Cardiovascular Physiology and Pathophysiology
  • 1
  • Principles of Developmental Cardiovascular Physiology and Pathophysiology
  • Principles of Developmental Physiology
  • Fetal Circulation
  • Transitional Physiology
  • Postnatal Circulation
  • Pressure, Flow, and Resistance
  • Organ Blood Flow Distribution
  • Microcirculatory Physiology (see Chapter 19)
  • Myocardial Function-Developmental Aspects
  • Developmental Cardiovascular Pathophysiology: Etiology and Pathophysiology of Neonatal Shock
  • Definition and Phases of Shock
  • Etiology of Neonatal Shock
  • Hypovolemia
  • Myocardial Dysfunction (see Chapter 26)
  • Vasodilation
  • Adrenal Insufficiency (see Chapter 30)
  • Downregulation of Adrenergic Receptors
  • Summary
  • REFERENCES
  • 2
  • Vascular Regulation of Blood Flow to Organs in the Preterm and Term Neonate
  • Regulation of Arterial Tone
  • The Role of Conduit Arteries in Regulating Vascular Resistance
  • Arterial Reaction to Pressure (Autoregulation)
  • Interaction of Autoregulation and Hypoxic Vasodilatation
  • Interaction of Autoregulation and Pco2
  • Interaction of Autoregulation and Functional Activation (Metabolic Blood Flow Control)
  • Flow-Mediated Vasodilatation
  • Sympathetic Nervous System
  • Humoral Factors in General Circulation
  • Blood Flow to the Brain
  • Autoregulation of Cerebral Blood Flow in the Immature Brain
  • Effect of Carbon Dioxide on Cerebral Blood Flow
  • Metabolic Control of Blood Flow to the Brain
  • Adrenergic Mechanisms Affecting Cerebral Blood Flow
  • Effect of Medications on Cerebral Blood Flow
  • Ischemic Thresholds in the Brain.
  • Blood Flow to Other Organs
  • Kidney
  • Liver
  • Stomach and Intestines
  • Distribution of Cardiac Output in the Healthy Human Neonate
  • Blood Flow to the Upper Part of the Body
  • Blood Flow to the Lower Part of the Body
  • Mechanisms Governing the Redistribution of Cardiac Output in the Fetal "Diving" Reflex
  • Aerobic Diving
  • Reactions to Hypoxia
  • Modifying Effects
  • Distribution of Cardiac Output in the Shocked Newborn
  • The Term Neonate With Low Cardiac Output
  • The Very Preterm Neonate During Immediate Postnatal Adaptation
  • Other Scenarios
  • REFERENCES
  • 3
  • Definition of Normal Blood Pressure Range: The Elusive Target
  • Measuring Blood Pressure
  • Blood Pressure Standards
  • Clinical Factors Affecting Blood Pressure
  • Antenatal Steroids
  • Placental Transfusion
  • Respiratory Support
  • Blood Pressure and Short- and Long-Term Outcomes
  • Bedside Clinical Assessment and Hemodynamic Monitoring
  • Conclusion
  • REFERENCES
  • B
  • Hemodynamic Principles of Postnatal Transition
  • 4
  • Cardiorespiratory Effects of Delayed Cord Clamping
  • The Transition to Newborn Life
  • Airway Liquid Clearance
  • Increase in Pulmonary Blood Flow at Birth in Response to Lung Aeration
  • The Cardiovascular Transition at Birth: Effect of Umbilical Cord Clamping
  • Neonatal Cardiovascular Responses to Umbilical Cord Clamping
  • Neonatal Cardiovascular Consequences of Umbilical Cord Milking
  • Placental Transfusion During Delayed Umbilical Cord Clamping
  • Potential Mechanisms for Placental Blood Transfusion
  • Gravity and Uterine Contraction
  • Increase in Pulmonary Blood Flow at Birth
  • Vaginal Birth
  • Clinical Effects of Delayed/Deferred Umbilical Cord Clamping
  • Potential Mechanisms of Benefit: Transfusion Versus Timing
  • Determinants of the Placental Transfusion
  • Time
  • Position/Gravity
  • Contractions/Oxytocics
  • Mode of Delivery.
  • Umbilical Blood Vessel Patency
  • Breathing/Crying
  • Prevention of Hypotension/Low Systemic Blood Flow
  • Less Intervention at Birth: Resuscitation Versus Transitioning
  • Physiologically Based Cord Clamping
  • Conclusions
  • REFERENCES
  • 5
  • Hemodynamic Significance and Clinical Relevance of Delayed Cord Clamping and Umbilical Cord Milking
  • Transitional Physiology and Animal Studies of Delayed Cord Clamping and Umbilical Cord Milking
  • Cardiovascular Effects of Delayed Cord Clamping and Umbilical Cord Milking in the Delivery Room
  • Hemodynamic Measurements in the First Hours After Birth Following Delayed Cord Clamping and Umbilical Cord Milking
  • Neonatal Blood Volume After Delayed Cord Clamping and Umbilical Cord Milking
  • Long-Term Outcomes and Mortality After Delayed Cord Clamping and Umbilical Cord Milking
  • Conclusions and Future Directions
  • REFERENCES
  • 6
  • Transitional Hemodynamics and Pathophysiology of Peri/Intraventricular Hemorrhage
  • Fetal and Transitional Circulation
  • Cerebral Blood Flow
  • Normal Changes in Cerebral Blood Flow
  • Cerebral Blood Flow and Peri/Intraventricular Hemorrhage
  • Vulnerabilities of Preterm Infants During Transition
  • Inherent Vulnerability of the Immature Brain
  • Immature Myocardium
  • Hypovolemia and Timing of Cord Clamping
  • Patent Ductus Arteriosus
  • Hypotension
  • Cardiorespiratory Interaction
  • Hypocapnia and Hypercapnia
  • Conclusions
  • REFERENCES
  • 7
  • The Immature Autonomic Nervous System, Hemodynamic Regulation, and Brain Injury in the Preterm Neonate
  • Magnitude of the Problem
  • Hemodynamic Vulnerability in Premature Infants
  • The Premature Autonomic Nervous System
  • The Premature Cardiovascular System
  • Cerebral Hemodynamic Control in Premature Infants
  • Evidence for an Association Between Systemic Hemodynamic Disturbances and Prematurity-Related Brain Injury.
  • Resolving the Relationship Between Systemic Hemodynamics and Prematurity-Related Brain Injury: Obstacles to Progress
  • Measurement of Relevant Hemodynamic and Metabolic Indices
  • Potential for "Dysmaturation" of the Autonomic Nervous System in Premature Newborns
  • Conclusion
  • REFERENCES
  • 8
  • Pathophysiology of Persistent Pulmonary Hypertension of the Newborn-Cellular Basis and Lessons from Animal Studies
  • Physiology of the Fetal Circulation
  • Low Placental Vascular Resistance
  • High Fetal Pulmonary Vascular Resistance
  • Transition at Birth
  • Animal Models of Pulmonary Hypertension in the Newborn
  • Antenatal Ductal Ligation Model in Sheep With Reduced Pulmonary Blood Flow
  • Cellular and Biochemical Changes
  • Aortopulmonary Graft With Pulmonary Overcirculation
  • Cellular and Biochemical Changes
  • Drug Induced Pulmonary Hypertension
  • Meconium Aspiration Model
  • Chronic Hypoxia
  • Monocrotaline-Induced Pulmonary Hypertension in Rats
  • Intrauterine Growth Restriction
  • Congenital Diaphragmatic Hernia
  • Fetal Surgical Model in Lambs
  • Cellular and Biochemical Changes
  • Nitrofen Model in Rats
  • Cellular and Biochemical Abnormalities
  • Medications in Pregnancy and Persistent Pulmonary Hypertension of the Newborn: Cellular Basis
  • Selective Serotonin Reuptake Inhibitors
  • Nonsteroidal Antiinflammatory Drugs
  • Antenatal Betamethasone
  • Free Radicals in Persistent Pulmonary Hypertension of the Newborn
  • Oxidative Stress
  • Reactive Nitrogen Species
  • Pathological Vascular Remodeling in Persistent Pulmonary Hypertension of the Newborn
  • Cellular and Biochemical Basis of Various Persistent Pulmonary Hypertension of the Newborn Therapies
  • Oxygen
  • Human Data on Hypoxic Pulmonary Vasoconstriction
  • Inhaled Nitric Oxide
  • Attenuating Inactivation of Inhaled Nitric Oxide by Superoxide.
  • Soluble Guanylate Cyclase Stimulators and Activators (see Fig. 8.9)
  • Inhibition of Phosphodiesterase 5
  • Hydrocortisone
  • Inhibition of Phosphodiesterase 3
  • Cellular Basis for Emerging Therapies
  • L-citrulline
  • Rho-kinase inhibitors
  • Stem Cell Therapies
  • Conclusion
  • Founding Sources
  • REFERENCES
  • 9
  • Pathophysiologically Based Management of Persistent Pulmonary Hypertension of the Newborn
  • Pathophysiology, Hemodynamics and Treatment Targets
  • Principles of Management of Persistent Pulmonary Hypertension of the Newborn
  • Supportive Care
  • Mechanical Ventilation and Surfactant
  • Vasodilator Therapy in Persistent Pulmonary Hypertension of the Newborn
  • Oxygen and Carbon Dioxide
  • Inhaled Nitric Oxide
  • Role of Inhaled Nitric Oxide in Preterm Oxygenation Failure
  • Weaning Inhaled Nitric Oxide
  • Other Pulmonary/Systemic Vasodilators
  • Phosphodiesterase-5 Inhibitors
  • Phosphodiesterase-3 Inhibitors
  • Prostaglandins
  • Endothelin Receptor Antagonists
  • Magnesium Sulfate
  • Utilizing Pathophysiology to Guide the Use of Vasodilators in Persistent Pulmonary Hypertension of the Newborn
  • Vasopressor Therapy in Persistent Pulmonary Hypertension of the Newborn
  • Using Pathophysiology to Guide Use of Vasopressors in Persistent Pulmonary Hypertension of the Newborn
  • Extracorporeal Membrane Oxygenation
  • Conclusions
  • REFERENCES
  • C
  • Diagnosis of Neonatal Cardiovascular Compromise: Methods and Their Clinical Applications
  • C1
  • Assessment of Systemic Blood Flow and Cardiac Function: Ultrasound
  • 10
  • Point of Care Ultrasound in the Assessment of the Neonatal Cardiovascular System
  • Politics of Ultrasound
  • What's in a Name?
  • Training and Accreditation in Point of Care Ultrasound
  • Using Physiology to Target Treatment
  • Uses of Point of Care Ultrasound in the Neonatal Intensive Care Unit.