Category Archives: Cardiac

Tip 147: hydrocortisone for hypotension

Hydrocortisone is effective in increasing blood pressure, with few other acute side-effects in the sick preterm infant. However, benefit data and long-term safety data are unknown. It is likely that it works by improving the immature neonatal stress response (due to … Continue reading

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Tip 142: dobutamine

Dobutamine is a cardio-selective synthetic analogue of isoprenaline. It possesses both inotropic (beta-1 adrenergic stimulation) and chronotropic (beta-2 adrenergic stimulation) properties. It increases cardiac output by increasing myocardial contractility and stroke volume and causes peripheral vasodilatation. Thus, it is a … Continue reading

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Tip 141: dopamine

Dopamine is a naturally occurring catecholamine precursor of noradrenaline. Dopamine affects all three major determinants of cardiovascular function (preload, myocardial contractility and afterload). It increases myocardial contractility, heart rate and systemic vascular resistance by stimulation of the alpha and beta receptors. … Continue reading

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Tip 114: pre- and post-ductal oxygen saturations

Pulse oximetry from the right upper limb (pre-ductal) and lower limbs (post-ductal) can identify a right-to-left shunt through the ductus arteriosus. In a right-to-left shunt, the post-ductal circulation contains mixed blood from the right-side (pre-lung) and the left-side (post-lung) and hence the … Continue reading

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Tip 82: supraventricular tachycardia (SVT)

Presentation varies from antenatal hydrops and tachycardia, neonatal heart failure within the first 12-24 hours, to being asymptomatic. The termination of SVT is usually easily achieved by vagal manoeuvres or intravenous adenosine. Unusually DC shock is needed, especially with evidence … Continue reading

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Tip 78: PDA medical treatment

Treatment of a symptomatic PDA in a preterm infant is usually by fluid restriction (and waiting for spontaneous closure) or ibuprofen (indomethacin is no longer available in the UK.) The Cochrane review below included the following findings. IV ibuprofen showed a … Continue reading

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Tip 76: PDA 2

Due to an increased left (aorta) to right (pulmonary artery) shunting, a significant PDA is associated with renal impairment / failure, intestinal perforation / NEC, and severe IVH / PVL, possibly due to systemic ‘steal’. The increase pulmonary blood flow can … Continue reading

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