Rios Danielle R, Lapointe Anie, Schmolzer Georg M, Mohammad Khorshid, VanMeurs Krisa P, Keller Roberta L, Sehgal Arvind, Lakshminrusimha Satyan, Giesinger Regan E
Department of Pediatrics, Division of Neonatology, University of Iowa, MS 200 Hawkins Drive 8800 JPP, Iowa City, IA, 52242, USA.
CHU Ste-Justine, Montreal University, CHU Sainte-Justine 3175, chemin Côte Sainte-Catherine Montréal (Québec), H3T 1C5, Canada.
Semin Fetal Neonatal Med. 2021 Aug;26(4):101277. doi: 10.1016/j.siny.2021.101277. Epub 2021 Aug 12.
Neonatal encephalopathy due to a hypoxic-ischemic event is commonly associated with cardiac dysfunction and acute pulmonary hypertension; both therapeutic hypothermia and rewarming modify loading conditions and blood flow. The pathophysiological contributors to disease are complex with a high degree of clinical overlap and traditional bedside measures used to assess circulatory adequacy have multiple confounders. Comprehensive, quantitative echocardiography may be used to delineate the relative contribution of lung parenchymal, pulmonary vascular, and cardiac disease to hypotension and/or hypoxemic respiratory failure. In this review, we provide a detailed overview of the contributors to hemodynamic instability following perinatal hypoxic-ischemic injury. Our proposed approach to therapy focuses on physiopathological considerations with interventions individualized to this potentially complex condition and considers the pharmacological idiosyncrasies, which may occur among neonates with NE presenting with multiorgan dysfunction while undergoing therapeutic hypothermia.
缺氧缺血性事件所致的新生儿脑病通常与心功能不全和急性肺动脉高压相关；治疗性低温和复温都会改变负荷状况和血流。该疾病的病理生理因素复杂，临床重叠度高，用于评估循环充足性的传统床边测量方法存在多种混杂因素。全面、定量的超声心动图可用于明确肺实质、肺血管和心脏疾病对低血压和/或低氧性呼吸衰竭的相对影响。在本综述中，我们详细概述了围产期缺氧缺血性损伤后血流动力学不稳定的影响因素。我们提出的治疗方法侧重于生理病理方面的考虑，针对这种潜在复杂情况进行个体化干预，并考虑在接受治疗性低温的多器官功能障碍新生儿中可能出现的药理学特质。
