Hemodynamic instability in the critically ill neonate: An approach to cardiovascular support based on disease pathophysiology

Semin Perinatol. 2016 Apr;40(3):174-88. doi: 10.1053/j.semperi.2015.12.005. Epub 2016 Jan 14.


Hemodynamic disturbance in the sick neonate is common, highly diverse in underlying pathophysiology and dynamic. Dysregulated systemic and cerebral blood flow is hypothesized to have a negative impact on neurodevelopmental outcome and survival. An understanding of the physiology of the normal neonate, disease pathophysiology, and the properties of vasoactive medications may improve the quality of care and lead to an improvement in survival free from disability. In this review we present a modern approach to cardiovascular therapy in the sick neonate based on a more thoughtful approach to clinical assessment and actual pathophysiology. Targeted neonatal echocardiography offers a more detailed insight into disease processes and offers longitudinal assessment, particularly response to therapeutic intervention. The pathophysiology of common neonatal conditions and the properties of cardiovascular agents are described. In addition, we outline separate treatment algorithms for various hemodynamic disturbances that are tailored to clinical features, disease characteristics and echocardiographic findings.

Keywords: blood pressure; hypotension; inotrope; neonate; premature; targeted neonatal echocardiography; vasopressor.

Publication types

  • Review

MeSH terms

  • Algorithms
  • Cardiovascular Agents / pharmacology*
  • Cardiovascular Diseases* / diagnosis
  • Cardiovascular Diseases* / physiopathology
  • Cardiovascular Diseases* / therapy
  • Cardiovascular System* / diagnostic imaging
  • Cardiovascular System* / drug effects
  • Cardiovascular System* / physiopathology
  • Critical Illness / therapy*
  • Echocardiography / methods
  • Hemodynamics / drug effects*
  • Humans
  • Infant, Newborn
  • Infant, Newborn, Diseases* / diagnosis
  • Infant, Newborn, Diseases* / physiopathology
  • Infant, Newborn, Diseases* / therapy
  • Symptom Assessment / methods
  • Treatment Outcome


  • Cardiovascular Agents