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Monitoring of Neonatal Haemodynamics

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Ayman Abou Mehrem
Health & MedicineBusiness
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Case 3 ,[object Object]
Monitoring of Neonatal Hemodynamics* Ayman Abou Mehrem, MD, CABP Neonatology Fellow University of Manitoba * Adapted from Early Human Development 86 (2010) 135-165
Monitoring of Neonatal Hemodynamics ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Introduction ,[object Object],[object Object],[object Object],[object Object],1 Dorland's illustrated medical dictionary. Philadelphia: Saunders; 2003
Introduction ,[object Object],[object Object],[object Object],[object Object]
Picture from: Kliegman: Nelson Textbook of Pediatrics, 18th ed
Introduction ,[object Object],[object Object],[object Object],[object Object],Picture from: www.learnhemodynamics.com/hemo/oxygen.htm
Introduction ,[object Object],[object Object],[object Object],[object Object],[object Object]
Objective ,[object Object],[object Object]
Part 1 Clinical Monitoring of Systemic Hemodynamics
What do your criteria to diagnose โ€œ circulatory insufficiencyโ€ in neonates?
Clinical monitoring of systemic hemodynamics ,[object Object],[object Object],[object Object],[object Object],2 Dempsey EM, Barrington KJ. Diagnostic criteria and therapeutic interventions for the hypotensive very low birth weight infant. J Perinatol 2006;26:677โ€“81.
Blood Pressure ,[object Object],[object Object],[object Object],[object Object]
Blood Pressure ,[object Object],[object Object],3 Osborn DA, Evans N, Kluckow M. Clinical detection of low upper body blood flow in very premature infants using blood pressure, capillary refill time, and centralโ€“peripheral temperature difference. Arch Dis Child Fetal Neonatal Ed 2004;89: F168โ€“73.
Blood Pressure
Blood Pressure ,[object Object],[object Object],[object Object],[object Object],4 Groves AM, Kuschel CA, Knight DB, Skinner JR. Relationship between blood pressure and blood flow in newborn preterm infants. Arch Dis Child Fetal Neonatal Ed. 2008 Jan;93(1):F29-32. Epub 2007 May 2.
Heart Rate ,[object Object],[object Object]
Heart Rate ,[object Object],[object Object],[object Object],5 Kluckow M, Evans N. Low superior vena cava flow and intraventricular haemorrhage in preterm infants. Arch Dis Child Fetal Neonatal Ed 2000;82: F188โ€“94.
Heart Rate
Color ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Color ,[object Object],[object Object],6 O'Donnell CP, Kamlin CO, Davis PG, Carlin JB, Morley CJ. Clinical assessment of infant colour at delivery. Arch Dis Child Fetal Neonatal Ed 2007;92:F465โ€“7.
Capillary refill time (CRT) ,[object Object],[object Object],[object Object],7 Raichur DV, Aralihond AP, Kasturi AV, Patil DH. Capillary refill time in term neonates: bedside assessment. Indian J Pediatr. 2001 Jul;68(7):613-5.
Capillary refill time (CRT) ,[object Object],[object Object],3 Osborn DA, Evans N, Kluckow M. Clinical detection of low upper body blood flow in very premature infants using blood pressure, capillary refill time, and centralโ€“peripheral temperature difference. Arch Dis Child Fetal Neonatal Ed 2004;89: F168โ€“73.
Capillary refill time (CRT)
Urine Output ,[object Object],[object Object],8 Miletin J, Pichova K, Dempsey EM. Bedside detection of low systemic flow in the very low birth weight infant on day 1 of life. Eur J Pediatr 2009;168:809โ€“13.
Urine Output
Lactate ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Lactate ,[object Object],[object Object],[object Object],[object Object],[object Object],9 Deshpande SA, Platt MP. Association between blood lactate and acidโ€“base status and mortality in ventilated babies. Arch Dis Child Fetal Neonatal Ed 1997;76: F15โ€“20.
Lactate ,[object Object],[object Object],[object Object],[object Object]
Lactate ,[object Object],[object Object],8 Miletin J, Pichova K, Dempsey EM. Bedside detection of low systemic flow in the very low birth weight infant on day 1 of life. Eur J Pediatr 2009;168:809โ€“13.
Lactate
Centralโ€“peripheral temp. difference (CPTd) ,[object Object],[object Object],3 Osborn DA, Evans N, Kluckow M. Clinical detection of low upper body blood flow in very premature infants using blood pressure, capillary refill time, and centralโ€“peripheral temperature difference. Arch Dis Child Fetal Neonatal Ed 2004;89: F168โ€“73.
Centralโ€“peripheral temp. difference (CPTd)
Acidโ€“base balance ,[object Object],[object Object],10 Kluckow M, Evans N. Low systemic blood flow and hyperkalemia in preterm infants. J Pediatr 2001;139:227โ€“32.
Venous oxygen saturation (SvO 2 ) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Venous oxygen saturation (SvO 2 )
Venous oxygen saturation (SvO 2 ) ,[object Object],[object Object]
Venous oxygen saturation (SvO 2 ) ,[object Object],[object Object],[object Object],11 Martin J, Shekerdemian LS. The monitoring of venous saturations of oxygen in children with congenitally malformed hearts. Cardiol Young 2009;19:34โ€“9.
Venous oxygen saturation (SvO 2 ) ,[object Object],[object Object],12 Hart J, Vemgal P, Cocks-Drew S, Harrison C, Andersen C. The relation between inferior vena cava oxygen saturation, superior vena cava flow, fractional oxygen extraction and haemoglobin affinity in sick newborns: a pilot study. Acta Paediatr 2006;95:50โ€“5.
Venous oxygen saturation (SvO 2 ) ,[object Object],[object Object],13 de Oliveira CF, de Oliveira DS, Gottschald AF, et al. ACCM/PALS haemodynamic support guidelines for paediatric septic shock: an outcomes comparison with and without monitoring central venous oxygen saturation. Intensive Care Med 2008;34:1065โ€“75.
Combination of different clinical hemodynamic variables de Boode. Clinical monitoring of systemic hemodynamics in critically ill newborns. Early Human Development 86 (2010) 137โ€“141
Conclusion ,[object Object]
Conclusion ,[object Object]
Conclusion ,[object Object]
Conclusion ,[object Object]
THANK YOU
Monitoring of Neonatal Haemodynamics
Monitoring of Neonatal Haemodynamics
Monitoring of Neonatal Haemodynamics
Monitoring of Neonatal Haemodynamics
Monitoring of Neonatal Haemodynamics
Monitoring of Neonatal Haemodynamics
Monitoring of Neonatal Haemodynamics
Monitoring of Neonatal Haemodynamics
Monitoring of Neonatal Haemodynamics
Monitoring of Neonatal Haemodynamics
Monitoring of Neonatal Haemodynamics
Monitoring of Neonatal Haemodynamics
Monitoring of Neonatal Haemodynamics
Monitoring of Neonatal Haemodynamics
Monitoring of Neonatal Haemodynamics
Monitoring of Neonatal Haemodynamics
Monitoring of Neonatal Haemodynamics
Monitoring of Neonatal Haemodynamics
Monitoring of Neonatal Haemodynamics
Monitoring of Neonatal Haemodynamics
Monitoring of Neonatal Haemodynamics
Monitoring of Neonatal Haemodynamics
Monitoring of Neonatal Haemodynamics
Monitoring of Neonatal Haemodynamics
Monitoring of Neonatal Haemodynamics
Monitoring of Neonatal Haemodynamics
Monitoring of Neonatal Haemodynamics
Monitoring of Neonatal Haemodynamics
Monitoring of Neonatal Haemodynamics
Monitoring of Neonatal Haemodynamics
Monitoring of Neonatal Haemodynamics
Monitoring of Neonatal Haemodynamics
Monitoring of Neonatal Haemodynamics
Monitoring of Neonatal Haemodynamics
Monitoring of Neonatal Haemodynamics
Monitoring of Neonatal Haemodynamics
Monitoring of Neonatal Haemodynamics
Monitoring of Neonatal Haemodynamics
Monitoring of Neonatal Haemodynamics
Monitoring of Neonatal Haemodynamics
Monitoring of Neonatal Haemodynamics
Monitoring of Neonatal Haemodynamics
Monitoring of Neonatal Haemodynamics
Monitoring of Neonatal Haemodynamics
Monitoring of Neonatal Haemodynamics
Monitoring of Neonatal Haemodynamics
Monitoring of Neonatal Haemodynamics
Monitoring of Neonatal Haemodynamics
Monitoring of Neonatal Haemodynamics
Monitoring of Neonatal Haemodynamics
Monitoring of Neonatal Haemodynamics
Monitoring of Neonatal Haemodynamics
Monitoring of Neonatal Haemodynamics
Monitoring of Neonatal Haemodynamics
Monitoring of Neonatal Haemodynamics
Monitoring of Neonatal Haemodynamics
Monitoring of Neonatal Haemodynamics
Monitoring of Neonatal Haemodynamics
Monitoring of Neonatal Haemodynamics
Monitoring of Neonatal Haemodynamics
Monitoring of Neonatal Haemodynamics
Monitoring of Neonatal Haemodynamics
Monitoring of Neonatal Haemodynamics
Monitoring of Neonatal Haemodynamics
Monitoring of Neonatal Haemodynamics
Monitoring of Neonatal Haemodynamics
Monitoring of Neonatal Haemodynamics
Monitoring of Neonatal Haemodynamics
Monitoring of Neonatal Haemodynamics
Monitoring of Neonatal Haemodynamics
Monitoring of Neonatal Haemodynamics
Monitoring of Neonatal Haemodynamics
Monitoring of Neonatal Haemodynamics
Monitoring of Neonatal Haemodynamics
Monitoring of Neonatal Haemodynamics
Monitoring of Neonatal Haemodynamics
Monitoring of Neonatal Haemodynamics
Monitoring of Neonatal Haemodynamics
Monitoring of Neonatal Haemodynamics
Monitoring of Neonatal Haemodynamics
Monitoring of Neonatal Haemodynamics
Monitoring of Neonatal Haemodynamics
Monitoring of Neonatal Haemodynamics
Monitoring of Neonatal Haemodynamics
Monitoring of Neonatal Haemodynamics
Monitoring of Neonatal Haemodynamics
Monitoring of Neonatal Haemodynamics
Monitoring of Neonatal Haemodynamics
Monitoring of Neonatal Haemodynamics
Monitoring of Neonatal Haemodynamics
Monitoring of Neonatal Haemodynamics
Monitoring of Neonatal Haemodynamics
Monitoring of Neonatal Haemodynamics
Monitoring of Neonatal Haemodynamics
Monitoring of Neonatal Haemodynamics

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