1. NEONATAL SHOCK and HYPOTENSION Steven M. Donn, M.D. Professor of Pediatrics Director, Neonatal-Perinatal Medicine C.S. Mott Children’s Hospital University of Michigan Health System

7. Stroke Volume To increase cardiac output Increase stroke volume or Increase heart rate or Increase both

10. Preload Equals End Diastolic Volume Stroke volume

12. Stroke volume Afterload is End-systolic Wall Stress or Resistance

13. Effects of changes in afterload on Frank-Starling curves. A shift from A to B occurs with increased afterload, and from A to C with decreased afterload. 100 Stroke volume (mL) LVEDP (mmHg) 50 0 0 10 20

20. SYSTOLIC BLOOD PRESSURE

39. EVALUATION OF SHOCK

54. AGENTS USED TO TREAT NEONATAL SHOCK Never administer intra-arterially 0.05-1 mcg/k/g/min IV Norepinephrine Vasocative drugs Afterload reducer 1-20 mcg/kg/min IV Phentolamine Afterload reducer 0.5-8 mcg/kg/min IV Nitroprusside Never administer intra-arterially 0.05-0.5 mcg/kg/min IV Isoproterenol Afterload reducer 0.1-0.5 mg/kg IV q3-6h Hydralazine Never administer intra-arterially 0.05-1 mcg/kg/min IV Epinephrine Never administer intra-arterially 5-20 mcg/kg/min IV Dobutamine Never administer intra-arterially 5-20 mcg/kg/min IV Dopamine Use O Neg 10-20 mL/kg IV Reconstituted blood products Limited availability 10-20 mL/kg IV Whole blood products Inexpensive, available 10-20 mL/kg/ IV Isotonic glucose Inexpensive, available 10-20 mL/kg IV Lactated Ringer solution Expensive 10-20 mL/kg IV Plasma Expensive 10-20 mL/kg IV Albumin (5%) Inexpensive, available 10-20 mL/kg IV Isotonic sodium Volume expanders Comments Dosage Agent Agent Type