DIAGNOSIS OF HEMODYNAMIC DISORDERS IN PREMATURE NEWBORNS. LITERATURE REVIEW.
Introduction. The article presents a review of the current literature on studies of hemodynamic disorders in preterm infants. In the pathogenesis of the development and progression of critical conditions in the specified contingent of newborns, the leading place is occupied by arterial hypotension (AH), which usually occurs in the first 24 hours after birth in 40% of infants. At the same time, hypertension plays a significant role in the implementation of perfusion disorders in vital organs, as well as in an increase in the frequency of deaths and severe neurological consequences.
The possibility of early diagnosis of perfusion disorders by using echocardiography, which is a rational and non-invasive method aimed at a comprehensive assessment of hemodynamic disorders in newborns and determining the tactics of their management, has been substantiated.
Aim. To study current data on studies of hemodynamic disorders in preterm infants by conducting a literature review.
Search strategy. Public access articles were studied using the following databases of scientific publications and specialized search engines: PubMed, Google Scholar, Web of Science, Scopus, Cochrane Library. A number of original publications and reviews in the field of research for the period 2012-2022 were analyzed, but also works published earlier than 2012 were included, since they have information on the pathology under study in the neonatal period and classical routine approaches in the treatment and diagnosis of hemodynamic disorders in newborns . The selection of publications was carried out in accordance with the purpose of the review.
Results. Functional echocardiography is a rational and non-invasive method that can play an important role in a comprehensive assessment of hemodynamic disorders in a newborn and tactics of its management.
In a newborn with a normal heart rhythm without significant fetal shunting, left ventricular CO (cardiac output) and superior vena cava (CVVC) blood flow are used to assess systemic blood flow. In the presence of significant shunting, data on the CO of the right ventricle and blood flow in the SVC are used.
The flow in the superior vena cava is one of the valuable parameters for informing clinicians about perfusion and cerebral blood flow. The association of significantly and persistently low blood flow with increased risk of morbidity, mortality, and dynamic measurement of superior vena cava flow beginning early after birth may help detect risk in these infants. The diagnostic accuracy of SVC flow for predicting poor perfusion will improve with the addition of other clinical and diagnostic parameters for comprehensive hemodynamic monitoring. SVC flow and cardiac output are considered key in neonatal shock and can be used for targeted treatment. SVC flow is an excellent monitoring method for assessing heart-lung interactions, ductus arteriosus shunt volume.
Conclusions. The main limitation of measuring SVC flow and cardiac output is that they are not a true measure of myocardial function. Blood flow is the interaction between the heart and blood vessels. The ventricular arterial junction is an excellent parameter of cardiovascular efficiency and pathways to heart failure, but it provides limited insight into intrinsic myocardial function.
In order to progress in research on diagnosing neonatal CVD, we must use well-understood parameters such as SVC flow, recognizing its limitations, and expanding our capabilities. Research and search for new methods of diagnosing the hemodynamic state of newborns can help identify and treat infants at risk of impaired perfusion in the neonatal period.
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Omargazina B.S., Chuvakova T.K., Khamidullina Z.G., Karin B.T., Jaxalykova K.K. Diagnosis of hemodynamic disorders in premature newborns. Literature review // Nauka i Zdravookhranenie [Science & Healthcare]. 2023, (Vol.25) 4, pp. 172-181. DOI 10.34689/SH.2023.25.4.022Related publications:
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