Diagnosis and treatment of preterm transitional circulatory compromise

Area of Science:

• Neonatal physiology
• Cardiovascular medicine
• Pediatric critical care

Background:

• Preterm infants are susceptible to low systemic blood flow (SBF) within the first 24 hours of birth.
• Risk factors include prematurity, high ventilation pressures, patent ductus arteriosus, increased vascular resistance, and poor cardiac contractility.

Purpose of the Study:

• To review the evidence for detecting and treating low systemic and organ blood flow in preterm infants during their first day of life.

Main Methods:

• Literature review of studies on SBF detection and treatment in preterm neonates.
• Analysis of risk factors, diagnostic methods (echocardiography vs. clinical signs), and therapeutic interventions.

Main Results:

• Clinical signs and blood pressure are insufficient for accurate SBF detection, leading to delayed treatment.
• Echocardiography is essential for early identification of low flows within hours of birth.
• Inotropes like dobutamine and dopamine show limited efficacy in improving mortality or long-term outcomes, with nearly 40% of infants unresponsive.
• Volume expansion is not routinely recommended; adrenaline and corticosteroids may be considered for refractory hypotension.

Conclusions:

• Echocardiography is critical for timely detection of low systemic blood flow in preterm infants.
• Current treatments lack proven benefits for mortality or long-term outcomes, necessitating further research.
• Future trials should focus on echocardiography-guided cardiovascular interventions.