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Published on: November 3, 2023
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Hemodynamic changes in preterm neonates with septic shock: a prospective observational study*.
Shiv Sajan Saini1, Praveen Kumar, Rohit Manoj Kumar
11Neonatal Unit, Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India. 2Department of Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Summary
Preterm neonates with septic shock exhibit elevated left ventricular output and normal ejection fraction, indicating vasoregulatory failure. Vasoactive drugs improved right ventricular output primarily by increasing heart rate.
Area of Science:
- Neonatal Medicine
- Pediatric Cardiology
- Critical Care Medicine
Background:
- Septic shock in preterm neonates presents unique hemodynamic challenges.
- Understanding these hemodynamic alterations is crucial for effective management.
- Functional echocardiography offers a non-invasive method to assess cardiac function in this population.
Purpose of the Study:
- To evaluate hemodynamic changes in preterm neonates with septic shock.
- To investigate the impact of vasoactive drugs on these hemodynamic variables.
- To elucidate the underlying pathophysiology of septic shock in this vulnerable group.
Main Methods:
- Prospective observational study in a Level III neonatal ICU.
- Enrolled 52 preterm neonates with septic shock and 52 matched healthy controls.
- Functional echocardiography assessed left and right ventricular output, and ejection fraction before and after vasoactive drug administration.
Main Results:
- Neonates with septic shock had higher baseline left ventricular output (305 mL/kg/min vs 233 mL/kg/min) but similar ejection fraction compared to controls.
- Vasoactive drug infusion significantly increased heart rate and right ventricular output (376 to 407 mL/kg/min).
- Left ventricular output and ejection fraction did not change significantly after vasoactive drug administration.
Conclusions:
- Preterm neonates with septic shock demonstrate elevated left ventricular output and normal ejection fraction, suggesting predominant vasoregulatory failure.
- Vasoactive drugs effectively increased right ventricular output, mainly through heart rate augmentation.
- These findings highlight the importance of hemodynamic monitoring and targeted therapy in neonatal septic shock.
