Neonatal sepsis and cardiovascular dysfunction I: mechanisms and pathophysiology

Area of Science:

• Neonatology
• Pediatric Cardiology
• Critical Care Medicine

Background:

• Neonatal sepsis has the highest incidence across all age groups, leading to significant mortality and morbidity.
• Cardiovascular dysfunction, including biventricular dysfunction and pulmonary arterial hypertension, frequently complicates neonatal sepsis.
• The hemodynamic response in neonatal sepsis is variable (hyperdynamic or hypodynamic) with heterogeneous pathophysiological mechanisms.

Purpose of the Study:

• To highlight the challenges in defining and diagnosing neonatal sepsis and associated cardiovascular dysfunction.
• To emphasize the need for consensus-based definitions and common datasets for advancing neonatal sepsis management.
• To underscore the importance of neonatal cardiovascular optimization in sepsis care.

Main Methods:

• Review of existing literature on neonatal sepsis and cardiovascular complications.
• Analysis of the pathophysiological mechanisms underlying cardiovascular dysfunction in neonatal sepsis.
• Discussion of diagnostic challenges and the lack of consensus in the field.

Main Results:

• Cardiovascular dysfunction is a prevalent complication of neonatal sepsis.
• There is a lack of consensus-based definitions for both neonatal sepsis and its cardiovascular complications.
• This lack of consensus impedes accurate incidence calculation and clinical trial design.

Conclusions:

• Consensus-based definitions and common datasets are crucial for improving the management of neonatal sepsis, particularly cardiovascular optimization.
• The inflammatory response in neonatal sepsis directly impacts myocyte function and systemic hemodynamics.
• Future research should focus on establishing standardized definitions to facilitate clinical trials and improve patient outcomes.