Trends and Challenges in Noninvasive Hemodynamic Monitoring of Neonates Following Cardiac Surgery: A Narrative Review

Hemodynamic monitoring is essential in the postoperative management of neonates undergoing cardiac surgery, enabling early identification of circulatory failure and its underlying cause, optimization of oxygen delivery to tissues, and evaluation of treatment response. Despite its significant role, there is still no consensus and there remains substantial heterogeneity in bedside hemodynamic monitoring practices. Pediatric intensivists typically rely on macro- and microcirculatory indicators, including arterial blood pressure, urine output, capillary refill time, mixed venous oxygen saturation, lactate concentration, and serial echocardiographic evaluations. However, most of these are indirect hemodynamic indicators and provide only intermittent snapshots of the hemodynamic status, which can be very fluctuating following cardiac surgery. Technological advancements have driven a shift toward continuous, noninvasive monitoring techniques, such as near-infrared spectroscopy (NIRS), electrical biosensing technology, and microcirculatory assessment tools. Real-time, simultaneous tracking of multiple physiological variables through a multimodal hemodynamic monitoring protocol facilitates the understanding of systemic and regional perfusion and oxygenation. This narrative review aims to summarize current techniques and innovations in neonatal hemodynamic monitoring following cardiac surgery, combining clinical evaluation with both intermittent and continuous noninvasive techniques.