Neonatal sepsis and cardiovascular dysfunction II: assessment

Neonatal sepsis-induced cardiovascular dysfunction includes impaired myocardial function (which may be systolic and/or diastolic) and vasoregulatory failure (which may lead to vasodilation or vasoconstriction). The haemodynamic response in neonatal sepsis may therefore be hyperdynamic or hypodynamic, and the underlying pathophysiological mechanisms are heterogenous. The assessment of the neonate with sepsis and cardiovascular dysfunction is critical for targeted pathophysiology-based management. However, this assessment is challenging; it may include clinical features, echocardiography, electrocardiography and heart rate variability monitoring, non-invasive cardiac output monitoring (NICOM), near-infrared spectroscopy (NIRS) and biomarkers. Neonatologist performed echocardiography (NPE), in particular, can aid in the evaluation of the pathophysiological mechanism of cardiovascular dysfunction specific to each patient and further guide individualised management. IMPACT: WHAT DOES THIS ARTICLE ADD TO THE EXISTING LITERATURE?: This review provides an integrative overview of current methods for assessing cardiovascular dysfunction in neonatal sepsis, combining clinical evaluation with echocardiographic, electrocardiographic, non-invasive hemodynamic (NICOM, NIRS), and biomarker-based approaches to support early recognition and management.