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Cardiopulmonary changes in the crying neonate
Insights
Crying significantly impacts newborn hemodynamics, increasing heart rate and blood pressure initially, but then causing significant drops in blood pressure and oxygen levels in infants recovering from respiratory distress syndrome (RDS).
Area of Science:
- Neonatal Physiology
- Cardiovascular Research
- Respiratory Medicine
Background:
- Respiratory distress syndrome (RDS) is a common condition in newborns.
- Understanding the physiological effects of infant crying is crucial for clinical care.
- Hemodynamic responses to crying in vulnerable infants are not fully characterized.
Purpose of the Study:
- To investigate the hemodynamic effects of crying in newborn infants.
- To assess changes in heart rate, blood pressure, and arterial blood gases during crying.
- To evaluate these effects in infants recovering from respiratory distress syndrome (RDS).
Main Methods:
- Studied 12 newborn infants recovering from RDS.
- Measured esophageal pressures during crying to assess respiratory effort.
- Monitored heart rate, systolic and diastolic blood pressures, and arterial blood gases (PaO2, PaCO2, pH, base excess).
Main Results:
- Crying induced significant increases in heart rate and initial blood pressure.
- Esophageal pressures showed significant inspiratory and expiratory ranges.
- Progressive decreases in blood pressure and pronounced reductions in pulse pressure were observed during sustained crying, along with a significant decrease in arterial oxygen tension (PaO2).
Conclusions:
- Crying elicits complex hemodynamic changes in infants recovering from RDS.
- The observed blood pressure fluctuations and decreased oxygenation warrant clinical attention.
- Further research is needed to understand the long-term implications of these crying-induced hemodynamic effects.
Abstract:
To determine hemodynamic effects of crying, 12 newborn infants recovering from the respiratory distress syndrome (RDS) were studied. When crying, the range of inspiratory esophageal pressure was -18.8 to -32.5 cm H2O and the range of espiratory pressure was +6.2 to 34.4 cm H2O. The esophageal pressure remained positive for a mean value of 66% of the respiratory cycle. There was a mean significant increase in heart rate of 19 beats/min. The systolic and diastolic blood pressures increased significantly at the beginning of strain to 115 and 135% of the respective control values. There was a progressive decrease in systolic and diastolic pressures during the period of strain and the systolic pressures reached values significantly less than control. With the decrease in systolic and diastolic pressures, there were pronounced reductions in pulse pressures. Three infants reached pulse pressure values less than 1% of control when cries were sustained for nine cardiac cycles. There was a significant mean decrease in arterial oxygen tension (PaO2) of 16.8 mm Hg. There were no changes in arterial carbon dioxide tension (PaCO2), pH, or base excess.