Approach to Shock and Hypotension in Neonates
Neonatal shock and hypotension occur in critically ill neonates and have different etiologies, posing a clinical challenge to neonatal intensivists.
Shock is a state of cellular energy failure, presenting with different pathogenesis (hypovolemia, cardiac, and/or vasoregulatory failure) and has different phases of advancing severity.
It is important to understand the principles of cardiovascular pathophysiology to select the most appropriate approach to manage the given phase and form of neonatal shock. Although at present antimicrobial therapy and supportive care in terms of fluid resuscitation and inotropes remain the foundation of treatment, early recognition and effective treatment of shock are crucial to prevent inevitable progression.
Immunomodulatory/anti-inflammatory agents may improve outcomes, especially for vulnerable premature neonates.
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