|Neonatal Cardiology, 2e|
Chapter 8. Approach to the Infant with Inadequate Systemic Perfusion
Topics Discussed: hypoperfusion; hypoperfusion in newborn; pediatric cardiology.
Sections: Pathophysiology of Inadequate Systemic Perfusion, Left Heart Obstruction, Suggested Readings.
Excerpt:"Inadequate systemic perfusion is the second most common manifestation
of symptomatic heart disease in newborn infants. The infant often
presents with moderate to severe respiratory distress in addition
to signs of decreased systemic perfusion. Respiratory distress is
caused by increased pulmonary venous pressure causing pulmonary
edema. Pulmonary venous pressures are increased because (1) there
is obstruction to the egress of blood from the lungs or from the
left atrium into the left ventricle, or (2) the left ventricle cannot
adequately eject blood. In some infants, the decrease in systemic
perfusion is profound, with decreased to absent peripheral pulses,
cool extremities, hypotension, and severe metabolic acidosis. In
these cases, the compromise of systemic blood flow is life threatening
and requires urgent diagnosis and therapy. In other infants, respiratory
distress is the most impressive finding and the signs of decreased
systemic perfusion are subtle, often leading to the erroneous conclusion
that the infant has primary pulmonary disease rather than heart
disease. Signs of decreased systemic perfusion, which may be indicated solely
by mildly decreased pulses or by a mild metabolic acidosis, should
be carefully sought and considered in all infants with significant
respiratory distress. ..."
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