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Care of the critically ill neonate with hypoxemic respiratory failure and acute pulmonary hypertension: framework for practice based on consensus opinion of neonatal hemodynamics working group

Journal of Perinatology volume 42, pages 3–13 (2022)Cite this article

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Abstract

Circulatory transition after birth presents a critical period whereby the pulmonary vascular bed and right ventricle must adapt to rapidly changing loading conditions. Failure of postnatal transition may present as hypoxemic respiratory failure, with disordered pulmonary and systemic blood flow. In this review, we present the biological and clinical contributors to pathophysiology and present a management framework.

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Fig. 1: The vicious cycle of neonatal acute pulmonary hypertension.
Fig. 2: Suggested approach to diagnosis of a neonate presenting with acute hypoxemia.
Fig. 3: Relationship between lung volume and pulmonary vascular resistance.
Fig. 4: Therapeutic strategies for the treatment of pulmonary hypertension refractory to inhaled nitric oxide therapy.

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Authors and Affiliations

  1. Department of Pediatrics, University of Toronto, Toronto, ON, Canada

    Amish Jain, Dany E. Weisz & Mjaye L. Mazwi

  2. Department of Pediatrics, University of Iowa, Iowa City, Iowa, USA

    Regan E. Giesinger & Patrick J. McNamara

  3. Department of Pediatrics, University of Manitoba, Winnipeg, MB, Canada

    Shyamala Dakshinamurti, Yasser ElSayed & Michael Narvey

  4. Department of Pediatrics, University of Ottawa, Ottawa, ON, Canada

    Robert P. Jankov

  5. Department of Pediatrics, University of California Davis, Sacramento, CA, USA

    Satyan Lakshminrusimha

  6. Department of Pediatrics, Dalhousie University, Halifax, NS, Canada

    Souvik Mitra

  7. Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada

    Joseph Ting

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Contributions

This document was reviewed and approved by both the Fetus and Newborn Committee at the Canadian Pediatric Society and the Neonatal Hemodynamics Research center. All authors [AJ, REG, SD, YES, RPJ, DEW, SL, SM, MLM, JT, MN, PJM] contributed equally to the intellectual content, writing, and have approved the final version of the manuscript.

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Correspondence to Patrick J. McNamara.

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Jain, A., Giesinger, R.E., Dakshinamurti, S. et al. Care of the critically ill neonate with hypoxemic respiratory failure and acute pulmonary hypertension: framework for practice based on consensus opinion of neonatal hemodynamics working group. J Perinatol 42, 3–13 (2022). https://doi.org/10.1038/s41372-021-01296-z

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