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Dec 9, 2019 19 tweets 9 min read Read on X
Next up is Dr. Satyan Lakshminrusimha talking on systemic hypotension in PPHN. Satyan is a Professor and Pediatrician-in-Chief at UC Davis Children's Hospital, Department of Pediatrics.
#HotTopicsNeo2019 Image
A brief talk on the definition of hypotension, cardiac output, pre and afterloads.
#HotTopicsNeo2019 @HotTopicsNeo ImageImage
"there's nothing like normal blood pressure"
We try to gather as much data as possible before deciding whether or not the infant has hypotension. Blood pressure is just one parameter of many.
#HotTopicsNeo2019 Image
Plenty of studies talking about blood pressure variability in infants in the first hours of life.
#HotTopicsNeo2019 Image
Maintaining systemic blood pressure seems to be vital in PPHN.
#HotTopicsNeo2019 Image
Causes of systemic hypotension in babies with PPHN.
#HotTopicsNeo2019 Image
Further illustration on the mechanism of systemic hypotension, this time mechanical ventilation involved (effect of mean airway pressure.)
#HotTopicsNeo2019 Image
The vicious cycle of PPHN, systemic hypotension, and RV failure. "Keeping the heart happy is a real goal in the management of PPHN."
#HotTopicsNeo2019 Image
Fluid management in PPHN. Dr. L prefers ringer's lactate over saline due to the chloride content of the latter. Image
Dopamine at high doses can impair end organ perfusion #HotTopicsNeo2019 Image
A (real) case discussion.
Starting Dopamine?
#HotTopicsNeo2019 Image
Dopamine was followed with a transient improvement.
#HotTopicsNeo2019 Image
So why only transient improvement?
Unfortunately, Dopamine is not selective to systemic circulation. Image
Another explanation, the pop-off valve are now closed.
(Ductal dependent systemic circulation)
#HotTopicsNeo2019 Image
How about Epinephrine and Norepinephrine?

The latter can cause pulmonary vasodilation due to stimulation of alpha-2 receptors. Response to norepi compared to dopamine is generally better in babies with PPHN. ImageImage
Another case where use of dopamine led to negative effects (Mec aspiration, PPHN, hypertrophied septum). Vasopressin, iNO and fluid management on the other hand resulted in significant improvement. ImageImage
There are no trials comparing norepinephrine with vasopressin. The effect of the latter on pulmonary circulation appears to be minimal. Image
High dose Hydrocortisone decreases PDE5 (Similar to Sildenafil's effect) Image
So how to choose the appropriate anti-hypotensive in the context of PPHN?
#HotTopicsNeo2019 Image

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More from @EBNEO

Dec 11, 2023
Bill Benitz from @StanfordChild reviews the published trial evidence for preterm PDA closure management
#HotTopicsNeo2023 #neoTwitter #neoEBM #PDA Image
Published PDA RCTs have been consistent in their findings of no benefit of PDA closure Image
Ibuprofen does not accelerate ductal closure, on average
#HotTopicsNeo2023 #neoTwitter #neoEBM #PDA Image
Read 9 tweets
Dec 7, 2020
Next up in "New Approaches to Cooling" Deirdre Murray of @CUH_Cork discussing “Neurodevelopmental Outcomes after Mild HIE.” Read more about Prof. Murray and her work: infantcentre.ie/who-we-are-2/o…

#HotTopicsNeo2020 @HotTopicsNeo
Murray begins by defining the population discussed in her lecture: those with encephalopathy 2/2 perinatal asphyxia.

#HotTopicsNeo2020 @HotTopicsNeo
How do infants with different HIE severity grades perform on IQ testing at 5 years of age? Summary from:
pubmed.ncbi.nlm.nih.gov/27650049/, which includes additional outcomes measures.

Take home point: mild and moderate HIE infants similar.

#HotTopicsNeo2020 @HotTopicsNeo
Read 6 tweets
Dec 7, 2020
Last in the Rx for BPD trio at #HotTopicsNeo2020: Dr. Reese Clark of @MEDNAX with: "What Drugs are we Using? Practice Variability and Potential Harm." Read more about Dr. Clark's distinguished care:
blog.mednax.com/mednax-neonato…
@HotTopicsNeo
Reese: Talk to focus on steroid use. To begin, what postnatal steroids are we using? Dexamethasone and hydrocortisone most common systematic exposures, budenoside most common inhaled exposure.

#HotTopicsNeo2020 @HotTopicsNeo
The unstoppable pendulum of postnatal steroid use; data from @MEDNAX clinical data warehouse suggests use again on the rise.

#HotTopicsNeo2020 @HotTopicsNeo
Read 4 tweets
Dec 7, 2020
Next up in #HotTopicsNeo2020: Erik Jensen of @ChildrensPhila discussing how the baseline risk of BPD impacts the number needed to treat when considering effective therapies.

chop.edu/doctors/jensen…

@HotTopicsNeo
Presentation builds on recently published report in @JPediatr: drugs to Prevent Bronchopulmonary Dysplasia: Effect of Baseline Risk on the Number Needed to Treat
jpeds.com/article/S0022-…

#HotTopicsNeo2020
Jensen: objectives of talk:

#HotTopicsNeo2020 @HotTopicsNeo
Read 8 tweets
Dec 7, 2020
From the last session on periviability at @HotTopicsNeo, let’s get the pulse of the #neoEBM community with a few surveys (thread) #HotTopicsNeo2020
What is the earliest gestational age, assuming dating is correct, where you (or your hospital) routinely offer active postnatal resuscitation if desired by the family
If an infant at 22-24 weeks GA has evidence of inadequate organ perfusion (low urine output, decreasing BP), what is your first line treatment:
Read 6 tweets
Dec 7, 2020
First up in: "Pharmacotherapy for BPD: We Know Less than We Think We Do" at #HotTopicsNeo2020 is Dr. Gerri Baer (@thegerribaer), Team Leader for Neonatology @US_FDA, discussing "Challenges in Studying Drugs for BPD"
@HotTopicsNeo #neoEBM
Baer: no (zero, zilch, none!) drugs approved in the USA to prevent or treat BPD.

Highlights various cohorts demonstrating the ongoing high burden of BPD:

#HotTopicsNeo2020 @HotTopicsNeo
Baer: broad view of challenges to BPD Rx, illustrated by 3 buckets: understanding phenotypes/endotypes, definitions and classification and choosing adequate endpoints.
#HotTopicsNeo2020 @HotTopicsNeo
Read 5 tweets

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