[Heart failure].

Low systemic blood flow in the first hours after birth of a preterm infant is an often unrecognized complication. Traditional measures of cardiovascular adequacy used in the neonatal intensive care unit such as capillary refill time and blood pressure may not identify this problem. Longitudinal measurement of systemic blood flow demonstrates a falling off of blood flow in the first 6-12 h after birth, often to less than half of normal, before a gradual return to normal values by 24-48 h of age. Identification and appropriate treatment of this reduction in flow may assist in preventing some of the complications of prematurity.

Cardiac Output, Low↗

PubMed2001

Altered cardiac function.

An understanding of the normal functioning of the heart and how it fails is important since it allows rational treatment. Pre-existing cardiac disease and myocardial dysfunction is common in the surgical patient. Moreover, the stress response of surgery and the alterations in body physiology seen in the post-operative period may further aggrivate any cardiac compromise. The end result may be a patient who has cold peripheries due to vasoconstriction and hypoperfusion with dyspnoea due to congested lungs and a heart that cannot function adequately. The postoperative patient is at risk of these changes because of the stress response, analgesic therapy, inappropriate fluid management, hypoxia and previous cardiac compromise. The patient with sepsis is at further risk because of alterations in both systolic and diastolic function, which may be the result of inadequate fluid resuscitation and also release of a variety of inflammatory mediators. Until treatments, which are aimed at correcting the effects of these mediators, are proven to be beneficial then the septic patient will continue to be managed according to the physiological principles as outlined by Starling.

Cardiac Output, Low↗