eMedicine Specialties > Pediatrics: Cardiac Disease and Critical Care Medicine > Neonatology

Shock and Hypotension in the Newborn: Follow-up

Author: Samir Gupta, MD, MRCP, FRCPCH, Consulting Neonatologist, University Hospital of North Tees
Coauthor(s): Sunil K Sinha, MBBS, MD, MRCP, PhD, FRCP, FRCPCH, Director of Neonatal Services, South Cleveland Hospital, UK; Steven M Donn, MD, Professor of Pediatrics, Director, Neonatal-Perinatal Medicine, Department of Pediatrics, University of Michigan Health System
Contributor Information and Disclosures

Updated: Jun 25, 2008

Follow-up

Further Inpatient Care

  • Infants recovering from neonatal shock are at risk for multiple sequelae and should be intensively screened for neurodevelopmental abnormalities using brain imaging and brainstem audiometric evoked responses. Other tests are determined by the clinical course and complications.

Further Outpatient Care

  • Outpatient care should include neurodevelopmental follow-up testing and other studies as indicated by the neonatal course.

Transfer

  • Infants presenting with evidence of shock should be transferred immediately to a full-service neonatal intensive care unit with adequate support, personnel, and expertise.

Deterrence/Prevention

  • Early recognition and treatment is essential to maximizing outcome in neonatal shock.

Complications

  • Complications of neonatal shock are related to both the underlying cause (eg, sepsis, heart disease) and the injury sustained during the period of inadequate tissue perfusion. Frequent sequelae include pulmonary, renal, endocrine, GI, and neurologic dysfunction.

Prognosis

  • Prognosis following neonatal shock is related to both the underlying cause (eg, sepsis, heart disease) and the injuries sustained during the period of inadequate perfusion.

Patient Education

Miscellaneous

Medicolegal Pitfalls

  • The major medicolegal pitfall is delayed diagnosis and treatment, leading to permanent neurologic sequelae such as cerebral palsy, epilepsy, and mental retardation.
  • Another potential pitfall is the misclassification of shock and subsequent inappropriate treatment.
  • Failure to transfer an affected infant to a level III neonatal intensive care unit in a timely manner is another pitfall.
 


More on Shock and Hypotension in the Newborn

Overview: Shock and Hypotension in the Newborn
Differential Diagnoses & Workup: Shock and Hypotension in the Newborn
Treatment & Medication: Shock and Hypotension in the Newborn
Follow-up: Shock and Hypotension in the Newborn
References
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References

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  2. Al-Aweel I, Pursley DM, Rubin LP, et al. Variations in prevalence of hypotension, hypertension, and vasopressor use in NICUs. J Perinatol. Jul-Aug 2001;21(5):272-8. [Medline].

  3. Kluckow M, Evans N. Superior vena cava flow in newborn infants: a novel marker of systemic blood flow. Arch Dis Child Fetal Neonatal Ed. May 2000;82(3):F182-7. [Medline].

  4. [Best Evidence] Osborn DA, Evans N, Kluckow M, et al. Low superior vena cava flow and effect of inotropes on neurodevelopment to 3 years in preterm infants. Pediatrics. Aug 2007;120(2):372-80. [Medline].

  5. Skinner JR, Milligan DW, Hunter S, et al. Central venous pressure in the ventilated neonate. Arch Dis Child. Apr 1992;67(4 Spec No):374-7. [Medline].

  6. Faix RG, Pryce CJ. Shock and hypotension. In: Neonatal Emergencies. Mount Kisco, NY: Futura Publishing Company Inc; 1991:371-386.

  7. Keeley SR, Bohn DJ. The use of inotropic and afterload-reducing agents in neonates. Clin Perinatol. Sep 1988;15(3):467-89. [Medline].

  8. Laughon M, Bose C, Allred E, et al. Factors associated with treatment for hypotension in extremely low gestational age newborns during the first postnatal week. Pediatrics. Feb 2007;119(2):273-80. [Medline].

  9. Noori S, Seri I. Pathophysiology of newborn hypotension outside the transitional period. Early Hum Dev. May 2005;81(5):399-404. [Medline].

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  12. Seri I. Hydrocortisone and vasopressor-resistant shock in preterm neonates. Pediatrics. Feb 2006;117(2):516-8. [Medline].

  13. Seri I. Inotrope, lusitrope, and pressor use in neonates. J Perinatol. May 2005;25 Suppl 2:S28-30. [Medline].

  14. Seri I, Evans J. Controversies in the diagnosis and management of hypotension in the newborn infant. Curr Opin Pediatr. Apr 2001;13(2):116-23. [Medline].

  15. Seri I, Noori S. Diagnosis and treatment of neonatal hypotension outside the transitional period. Early Hum Dev. May 2005;81(5):405-11. [Medline].

  16. Seri I, Tan R, Evans J. Cardiovascular effects of hydrocortisone in preterm infants with pressor-resistant hypotension. Pediatrics. May 2001;107(5):1070-4. [Medline].

  17. Subhedar NV. Treatment of hypotension in newborns. Semin Neonatol. Dec 2003;8(6):413-23. [Medline].

  18. Zubrow AB, Hulman S, Kushner H, et al. Determinants of blood pressure in infants admitted to neonatal intensive care units: a prospective multicenter study. Philadelphia Neonatal Blood Pressure Study Group. J Perinatol. Nov-Dec 1995;15(6):470-9. [Medline].

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Further Reading

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Keywords

shock, hypotension, hypoperfusion, cardiac ischemia, circulatory collapse, septic shock, hypovolemic shock, distributive shock, cardiogenic shock, obstructive shock, dissociative shock, maldistributive shock, hypothermia, hyperkalemia, end-organ injury, sepsis, vasodilators, myocardial depression, endothelial injury, cardiomyopathy, heart failure, arrhythmias, myocardial ischemia, tension pneumothorax, cardiac tamponade, methemoglobinemia, metabolic acidosis, patent ductus arteriosus, PDA, disseminated intravascular coagulopathy, DIC, acute tubular necrosis

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Contributor Information and Disclosures

Author

Samir Gupta, MD, MRCP, FRCPCH, Consulting Neonatologist, University Hospital of North Tees
Samir Gupta, MD, MRCP, FRCPCH is a member of the following medical societies: British Medical Association, European Society for Paediatric Research, Indian Academy of Pediatrics, Royal College of Paediatrics and Child Health, and Royal College of Physicians of Ireland
Disclosure: Nothing to disclose.

Coauthor(s)

Sunil K Sinha, MBBS, MD, MRCP, PhD, FRCP, FRCPCH, Director of Neonatal Services, South Cleveland Hospital, UK
Sunil K Sinha, MBBS is a member of the following medical societies: British Medical Association and Royal College of Physicians
Disclosure: Nothing to disclose.

Steven M Donn, MD, Professor of Pediatrics, Director, Neonatal-Perinatal Medicine, Department of Pediatrics, University of Michigan Health System
Steven M Donn, MD is a member of the following medical societies: American Pediatric Society
Disclosure: Nothing to disclose.

Medical Editor

Steven M Donn, MD, Professor of Pediatrics, Director, Neonatal-Perinatal Medicine, Department of Pediatrics, University of Michigan Health System
Steven M Donn, MD is a member of the following medical societies: American Pediatric Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine.com, Inc
Disclosure: Pfizer Inc Stock Investment from broker recommendation; Avanir Pharma Stock Investment from broker recommendation

Managing Editor

David A Clark, MD, Chairman, Professor, Department of Pediatrics, Albany Medical College
David A Clark, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American Pediatric Society, Christian Medical & Dental Society, Medical Society of the State of New York, New York Academy of Sciences, and Society for Pediatric Research
Disclosure: Nothing to disclose.

CME Editor

Carol L Wagner, MD, Professor of Pediatrics, Medical University of South Carolina
Carol L Wagner, MD is a member of the following medical societies: American Academy of Pediatrics, American Chemical Society, American Medical Women's Association, American Public Health Association, American Society for Bone and Mineral Research, American Society for Clinical Nutrition, Massachusetts Medical Society, National Perinatal Association, and Society for Pediatric Research
Disclosure: Nothing to disclose.

Chief Editor

Ted Rosenkrantz, MD, Professor, Departments of Pediatrics and Obstetrics/Gynecology, Division of Neonatal-Perinatal Medicine, University of Connecticut School of Medicine
Ted Rosenkrantz, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, American Pediatric Society, Connecticut State Medical Society, Eastern Society for Pediatric Research, and Society for Pediatric Research
Disclosure: Nothing to disclose.

 
 
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