Amir H. Ashrafi, MDCorresponding Author; Mjaye Mazwi, MD; Nathaly Sweeney, MD, MPH, MS; Charlotte S. van Dorn, MD; Laurie B. Armsby, MD; Pirooz Eghtesady, MD, PhD; Jacob R. Miller, MD; Megan Ringle, MD; Lindsey B. Justice, DNP, RN, CPNP-ACh; Seth B. Gray, MD; Victor Levy, MD

Abstract

Clinicians caring for neonates with congenital heart disease encounter challenges in clinical care as these infants await surgery or are evaluated for further potential interventions. The newborn with heart disease can present with significant pathophysiologic heterogeneity and therefore requires a personalized therapeutic management plan. However, this complex field of neonatal–cardiac hemodynamics can be simplified. We explore some of these clinical quandaries and include specific sections reviewing the anatomic challenges in these patients. We propose this to serve as a primer focusing on the hemodynamics and therapeutic strategies for the preoperative neonate with systolic dysfunction, diastolic dysfunction, excessive pulmonary blood flow, obstructed pulmonary blood flow, obstructed systemic blood flow, transposition physiology, and single ventricle physiology.

Topics:alprostadil, common ventricle, congenital heart disease, heart, heart failure, diastolic, newborn, physiology, preoperative care, pulmonary circulation, systolic dysfunction

The newborn with heart disease can present with significant pathophysiologic heterogeneity and therefore requires a personalized therapeutic management plan. However, this complex field of neonatal–cardiac hemodynamics can be simplified into 7 physiologic subtypes. It is important to note, these physiologies are not mutually exclusive and therefore any patient can be simultaneously afflicted with multiple physiologic subtypes.

This manuscript is part of a larger series of articles simultaneously published as a Supplement in Pediatrics by the Neonatal Cardiac Care Collaborative. Please refer to the executive committee introductory paper for discussion on Class of Recommendations and Level of Evidence (LOE), writing committee organization, and document review and approval.