RT Book, Section
A1 Artman, Michael
A1 Mahony, Lynn
A1 Teitel, David F.
SR Print(0)
ID 1140363452
T1 Approach to the Infant With Inadequate Systemic Perfusion
T2 Neonatal Cardiology, 3e
YR 2017
FD 2017
PB McGraw-Hill Education
PP New York, NY
SN 9780071834506
LK accesspediatrics.mhmedical.com/content.aspx?aid=1140363452
RD 2023/06/05
AB Inadequate  systemic  perfusion  is  the  second  most  common  manifestation  of  symptomatic  heart  disease  in  newborn  infants.  Affected  infants  present  with  moderate  to  severe  respiratory  distress  in  addition  to  signs  of  decreased  systemic  perfusion.  Respiratory  distress  is  caused  by  increased  pulmonary  venous  pressure  causing  pulmonary  edema.  Pulmonary  venous  pressures  are  increased  because  (1)  there  is  obstruction  to  the  egress  of  blood  from  the  lungs  or  from  the  left  atrium  into  the  left  ventricle  or  (2)  the  left  ventricle  cannot  adequately  eject  blood.  In  some  infants,  the  decrease  in  systemic  perfusion  is  profound,  with  decreased  to  absent  peripheral  pulses,  cool  extremities,  hypotension,  and  severe  metabolic  acidosis.  In  these  cases,  the  compromise  of  systemic  blood  flow  is  life  threatening  and  requires  urgent  diagnosis  and  therapy.  In  other  infants,  respiratory  distress  is  the  most  impressive  finding,  and  the  signs  of  decreased  systemic  perfusion  are  subtle,  often  leading  to  the  erroneous  conclusion  that  the  infant  has  primary  pulmonary  disease  rather  than  heart  disease.  This  is  particularly  true  when  the  infant  does  not  have  a  heart  murmur,  which  may  occur  in  this  group  of  cardiac  defects.  Signs  of  decreased  systemic  perfusion,  which  may  be  indicated  solely  by  mildly  decreased  pulses  or  by  a  mild  metabolic  acidosis,  should  be  carefully  sought  and  considered  in  all  infants  with  significant  respiratory  distress.