Suspected cardiovascular compromise ELBW infant, Day #1

No hypotension

Cardiac ultrasound

Normal cardiac Normal cardiac

output + low CrSO2 output (CO) and Low CO
(<55%) by NIRS CrSO2 by NIRS

Consider”: No treatment
 ↑ PaCO2 to 45-
55mmHg
 ↑ FiO2
 Milrinone
 Suspected cardiovascular compromise ELBW infant, Day #1

Hypotension

Is there an easily correctable cause?

 Measurement error
 Overventilation

Cardiac ultrasound

Low CO Normal CO + MBP Normal CO + MBP

>20mmHg + low >20mmHg + High LCO
CrSO2 normal CrSO2

Impaired LV contracitility Hypovolemia; under-Filled LV  ↑ PaCO2 to 45- No treatment No Hs

55mmHg PDA PDA
 ↑ FiO2
Inotrope/Lusitrope  Pressor-inotrope
Dobutamine (5- (dopamine 2-15
Volume expansion 20 Pressor-inotrope Treat
20mcg,kg/min) or mcg/kg/min) aim
mls/kg crystaloid dopamine (2-15 PDA
Milirinone (0,01-0,06 for MBP>28-30
mmHg mcg/kg/min)
mcg/kg/min)
 Ensure CO
remains normal

Persistent Hypotension ± Low CO ± Low CrSO2

Consider repeat cardiac ultrasound – assess volume status/contractility/VO

Volume expander Additional volume Volume expansion Volume expansion

dopamine (2-10 expansion Hydrocortisone Hydrocortisone
mcg/kg/min) Consider transfusion (img/kg q 12 hr) (img/kg q 12 hr)

Hydrocortisone Nor/epinephrine Nor/epinephrine

(1mg/kg q12hr) (0,05-1 mcg/kg/min) (0,05-1 mcg/kg/min)

Epinephrine (0,05-1 mcg/kg/min) Vasopressin (0,01-0,06 units/kg/hr)