4 *MYTHS* about Newborn Blood Pressure!! And why they're WRONG!!
ฝัง
- เผยแพร่เมื่อ 14 เม.ย. 2024
- Inotropes? Vasopressors? Why do we even CARE about BPs? What about Oxygenation status? What is a LOW blood pressure in a baby? Do we just care about the MEAN BP? Or systolic and diastolic BPs too? How should we treat hypotension? Should we always treat low BPs?
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Dr. Tala is a board-certified neonatologist and has worked in busy level III and IV units for the past 15 years. She has won multiple teaching awards throughout her time as a neonatologist.
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References:
Giesinger RE, McNamara PJ. Hemodynamic instability in the critically ill neonate: An approach to cardiovascular support based on disease pathophysiology. Semin Perinatol. 2016 Apr;40(3):174-88. doi: 10.1053/j.semperi.2015.12.005. Epub 2016 Jan 14. PMID: 26778235.
Mullaly R, El-Khuffash AF. Haemodynamic assessment and management of hypotension in the preterm. Arch Dis Child Fetal Neonatal Ed. 2024 Feb 19;109(2):120-127. doi: 10.1136/archdischild-2022-324935. PMID: 37173119.
Dionne JM, Bremner SA, Baygani SK, Batton B, Ergenekon E, Bhatt-Mehta V, Dempsey E, Kluckow M, Pesco Koplowitz L, Apele-Freimane D, Iwami H, Klein A, Turner M, Rabe H; International Neonatal Consortium. Method of Blood Pressure Measurement in Neonates and Infants: A Systematic Review and Analysis. J Pediatr. 2020 Jun;221:23-31.e5. doi: 10.1016/j.jpeds.2020.02.072. PMID: 32446487.
St Peter D, Gandy C, Hoffman SB. Hypotension and Adverse Outcomes in Prematurity: Comparing Definitions. Neonatology. 2017;111(3):228-233. doi: 10.1159/000452616. Epub 2016 Nov 30. PMID: 27898415.
Fanaroff JM, Wilson-Costello DE, Newman NS, Montpetite MM, Fanaroff AA. Treated hypotension is associated with neonatal morbidity and hearing loss in extremely low birth weight infants. Pediatrics. 2006 Apr;117(4):1131-5. doi: 10.1542/peds.2005-1230. PMID: 16585307
Dempsey EM, Barrington KJ, Marlow N, O'Donnell CPF, Miletin J, Naulaers G, Cheung PY, Corcoran JD, El-Khuffash AF, Boylan GB, Livingstone V, Pons G, Macko J, Van Laere D, Wiedermannova H, Straňák Z; HIP consortium. Hypotension in Preterm Infants (HIP) randomised trial. Arch Dis Child Fetal Neonatal Ed. 2021 Jul;106(4):398-403. doi: 10.1136/archdischild-2020-320241. Epub 2021 Feb 24. PMID: 33627329; PMCID: PMC8237176.
Faust K, Härtel C, Preuß M, Rabe H, Roll C, Emeis M, Wieg C, Szabo M, Herting E, Göpel W; Neocirculation project and the German Neonatal Network (GNN). Short-term outcome of very-low-birthweight infants with arterial hypotension in the first 24 h of life. Arch Dis Child Fetal Neonatal Ed. 2015 Sep;100(5):F388-92. doi: 10.1136/archdischild-2014-306483. Epub 2015 Jul 21. PMID: 26199082.
St Peter D, Gandy C, Hoffman SB. Hypotension and Adverse Outcomes in Prematurity: Comparing Definitions. Neonatology. 2017;111(3):228-233. doi: 10.1159/000452616. Epub 2016 Nov 30. PMID: 27898415
Kluckow M, Evans N. Low superior vena cava flow and intraventricular haemorrhage in preterm infants. Arch Dis Child Fetal Neonatal Ed. 2000 May;82(3):F188-94. doi: 10.1136/fn.82.3.f188. PMID: 10794784; PMCID: PMC1721081.
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**TIMESTAMPS**
01:03 MYTH #1: 'Vasopressor' and 'Inotrope' mean same thing
05:23 Myth # 2: A blood pressure is a good indicator of a baby's Oxygenation status
11:04 Myth # 3: Mean BP is most important indicator of status
16:22 Myth # 4: Routinely treating hypotension in neonates improves outcomes
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*Disclaimer*: This video is intended for educational purposes only and while
we strive to give the most accurate information, errors may occur. Subsequently,
this video should not be a replacement for medical advice.
thanks Dr Tala! your videos have been a huge help on my studies as a neonatal ANP.
Another terrific topic Fr. Tala!
Thank you so much! Always love your encouraging comments :)
Thank you for such simplicity… ❤
That’s what we were aiming for!!! Thank you!!!
Thanks for all your clear explanations in all your videos. Your TH-cam channel is my favorite.
What a lovely comment- thank you so.much!!!! Really appreciate your support!
Another great video!!! Over the last 20 years, it has been great to see how much better hypotension is managed in neonates, we are getting better at not "over treating " hypotension. NIRS and more focused attention to perfusion markers has helped to decrease putting kids on meds based soley on numbers. Loved the breakdown of the myths that were considered law for so long. The HIP trial was a great try to find more answers. Getting IRB approval for that trial had to be "fun" 😂
You always get to the heart of everything!!!! Completely agree with everything!!!! And yes the IRB! Dr. Barrington sums up the difficulties they had in that trial in his blog (Neo research). He’s brilliant and hysterical and you’d love it!!!
@TalaTalksNICU oooh, I'm going to look into that blog!! Thank you. The few times I've been involved in the IRB process for much less controversial trials made me question all of my life choices, lol. Keep up the great work +
@laraeb2514 ha couldn’t agree more!!!! LOL
Thank you...
Thanks for being here :)
Awesome video. I’m from Ottawa Canada. We use epi and norepi the most now it seems.
Ottawa is so beautiful!!! That’s great those are the meds you’re using! So very targeted BP management! Thanks so much for letting us know!
Thank you Dr. Tala
That was really wonderful...
Watching you from Libya
So happy you found it helpful- thanks so much for watching and for telling us where you're from!
Great video, I'm studying to take final exams and boards and this info is presented so easy to understand. When will the next videos in the series come out? I live in Ohio, we use Dopamine to start for low BP and then Epi.
Oh thank you so much for your lovely comment! And Ohio! I’m not sure if we had that on the map yet! I think that’s what a lot of us do- dopa and then epi. We’re releasing one on recent jaundice guidelines and then the BP ones will be out of that! So 3 weeks!!! Thank you!
Excellent revision....All examples quoted leave a permanent imprint. Easy for neurons to refire ...Thanks Dr Tala
Oh perfect! Love neurons re-firing!!! haha!
Another great video from Dr. Tala .. Thank U very much Dr. Tala .. I've learned a lot from that one.
Thank you so much for letting us know! (And for subscribing!) So glad it was helpful!
Thank you Dr Tala, very informative 👍
@setiramsan5913 so glad you thought so! Thank you for taking the time to write!
amazing lectures as always, your videos always make learning fun, thanks to the entire team for all the amazing content and references 😊
Hi Dr. Singh! Thank you so much for your lovely comment! Hoping all is good with you in your part of the world!
@@TalaTalksNICU thanks 😊, all is well trying to beat the heat in Guyana, thanks again for all the amazing contents
neonatology made easy❤thank you Dr Tala.
watching you from zambia
Zambia! How beautiful! Thank you so much! Literally our goal to make neonatology easy (and loved!) ha! Really appreciate she your comment!
Thanks for your easy explanation, please could you explain apnea topic
YES! I’m sorry! We’ve promised this to be released soon! We’re getting there! Sorry!!! Thank you for being here
Wonderful
Thank you so much!!!! Love that you’re watching this!
Maldives, norepinephrine for sepsis, dopamine used a lot , dobutamine for cardiogenic, for PPHN mostly end up using all 4 if bad as we have no NO
Hi! I mean you should be filming this video! Basically sums up the third one!!!! Thanks for watching until the end (and for subscribing!)!!!
Very good vídeo Dr Tala! Thanks a lot. And have you ever made a video about NIRS monitorization? Do you have experience with this in your unit? Thanks a lot.
Thank you so much!!! We have been working with the NIRS people trying to get access to their pictures and stuff! I promise will be out eventually! Thanks so much still being here- and for your lovely thoughtful comments :)
youtube.com/@nirsconsortium1974?si=ky17bQD0v0LBDyVE
I can't wait for Dr Tala to do this subject,but this may help in the meantime!
@@anneshields8188 Thanks a lot!
Excellent, excellent talk, especially, considering post on-call. Salute.
Thank you so much! But did you notice how Arianna had to edit vasopressor a couple of times cos I’m so used to saying vasopressin!!!! Ha! Thank you for watching and for being here :)
@@TalaTalksNICU How I wish you were my teacher………. 25 years ago!!! I have just retired from Neonatal work in UK. I fully understand that feeling of “post on-call” to put it mildly, disorienting. I came across your site from a non-medic and have subscribed, just to keep up. Please persevere in the same passion and spirit. You are a gifted teacher.
That’s an amazing career/ and I’m so impressed you still find it interesting! What made you leave? Obviously you still love it?! Do you miss it? Thanks so much for being here! Yes! Post call! And older I get the harder it is!!!
@@TalaTalksNICU Yes, the older we get the harder the on-calls become and for some reason lonelier!!!
The use of Vasopressors in Neonatal units is not as judicious as in PICU’s and Adult ICU’s. You have astutely picked upon this and explained it so well. While I have upvoted all your videos, this for me was a gem. You have addressed the pathophysiology, which is often overlooked in NICU’s and tailor the treatment, accordingly.
Watching your videos gives a great satisfaction and validation of having completed a good job. Self reflection.
Beware that we may get out of NICU but NICU doesn’t get out of our system 😂
If you have not done a video on pulmonary graphics, please, please, please consider this despite the onerous job that you do. Also, on the new/future developments in the frontiers of Neonatology. ? AI
Lastly, your explanations are crisp, clear and concise. Pitched perfectly for the purpose. Long may your passion last. Remember that you are doing a great service for the parts of the world that lack teaching. This would be a great motivation (cup of coffee) for “post on-call” videos 😬 The very best in everything that you do, so well.
Good morning!!!! I’m not sure why I’m just seeing this lovely comment now! Thank you thank you thank you so much!!!! Thank you for all of it!!! I’m setting up a pulmonary graphics video in house with a friend of mine who is an amazing respiratory therapist. It’s all logistics! And yes AI!!! We should all be discussing that more- I’ll try to find more of a techy expert!! Couldn’t agree more about calls being harder and lonelier!!!! Now even if I’ve had a few hours of sleep I need a nap! Something about hospital sleep and being more nervous about stuff!!!! Anyway- thank you so so much for all your lovely comments!!
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Thank you :)
Once again, you preformed well UNDER PRESSURE 😂
Hahahah BRILLIANT! Hahahaha
Wow has it really been 16 years!!??
YES AMY!!! Can you believe it? I still feel like I’m 30!!!!
I am eagerly waiting for subsequent videos, which drug for which condition.
Yes! There’s another myth one (seemed easiest way of covering basics) and then we’ll run through scenarios in third one!
INO in and out can't forget
Haha! Helped me!!!!