Table 1 Summary of clinical presentations of the three cases.
From: Diagnostic and therapeutic precision in cardiovascular diseases in the neonatal intensive care
Clinical scenario | GA (weeks) | Birth weight | Antecedent therapies | Concurrent medical issues | Investigation | Therapy | Outcome |
|---|---|---|---|---|---|---|---|
IDM with asymmetric HCM | 39 | 4075 g | *Hypoglycemic treated with dextrose bolus -RDS requiring CPAP | *Macrosomia | *CXR *Serial TNE *Serial assessment of lactate *Co-management with pediatric cardiology | -*Intubation to increase transmural pressure gradient and support LV function *Vasopressin to promote LV filling *Rate control with esmolol, and sedation | *Improved LVOT gradient *Discharge home in room air |
TTTS-recipient twin | 28 | 1290 g | *No fetal intervention performed *Intubated at delivery, Apgar scores 4, 8. *Surfactant for RDS | *RDS secondary to prematurity | Serial TNE to guide therapies | *Dobutamine *Epinephrine | -Off dobutamine day 2, off epinephrine day 5, with normal cardiac function and initially persistent hypertrophy. -TNE prior to discharge with normal biventricular size and function, no evidence of pulmonary hypertension. -Discharged home at PMA 46 weeks (130 days) on low flow oxygen |
BPD associated cPH | 27 | 560 g | *Intubation *Surfactant for RDS *Paracetamol for PDA closure | Between 27 and 36 weeks: *Inability to extubate *Need for 35–60% oxygen *Unexplained splinting accompanied by increased FiO2 *Systemic hypertension | TNE to exclude pulmonary artery hypertension | *Co-management with pediatric cardiology *Captopril for 5 weeks | *Cessation of splinting episodes *Successful extubation *Improved cardiac indices^ *Discharge home on low flow oxygen and maintenance captopril |
