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Start Over Author "McNamara P" Journal journal of perinatology
119 results on '"McNamara P"'

7. Hemodynamic consequences of respiratory interventions in preterm infants.

Author

Sehgal, Arvind, Ruoss, J, Stanford, Amy, Lakshminrusimha, Satyan, and McNamara, Patrick

Subjects
Humans, Respiratory Distress Syndrome, Newborn, Infant, Premature, Diseases, Pulmonary Surfactants, Intermittent Positive-Pressure Ventilation, Infant, Infant, Newborn, Infant, Premature, Hemodynamics
Abstract

Advances in perinatal management have led to improvements in survival rates for premature infants. It is known that the transitional period soon after birth, and the subsequent weeks, remain periods of rapid circulatory changes. Preterm infants, especially those born at the limits of viability, are susceptible to hemodynamic effects of routine respiratory care practices. In particular, the immature myocardium and cardiovascular system is developmentally vulnerable. Standard of care (but essential) respiratory interventions, administered as part of neonatal care, may negatively impact heart function and/or pulmonary or systemic hemodynamics. The available evidence regarding the hemodynamic impact of these respiratory practices is not well elucidated. Enhanced diagnostic precision and therapeutic judiciousness are warranted. In this narrative, we outline (1) the vulnerability of preterm infants to hemodynamic disturbances (2) the hemodynamic effects of common respiratory practices; including positive pressure ventilation and surfactant therapy, and (3) identify tools to assess cardiopulmonary interactions and guide management.

Published
2022

24. Catecholamine-resistant hypotension and myocardial performance following patent ductus arteriosus ligation

Author

Noori, S, McNamara, P, Jain, A, Lavoie, PM, Wickremasinghe, A, Merritt, TA, Solomon, T, Sekar, K, Attridge, JT, Swanson, JR, Gillam-Krakauer, M, Reese, J, Poindexter, BB, Brook, M, Auchus, RJ, and Clyman, RI

Subjects
Paediatrics, Biomedical and Clinical Sciences, Congenital Heart Disease, Cardiovascular, Perinatal Period - Conditions Originating in Perinatal Period, Heart Disease, Preterm, Low Birth Weight and Health of the Newborn, Rare Diseases, Pediatric, Cardiac Surgical Procedures, Cardiotonic Agents, Catecholamines, Dobutamine, Dopamine, Drug Resistance, Ductus Arteriosus, Patent, Echocardiography, Female, Humans, Hypotension, Infant, Newborn, Infant, Premature, Ligation, Male, Postoperative Complications, Treatment Outcome, PDA Ligation/Hypotension Trial Investigators, Clinical Sciences, Paediatrics and Reproductive Medicine, Pediatrics
Abstract

ObjectiveWe performed a multicenter study of preterm infants, who were about to undergo patent ductus arteriosus ligation, to determine whether echocardiographic indices of impaired myocardial performance were associated with subsequent development of catecholamine-resistant hypotension following ligation.Study designA standardized treatment approach for hypotension was followed at each center. Infants were considered to have catecholamine-resistant hypotension if their dopamine infusion was > 15 μg kg(-1)min(-1). Echocardiograms and cortisol measurements were obtained between 6 and 14 h after the ligation (prior to the presence of catecholamine-resistant hypotension).ResultForty-five infants were enrolled, 10 received catecholamines (6 were catecholamine-responsive and 4 developed catecholamine-resistant hypotension). Catecholamine-resistant hypotension was not associated with decreased preload, shortening fraction or ventricular output. Infants with catecholamine-resistant hypotension had significantly lower levels of systemic vascular resistance and postoperative cortisol concentration.ConclusionWe speculate that low cortisol levels and impaired vascular tone may have a more important role than impaired cardiac performance in post-ligation catecholamine-resistant hypotension.

Published
2015

33. Hemodynamic response to milrinone for refractory hypoxemia during therapeutic hypothermia for neonatal hypoxic ischemic encephalopathy

Author

Bischoff, Adrianne R., Habib, Sharifa, McNamara, Patrick J., and Giesinger, Regan E.

Abstract

Objective: Characterize the impact of milrinone on arterial pressure of neonates with persistent hypoxemic respiratory failure (HRF) and hypoxic ischemic encephalopathy (HIE) treated with inhaled nitric oxide and therapeutic hypothermia (TH). Study design: Retrospective cohort study. Arterial pressure was assessed hourly for 24 h. The primary outcome was change in diastolic arterial pressure (DAP). Results: 56 patients were included [(i) cases: HIE/TH who received milrinone (n= 9), (ii) Milrinone controls (n= 17), (iii) HIE controls (n= 30)]. Baseline demographics, severity of HRF and arterial pressure were comparable between groups. Only milrinone treated patients with HIE/TH had a marked drop in DAP in the first hour, which persisted for more than 12 h despite escalation in inotropes (p= 0.008). Conclusion: Milrinone treated patients with HRF and HIE/TH develop profound reduction in DAP and require escalation of cardiovascular support. The risk benefit profile of milrinone should be considered and pharmacological studies are warranted to evaluate drug metabolism and clearance in this population.

Published
2024
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