Authors: Irene Baquedano Lobera, Segundo Rite Gracia, Daniel Palanca Arias.
Introduction: Neonatal cardiogenic shock is an uncommon condition whose detection and management continues to be a major challenge in the NICU.
Clinical case: We present a case of neonatal cardiogenic shock in a 25 days old newborn admitted in the NICU due to renal failure, where the point-of-care ultrasound was the main tool for hemodynamic management. After progressive deterioration of renal function (creatinine 5.67mg/dl, urea 96mg/dl), she needs peritoneal dialysis during 6 days. Two weeks after the extrarrenal assistance withdrawal, and simultaneously with a blood transfusion, she suffers a clinical descompensation with maintained blood pressure >p99, tachycardia, oligoanuria and respiratory distress needing CPAP. Point-of-care ultrasound is practiced showing systolic dysfunction and left ventricle dilatation (left ventricle ejection fraction 23%), moderate mitral and tricuspid insufficiency, mild aortic insufficiency and acute pulmonary edema findings. The clinical signs supported by the echographical findings presuppose an increased systemic postcharge within nephrogenic hypertension and hypervolemia due to blood transfusion, triggering a left heart failure with postcapillary pulmonary hypertension, acute pulmonary edema and, secondarily, right heart overload. Diuretics are started (furosemide=1mg/kg/h) and inodilators (milrinone=0.75mcgr/kg/min and dobutamine=5mcgr/kg/min), monitoring the hemodynamic response with point-of-care ultrasound, adding four hours later vasodilators (nitroprusside=0, 75 mcgr/kg/min). Early heart failure improvement is observed, withdrawing all hemodynamic support after 36 hours, with recovery of myocardial contractility, normalisation of the valve insufficiencies, and resolution of pulmonary edema.
Conclusions: Point-of-care ultrasound guided the physiopathology of the cardiogenic shock as well as the therapeutic decisions allowing optimizing the hemodynamic management, minimizing therapeutic delays and early reverting the life-threatening descompensation.
View/Download pdf