Recognition and Management of Cardiovascular Insufficiency in the Very Low Birth Weight Newborn

Publication Date: February 28, 2022

Last Updated: March 16, 2022

Summary and Recommendations

The diagnosis of cardiac insufficiency in the VLBW infant should not be based on a threshold BP value alone. The measurement of BP in this population is not simple and may be erroneous.
Assessment of BP should be based on multiple parameters including gestational age, weight, and postnatal age using standardized tables that recognize values >2 standard deviations below the mean. The diagnosis of cardiac insufficiency that warrants treatment should consider other factors including physical findings, such as hypotonia, tachycardia, and poor capillary refill, clinical findings, such as poor urine output, laboratory studies, such as metabolic acidosis and increased lactate concentrations, and bedside evaluation using technology such as functional echocardiography (when available).
The treatment of cardiac insufficiency is not without hazard, and the decision to treat should consider the potential complications of such treatment.
Delayed cord clamping, decreased blood sampling, appropriate ventilatory management (ie, avoiding excessive mean airway pressure and hypocarbia), and other attempts to avoid hypovolemia, anemia, and decreased cardiac output may have an important role in avoiding or mitigating hypoperfusion states in the VLBW infant.