Associated professor of neonatology Hamadan University of Medical
• Upon completion of this chapter, you will be able to:
• • Identify infants who require cardiovascular stabilization.
• • Apply the Acute Care of at-Risk Newborns (ACoRN) Cardiovascular Sequence.
• • Assess adequacy of circulation and end-organ perfusion.
• • Recognize and manage circulatory shock.
• • Recognize and manage cyanosis.
• • Know how to perform and interpret a critical congenital heart disease (CCHD) screen.
• • Recognize and manage supraventricular tachycardia (SVT).
• • Recognize when to exit the Cardiovascular Sequence to other
• 1. Shock, cyanosis unresponsive to oxygen, and tachycardia all indicate cardiovascular instability.
• 2. Initially, infants with underlying congenital heart disease (CHD) can appear well.
• 3. Routine screening for CCHD identifies infants who require assessment to rule out severe or cyanotic CHD.
• 4. The underlying cause of shock can be difficult to ascertain at
presentation, but all causes are characterized by underperfusion of vital organs. Always consider volume expansion while establishing a diagnosis.
• 5. Cardiovascular instability and shock may be the initial presentation of sepsis. These infants should be treated with antibiotics as soon as possible after stabilizing the systems identified by the ACoRN Primary Survey.
• 6. Cyanosis and shock may both be present with duct-dependent CHD.
• 7. Prostaglandin E1 (PGE1) is the life-saving treatment in duct-dependent CHD.
• 8. Consider SVT when an infant’s heart rate (HR) is more than 220 bpm.