- Rising lactate
- Worsening metabolic acidosis
- Oliguria
- MAP < gestational age
- Diastolic Blood Pressure < 25 mmHg
- Echocardiography
- Sedation or neuromuscular blockade
- Prostaglandin E1 for RV dysfunction to allow right to left flow through PDA
- Fluid bolus for hypotension and underfilled LV
- Sodium bicarbonate for low pH with unimpaired ventilation
- iCa>1.2, normal magnesium and potassium levels
- Low dose dopamine and epinephrine, or milrinone for biventricular cardiac dysfunction
- Low dose vasopressin for catecholamine sparking effect if tachycardic
- Avoid iNO with LV dysfunction
- Esmolol for RVOT obstruction
Is there any improvement?