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KMID : 0438520120190020065
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Journal of the Korean Society of Neonatology
2012 Volume.19 No. 2 p.65 ~ p.70
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Adjunctive Management of Neonatal Sepsis and Septic Shock
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Lee Jung-Hyun
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Abstract
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In addition to antibiotic therapy, the administration of supportive care is of utmost importance in sepsis deteriorating to septic shock. Close attention to cardiovascular, respiratory, fluid and electrolyte, hematological, renal and metabolic/nutritional support is essential to optimize the outcome. Firstly, fluid resuscitation is important to attain appropriate heart rate, blood pressure, and refill time. In case of nonresponse to fluid resuscitation, inotropes are used to increase cardiac output, and to improve perfusion of the tissues. Ideally, vasoactive agents, including epinephrine, should be administered by a secure central venous route, but in an emergency, it may be infused through a peripheral route. To improve the imbalance between the need for oxygen and consumption, early intubation and mechanical ventilation should be considered. In newborns with inadequate urine output, hepatomegaly, rale, and 10% weight gain, despite other supportive cares, dialysis or continuous renal replacement therapy should be performed, while on the extracorporeal membrane oxygenation circuit. Central venous access and arterial pressure monitoring are recommended in infants with fluid-refractory shock. Hemodynamic support directed to goals of mixed venous saturation, and cardiac index in newborns is associated with improved survival and neurologic function.
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KEYWORD
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Sepsis, Shock, Inotropes, Blood pressure, Cardiac output
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