Persistent Critical Illness in Newborns

The problem of persistent critical illness (PCI) in newborns is poorly understood. The epidemiology of this pathological condition in newborns has not been precisely established, however, it is known that PCI is considered a predictor of an unfavorable outcome in any pathology and proceeds more severely then in adults and children. Long-term outcomes of PCI in surviving newborns are associated with subsequent asthenia, cognitive impairment, chronic fatigue syndrome, a high incidence of disability, complex physiological abnormalities, and chronic organ dysfunction from which they rarely recover.Nutritional, respiratory and hemodynamic supports are key components of neonatal PCI therapy. The physiology of a newborn is different from that of an adult patient; therefore, inotropic therapy in this category of patients requires special approaches. In the past few years, in addition to dopamine, dobutamine and adrenaline, newborns have been prescribed milrinone, norepinephrine, vasopressin, and levosimendan as hemodynamic support. The clinical potential of these drugs in neonates is still under evaluation but there is some evidence for their benefits for use in PCI.