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In this episode of From the Heart, Dr. Nim Goldshtrom and Dr. Adrianne Bischoff walk through a complex neonatal case involving sudden decompensation shortly after birth. With few early clues and no clear diagnosis, the team discusses how to approach circulatory shock, differentiate pulmonary hypertension from congenital heart disease, and manage critically ill neonates before imaging is available.

Using this case as a reverse journal club, the hosts break down relevant literature and decision-making pathways: when to start prostaglandin, when epinephrine makes sense even without low blood pressure, and why relying only on numbers like MAP can be misleading. They also examine the role of therapeutic hypothermia in unstable infants and the potential cardiovascular consequences of cooling.

Later, the conversation focuses on left ventricular dysfunction, balancing systemic and pulmonary circulation via the ductus, and using bedside markers like lactate and perfusion to guide treatment when echo isn’t immediately available. The episode closes with thoughts on autoregulation, cerebral protection, and the evolving role of emerging technologies in neonatal hemodynamics.

A real-world deep dive into diagnostic uncertainty, evolving physiology, and decision-making under pressure in the NICU.

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As always, feel free to send us questions, comments, or suggestions to our email: [email protected]. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below.

Enjoy!