Hemodynamics: Functions of the Heart
By Kieran Bergmann Powers
Parents of a baby in the NICU quickly become accustomed to the slew of specialists, tests and interventions that their babies are met with – heel pricks to test blood, respiratory support, head ultrasounds, chest x-rays, blood transfusions. The list goes on. But a lesser known area in the world of neonatology is Neonatal Hemodynamics.
Hemodynamics is the movement or flow of blood through the body. When a baby is admitted to the NICU, doctors need to ensure that their heart is functioning well enough to help their lungs to develop, and to pump blood through their tiny body and to their brains. Targeted Neonatal Echocardiography (TNE) is a way of assessing adequacy of blood flow using ultrasound to take pictures of a baby’s heart, valves, and blood vessels. This allows doctors to observe how their heart is functioning, pin-point the specific cause of circulation problems and to develop an individualized care plan for that specific baby.
In the NICU at Mount Sinai Hospital in Toronto, if a baby is really sick and TNE is needed, they call Dr. Amish Jain. Dr. Jain is a staff neonatologist and clinician scientist at the Sinai Health System/Lunenfeld-Tanenbaum Research Institute, Associate Professor in Pediatrics at the University of Toronto, and he is also the site Director of the TNE Program in the NICU at Mount Sinai Hospital.
The most common symptoms that Dr. Jain and his team are asked to help with are severe pulmonary (respiratory) dysfunction (oxygenation failure which doesn't respond to usual measures like giving oxygen and mechanical ventilation), heart dysfunction, circulation compromise (inadequate organ perfusion, low blood pressure). Most commonly these are caused by complication around delivery resulting in inadequate transition to the postnatal environment, infection at or after birth, NEC, severe chronic lung disease, and pulmonary hypertension.
When Stephanie Scarpelli’s water broke when she was 24 weeks pregnant, she was immediately put on bedrest and given celestone steroid injections to help her baby’s lungs develop. Sebastian was born five weeks later at 29 weeks, but because he had low amniotic fluid for that time, his lungs were very underdeveloped. Within the first hour of his life his oxygen saturation levels and heart rate levels were low and it took them 85 minutes to resuscitate him.
Dr. Jain came to see Sebastian for the first time within twelve hours of his birth. Using TNE, he was able to identify that not only were Sebastian’s lungs struggling, but he had fluid around his lungs and heart, and his heart was working too hard. He was diagnosed with pulmonary hypertension, and Dr. Jain developed a care plan just for Sebastian including trying out various medications until they found one that helped. For the first few days of his life Sebastian had multiple echos a day, and Dr. Jain checked in on him throughout his NICU stay.
According to Stephanie, “Dr. Jain worked so hard to figure out what was wrong with Sebastian and he supported us through our NICU journey. We owe Sebastian’s life to him.”
Sebastian went home after 89 days in the NICU. He recently turned two and is thriving!
Sebastian is one of many babies to have benefited over the years from having access to this specialist technology in the NICU of Mount Sinai Hospital. However, not all NICUs have
this facility available.In a recent study conducted by Dr. Jain and his team, they evaluated the impact of TNE in premature babies with critical illnesses over an eight-year period in two Toronto NICUs.
428 babies were included in the study; 258 did not have TNE and 170 did. The study found thatthat TNE when used within 24 hours of illness starting was associated with improved outcomes and higher survival rates amongst critically ill premature babies.
Dr. Jain has recognized a major gap in the area of Neonatal Hemodynamics despite the high mortality and complication rates that these babies face. He therefore set up the ‘The Neonatal Hemodynamics Research Centre’ to bring various centers and experts together to highlight the work, research, and training being done in this important area of neonatology.
For more information, visit http://www.neonatalhemodynamics.com .
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