Nurturing Tiny Hearts: Hemodynamics Care in the NICU

April 16, 2024 | by Stephani Monhollon
Nurturing Tiny Hearts: Hemodynamics Care in the NICU

In the high-stakes environment of the neonatal intensive care unit (NICU), every heartbeat counts. For the tiniest and most vulnerable patients, hemodynamics care is paramount to ensuring their fragile cardiovascular systems function optimally.

The Pediatrix® Neonatology of Florida team at Orlando Health Winnie Palmer Hospital for Women & Babies in Orlando, Florida, is a member of the Neonatal Hemodynamics Research Centre, an international collaborative focused on fostering high-quality research and quality-improvement work to improve the hemodynamics care provided to newborns in intensive care units across the globe.

“Being a part of the Neonatal Hemodynamics Research Centre places us at the forefront of the pioneering efforts to understand cardiac and pulmonary interactions, enhancing the health of the youngest and most vulnerable among us,” said Lauren Ruoss, M.D., a neonatologist at Pediatrix Neonatology of Florida who leads the team’s hemodynamics program.

Understanding Hemodynamics in the NICU

Hemodynamics is the study of the forces involved in blood circulation throughout the body. In the NICU, where premature infants and critically ill newborns receive intensive medical care, hemodynamics takes on a heightened significance. These fragile patients often face challenges related to their cardiovascular health, including immature organ development, respiratory distress and congenital heart defects.

“Using hemodynamic screening to guide treatment plans improves outcomes in the tiniest babies,” said Dr. Ruoss. “I am excited to build this innovative program in the NICU with close collaboration with the Winnie Palmer Tiny Baby Team and Pulmonary Hypertension Team.”

Monitoring Vital Signs

One of the cornerstones of hemodynamics care in the NICU is the continuous monitoring of vital signs. This includes heart rate, blood pressure, oxygen saturation and perfusion (the passage of fluid through the circulatory or lymphatic systems to an organ or tissue). Advanced monitoring technologies allow NICU providers to closely track these vital signs, enabling early detection of any abnormalities and prompt intervention when necessary.

Assessment and Intervention

NICU professionals carefully assess hemodynamic status through a combination of clinical observation and diagnostic tests. In addition to monitoring vital signs, a neonatal hemodynamics specialist may perform targeted neonatal echocardiograms to evaluate cardiac function and circulation. Based on these assessments, timely interventions are initiated to support hemodynamic stability.

Medications and Therapies

Pharmacological interventions play a crucial role in hemodynamics care in the NICU. Medications, such as inotropes (medicines that change the force of the heart’s contractions) and vasopressors (medicines used to make blood vessels constrict or become narrow in people with low blood pressure), may be given to enhance the heart muscle’s ability to contract and pump blood, regulate blood pressure and improve tissue perfusion.

Combining the expert neonatologists on the highly specialized neonatal critical teams with a neonatal hemodynamics specialist further aids in the close adjustment of these medications through continual monitoring of hemodynamics.

Fluid Management

Optimal fluid balance is essential for maintaining hemodynamic stability in NICU patients. The neonatal experts closely monitor fluid intake and output, adjusting intravenous fluids and electrolyte solutions as needed. Too much or too little fluid can significantly affect cardiovascular function.

Specialized Interventions

In some cases, NICU patients may require specialized interventions to address complex hemodynamic challenges. This could include procedures like blood transfusions to correct anemia, mechanical ventilation to support respiratory function or surgical interventions to repair congenital heart defects. These interventions are performed by highly skilled neonatal specialists in collaboration with multidisciplinary teams.

“The Tiny Baby Team at Winnie Palmer Hospital is a specialized, multidisciplinary team of nurses, respiratory therapists, pharmacists, nutritionists, developmental therapists, palliative care specialists and neonatologists,” said Dr. Ruoss. “It is through this collaborative approach that our center has been able to achieve incredible outcomes.”

Family-Centered Care

Throughout the hemodynamics care process, NICU health care providers prioritize family-centered care, recognizing the critical role of parents and caregivers in the well-being of their infants. Families are actively involved in decision-making, provided with education and support, and encouraged to participate in their baby’s care to the extent possible.

“Our approach to family-centered care optimizes outcomes and further reinforces the importance of shared decision-making,” explained Dr. Ruoss.

Hemodynamics care in the NICU is a multifaceted endeavor aimed at safeguarding the cardiovascular health of premature and critically ill newborns. NICU health care providers strive to optimize outcomes for these vulnerable patients through meticulous monitoring, targeted interventions and a commitment to family-centered care. As medical technologies and expertise continue to advance, the future holds promise for further enhancing hemodynamics care and improving the lives of NICU infants and their families.

“Our NICU team is committed to being at the forefront of neonatal care for the tiniest babies,” said Dr. Ruoss. “As a member of the Neonatal Hemodynamics Research Centre, through innovation, compassion and multidisciplinary teamwork, we will aid in the advancement of neonatal care not just in our community but in the care of neonates internationally.”

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