Developmental Cardiovascular Research Program

There have been remarkable advances in the management of neonates with cardiovascular disorders during the last two decades. This has included neonates with non-structural cardiac disorders such as circulatory compromise due to infection, immaturity and/or myocardial dysfunction, which falls in the scope of practice of the neonatologists. The main function of this section is to provide consultation, teaching and research in neonates with non-structural cardiovascular disorders.

Consultation

At the request of the attending neonatologist, all neonates with suspected cardiovascular disorders will have a complete evaluation of their cardiac structure and function using state-of-the-art echocardiographic technology. The patient’s echocardiographic findings will then be reviewed by a board-certified pediatric cardiologist from the Division of Pediatric Cardiology at the Childrens Hospital Los Angeles to rule out the presence of structural heart disease. If the patient is found to have structural heart disease, the treatment will be guided by a pediatric cardiologist and, if appropriate, a cardiothoracic surgeon from the Heart Institute at the Childrens Hospital Los Angeles in close collaboration with the attending neonatologist. If structural heart disease is not present, the patient’s hemodynamic compromise might be due to functional cardiovascular problems and treatment will be directed by the neonatology attending using serial functional echocardiographic studies at the bedside to better guide the clinical management.

Teaching

Normal and abnormal fetal, transitional and postnatal circulation is taught through a series of lectures and small group discussions. Management of non-structural cardiac disorders and follow-up of the effectiveness of treatment is demonstrated by the use of serial bedside functional echocardiography studies and discussed in a series of case presentations. Presentation, differential diagnosis and initial management of neonates with congenital cardiac defects are also taught using a series of lectures and case reviews. The technique of functional neonatal echocardiography as a clinical and research tool is now taught as a six-week, well-structured intensive course to all neonatal fellows enrolled in the Neonatal Fellowship Program at the USC Division of Neonatal Medicine.

Research

The section invites all research and neonatal fellows to get involved in the investigation of any area of developmental functional cardiovascular disorders in the neonate. There are three state-of-the-art research tools of cardiovascular function being used at the USC Division of Neonatal Medicine: echocardiography (three, Philips 5500 ultrasound machines), near-infrared spectroscopy (NIRS) (one NIRO-300 and one niroscope for animal research) and magnetic resonance imaging (in collaboration with the Department of Radiology at the Childrens Hospital Los Angeles). To our knowledge, the routine use of functional echocardiography for guiding the management of cardiovascular compromise in critically ill neonates and the use of all three diagnostic modalities for developmental cardiovascular translational research and neonatal fellow education are unparalleled features of the USC Division of Neonatal Medicine.

The following areas are presently the focus of research by the section:

• Evaluation of organ blood flow changes in response to treatment in neonates with hypotension/shock.
  
• Determination of condition-specific lower blood pressure limits of organ blood flow autoregulation in critically ill preterm and term neonates.
  
• Effect of ECMO on cerebral blood flow autoregulation in critically ill neonates.
  
• Cardiovascular evaluation of neonates with catecholamine resistant hypotension/shock.
  
• Normal and abnormal superior vena cava flow in VLBW neonates at risk for intraventricular hemorrhage.
  
• Adverse effect of assisted ventilation on cardiac function of neonates.
  
• Aortopulmonary collaterals in VLBW infants and its contribution to chronic lung disease.
  
• Ductal aneurysm in infants of diabetic mothers.

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