NICU nurse, NICU mother

Laura Corbett, RN, MNHP, nurse manager in the NICU at UI Stead Family Children’s Hospital, knows firsthand how teamwork pays off in newborn health and survival. 

She sees it in action when she’s on the job, but she has also witnessed it as a NICU mother. Two of her three children were born prematurely at the UI, and she says she couldn’t have asked for better care for her babies.

“When you're wheeled into the NICU as the mother of a premature baby, you're feeling a real fear in your heart,” Corbett says. “’Is she OK?’ But suddenly you look at all of the medical and nursing team, and you see how calm they are. They look at you and say, ‘Congratulations,’ and begin explaining what is happening. Your fear settles, and you know that it is going to be OK. This is what our NICU is able to provide families: a sense of calm and confidence in what is going to come next. As a mother, you can get through anything as long as you have this.”

Neonatal hemodynamics: a ‘transformative’ change in care

In keeping with UI Stead Family Children’s Hospital’s history of medical innovation, neonatology experts believe that the use of ultrasound technology to evaluate hemodynamics—a technique that helps doctors understand and improve blood flow and function of the heart—could further boost survival rates and improve outcomes of premature and critically ill infants.

Inside the womb, a fetus receives oxygen through the placenta, which allows time for the lungs to adequately develop. When a premature baby is born, it’s critically important to ensure that the infant’s heart makes the necessary transitions to allow the lungs to both mature and receive the blood they need to function correctly. One way to do this is to monitor an infant’s blood pressure. However, medical research has shown that normal blood pressure does not equate to normal blood flow.

The use of ultrasound to view a premature infant’s heart and observe how it functions is more accurate and can help prevent bleeding in the brain, which is a major contributor to death and brain injury among premature babies. At UI Stead Family Children’s Hospital, all newborns under 27 weeks receive their first echocardiogram by the end of their first day after delivery. The sickest infants are evaluated within minutes or hours of birth, if needed. Focusing on hemodynamics to stabilize heart and lung function also can reduce the use of extracorporeal membrane oxygenation (ECMO), or cardiac bypass, in full-term critically ill newborns, which often means a shorter stay in the NICU and a lower risk of complications.

This past year, neonatologist and neonatal hemodynamics expert Regan Giesinger, MD, used echocardiography to perform roughly 800 ultrasounds on sick or premature babies. About 75% of NICU patients were examined. Moving a tiny ultrasound wand over a newborn’s chest, Giesinger can quickly and efficiently capture 120 images of a baby’s heart, valves, and vessels in 10 to 15 minutes. She follows a strict assessment protocol to ensure that she captures a complete and comprehensive picture. 

“It’s important to take images of the heart from many angles because it is a very complex organ,” says Giesinger, a clinical assistant professor in the Division of Neonatology in the Stead Family Department of Pediatrics. “Our assessment is designed to evaluate heart function and blood flow both to the body and to the lungs. We use this information to provide the baby’s primary doctor with a customized treatment plan. If structural heart defects are identified incidentally, a referral to a pediatric cardiologist for their prompt review and consultation is facilitated.”

Giesinger came to Iowa with her mentor, Patrick McNamara, MB, BCh, director of the Division of Neonatology in the Stead Family Department of Pediatrics and leader of the neonatal hemodynamics initiative that monitors fragile newborns using echocardiography, along with near-infrared spectroscopy and electroencephalogram (EEG), to assess brain health. 

“With neonatal hemodynamics we are able to investigate the relationship of the heart to the brain,” says McNamara. “And then we can come up with therapies or strategies that, by helping the heart, we’re actually improving brain outcomes, which is fairly transformative in terms of neonatal care.”

For example, an enhanced understanding of neonatal hemodynamics helps doctors treat brain asphyxia, or lack of oxygen to the brain prior to birth. In these cases, standard of care is the use of therapeutic hypothermia to cool the infant’s body. However, 40% to 50% of babies still suffer brain damage. Research by McNamara and his team shows that right heart dysfunction (identified by ultrasound) seems to be a precursor to this outcome.