Adrianne R Bischoff @arbischoff Twitter profile

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Adrianne R Bischoff

@arbischoff

10 months

Exciting news! The book has been released, featuring numerous outstanding collaborators in this latest edition that concentrates on Neonatal Hemodynamics. Take a look at our chapter, which provides a contemporary perspective on the interventional management of the PDA.

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Adrianne R Bischoff

@arbischoff

1 year

Hello! I'm a proud member of the Iowa Neonatal Hemodynamics Program at @uihealthcare @UIchildrens ! ♥️🩺👶 #FirstTweet 😀

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Adrianne R Bischoff

@arbischoff

9 months

Systemic hypertension is underappreciated in the NICU. For extreme premature babies (<27 weeks) we monitor BP carefully during the evolving-BPD phase. We use Dionne JM et al, Pediatr Nephrol (2012) 27:17–32 as reference. What are the practices in your unit?

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Adrianne R Bischoff

@arbischoff

1 year

For Regan: You are such an inspiration to all of the Neonatal Hemodynamics community. But to me you are much more than a colleague and a mentor. You’re a wonderful friend and I miss you already. @NeoHemodynamics @UIowaPeds @UIchildrens

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Adrianne R Bischoff

@arbischoff

1 year

Excited to share that I was awarded the designantion of Fellow of the American Society of Echocardiography (FASE)! Proud to represent the neonatal hemodynamics community in this important organization. #neohemodynamics #tnecho @UIchildrens @NeoHemodynamics

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Adrianne R Bischoff

@arbischoff

10 months

As part of our mission to enhance cardiovascular care, we are studying the different factors that impact preemie’s blood pressure and how it relates to diseases and outcomes. Keep an eye out for our publications on a contemporary approach to blood pressure in the NICU!

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Adrianne R Bischoff

@arbischoff

1 year

In a high performing center with high survival free of significant morbidity in extremely preterm infants we have shown that introduction of a NeoHD program reduced death and IVH despite babies/mothers being younger and sicker overtime. @uihealthcare @NeoHemodynamics @UIowaPeds

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Adrianne R Bischoff

@arbischoff

7 months

When people ask me "What drugs do you use in neonatal sepsis?" this is what comes to my head! Bottom line, it depends! The physiological spectrum and the interplay between them is very variable from patient to patient, and even within the same patient. It's all about precision 🩺

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Adrianne R Bischoff

@arbischoff

10 months

Echocardiography lesson: important findings should ideally be seen from two planes for a complete assessment!

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Adrianne R Bischoff

@arbischoff

9 months

Targeting high BPs to "overcome" high pulmonary pressures (ie: RVSp on Echo) in pulmonary hypertension is NOT sustainable. Although it may transiently improve FiO2 and the SpO2 gradient, it can worsen the afterload to the RV. Focus on fixing the 1ry problem which is elevated PVR!

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Adrianne R Bischoff

@arbischoff

8 months

Happy valentines day! ♥️🩺If anyone knows about the heart, it's me! 🙃 Physiology after PDA definitive closure: Pre-closure: pulmonary overcirculation, low afterload to LV (exposed to PVR as well). Post-closure: drop in LA preload + increase in LV afterload = decreased LVO.

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Adrianne R Bischoff

@arbischoff

7 months

PDA and acetaminophen 1st line for preterm infants 1st 14 days of life: ✅Rate of response is similar to NSAIDs ✅Response is >50% for all GAs (minus 21-22wks) ✅Response is associated with: IUGR, placental insufficiency and maternal hypertension.

Clinical and echocardiography predictors of response to first-line acetaminophen treatment in...

Journal of Perinatology - Clinical and echocardiography predictors of response to first-line acetaminophen treatment in preterm infants with hemodynamically significant patent ductus arteriosus

www.nature.com

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Adrianne R Bischoff

@arbischoff

8 months

Agreed. Conclusion: randomizing babies by PDA diameter (which is an extremely poor way of assessing the duct) to a tx that is not effective = no difference in outcomes. To assess impact of CLOSING the duct: need better inclusion criteria and a tx that is truly effective

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Adrianne R Bischoff

@arbischoff

9 months

Looking forward to connecting with colleagues in NYC this year! NeoHeart 2024 registration is now available at . Don't miss my session, "When the Right Ventricle Goes Wrong," where I'll be sharing valuable insights!

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Adrianne R Bischoff

@arbischoff

10 months

Interesting study about the use of acetaminophen for PDA in extremely preterm infants. Higher loading dose followed by 5 days of medical therapy. Should we be adjusting our practice? @NeoHemodynamics

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Adrianne R Bischoff

@arbischoff

7 months

Interesting large study on pulm hemorrhage! In our center, with the exception of the 1st dose of surf, we tend to do an Echo before repeat doses to make sure hsPDA is not the main problem - in which case surfactant (and further drops in PVR) could precipitate pulm hemorrhage

Michael Narvey 🇨🇦

@NICU_Musings

7 months

Risk factors for massive pulmonary hemorrhage (MPH)in VLBW ✅small for gestational age ✅multiple gestation ✅high CRIB-II score ✅use of surfactant ✅symptomatic patent ductus arteriosus (sPDA) 18.6% mortality in those with MPH #neoTwitter

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Adrianne R Bischoff

@arbischoff

7 months

Optimizing lung parenchyma and improving FRC (+opening the PDA + possible pulmonary vasodilator effects of PGE) can sometimes lead to dramatic improvement on clinical status but also echocardiographic features of Pulmonary Hypertension in newborns.

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Adrianne R Bischoff

@arbischoff

9 months

Excited for our group's recently accepted publication in Journal of Neonatal-Perinatal Medicine: "Postnatal Cytomegalovirus infection and pulmonary vascular disease in extremely premature infants: a case series." Have you seen it? Pulmonary vascular disease associated with CMV?

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Adrianne R Bischoff

@arbischoff

1 year

Happy Memorial Day weekend from St Lucia!

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Adrianne R Bischoff

@arbischoff

10 months

Percutaneous PDA closure is less invasive and seems to be associated with less cardiovascular instability than traditional surgical ligation. However, post-closure cardiac syndrome still exists and neonatologists need to be educated on its presentation and how to manage it.

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Adrianne R Bischoff

@arbischoff

8 months

Don't miss the PAS Postgraduate Course: Towards Enhanced Neonatal Hemodynamic Care in the NICU #pas2024 ! Dr. McNamara and myself are pleased to be co-chairs in this initiative showcasing speakers in the Neonatal Hemodynamics field! @rachaelmhyland @HebertAudrey3 @Dr_AmishJain

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Adrianne R Bischoff

@arbischoff

8 months

It’s a pleasure to present to this group! Thanks for the invite! @NeoHemodynamics @iowaneohd

Neonatal Hemodynamics Research Centre

@NeoHemodynamics

8 months

The next TNE/NPE Foundations Curriculum lecture is on February 7th @ 2pm ET/1pm CT. Dr. Adrianne Rahde Bischoff from @iowaneohd will be presenting on Post PDA Closure. #neoTwitter #neohemodynamics Registration:

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Adrianne R Bischoff

@arbischoff

11 months

Final prep on my slides for the Research Seminar series for the neonatology group at the @UWMadison (University of Wisconsin) today!

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Adrianne R Bischoff

@arbischoff

10 months

Pulmonary vascular disease, characterized by PA Doppler notching and/or an elevated RVET:PAAT ratio, may manifest as part of the post-capillary phenotype in former preterm infants with bronchopulmonary dysplasia and concurrent systemic hypertension.

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Adrianne R Bischoff

@arbischoff

9 months

Hustling through the holidays! The babies in the NICU are unaware that it's the season of Santa. Who else is putting in the work while enjoying the holiday vibes? #WorkHardPlayHard #HolidayHustle #GrindNeverStops

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Adrianne R Bischoff

@arbischoff

7 months

Treatment of neonatal systolic heart dysfunction depends on the type: 🫀Univentricular dysfx: inotropic support + appropriate use of afterload-reducing agents +/- PGE and management of ductal shunt direction 🫀Biventricular dysfx: PGE/ductal shunt less likely to be helpful

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Adrianne R Bischoff

@arbischoff

1 year

It was a pleasure being a panelist in the discussion about the role of early targeted PDA treatment in extremely preterm infants at the 23rd Congresso Brasileiro de Perinatologia. #neohd #neohemodynamics #tnecho @NeoHemodynamics

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Adrianne R Bischoff

@arbischoff

10 months

We received some questions about the assessment of PH with TnECHO. Straight from our atlas, some guidance on how to assess the Pulmonary vascular resistance index from the Pulmonary artery Doppler

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Adrianne R Bischoff

@arbischoff

1 year

This week’s TnECHO lecture! Super important topic, not to be missed. #neohemodynamics #nicu

Neonatal Hemodynamics Research Centre

@NeoHemodynamics

1 year

Join us on June 21st @ 2pm ET for the next International Neonatal Hemodynamics webinar: Precision in the Transition Period for Extremely Low Birth Weight Infants with Dr. Poorva Deshpande! #neoTwitter Click here to register:

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Adrianne R Bischoff

@arbischoff

7 months

Tissue Doppler Imaging is a game-changer in assessing heart function in neonates. Let's prioritize this vital tool and recognize its strengths and caveats! How do you use it? @CardioNeo @NeoHemodynamics @HebertAudrey3 @JosephTing13 @souvik_neo

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Adrianne R Bischoff

@arbischoff

7 months

What's the physiology (worst case scenario) in the event of in utero PDA closure?

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Adrianne R Bischoff

@arbischoff

7 months

Not to be missed, very important topic! TNE/NPE Foundations Curriculum lecture today @ 2pm ET/1pm CT. Dr. Dany Weisz from @Sunnybrook will be presenting on ELGANs and Hemodynamic Instability in Transition. Registration:

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Adrianne R Bischoff

@arbischoff

10 months

In this small study we showed that response to late surfactant administration in <27 wks is influenced significantly by PDA status. In fact, surf in the “wrong” patient population can make babies worse. We routinely obtain a TnEcho in babies we are considering late surf.

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Adrianne R Bischoff

@arbischoff

1 year

Good morning Florianopolis (Brazil)! Getting ready for the 23rd Congresso Brasileiro de Perinatologia. Excited to share about #neohemodynamics with this crowd, exchange knowledge and research findings! #nicu #neohd #tnecho @neohemodynamics #neotwitter

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Adrianne R Bischoff

@arbischoff

1 year

Thanks to the @nicupodcast for showcasing our work at @UIowaPeds ! Proud to be part of this group and continuing to work towards improving outcomes for tiny babies!

The Incubator Podcast

@nicupodcast

1 year

📄 This paper from @UIowaPeds not only outlines their hemodynamic screening approach to PDA in infants ≤ 26 wks but also reports how that strategy reduced rates of death or severe #BPD by 50% and improved survival free of severe morbidities to 73% in 22-23 wks infants!

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Adrianne R Bischoff

@arbischoff

7 months

PVR behaves in a U-shaped manner with lung inflation. Establishing adequate FRC is important to optimize PVR since this is the initial event in the cascade of transitional physiological changes.

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Adrianne R Bischoff

@arbischoff

9 months

Applause to the Quebec group and @HebertAudrey3 on their publication. I love how they are calling it "acute PH" and not PPHN which is too broad of a term and doesn't convey the different nuances of PH in the neonatal period.

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Adrianne R Bischoff

@arbischoff

10 months

On December 4th I'm an invited speaker at the TnECHO Quebec day! "Catheter-based closure of the PDA in the extremely preterm infants" Too bad I can't come to visit the beautiful Quebec in person! @HebertAudrey3 @CardioNeo

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Adrianne R Bischoff

@arbischoff

7 months

Excellent talk by Aisling Smith at Lecture Series hosted by @NeoHemodynamics this week! Highlights: 🫀 PH is common in patients with DS and no CHD 🫀 Heart sizes are different in DS 🫀 DS: impaired systolic and diastolic function 1st 2y @afif_elKhuffash

Serial Assessment of Cardiac Function and Pulmonary Hemodynamics in Infants With Down Syndrome -...

Infants with DS exhibit impaired maturational changes in myocardial function and pulmonary vascular resistance. Such novel findings provide valuable insights into the pathophysiology affecting...

pubmed.ncbi.nlm.nih.gov

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Adrianne R Bischoff

@arbischoff

7 months

#proud #neoTwitter @iowaneohd @NeoHemodynamics

UI Health Care Stead Family Children's Hospital

@UIchildrens

7 months

Adrianne Bischoff, MD, clinical assistant professor of pediatrics in neonatology, explains why participating our neonatal hemodynamics fellowship is important and how it impacted her decision to care for the tiniest patients.

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Adrianne R Bischoff

@arbischoff

11 months

Finally taking a breather after @PASMeeting abstract deadline! I love the “discovery” process of clinical research and getting younger trainees excited about their projects! What’s your favorite part of mentoring?

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Adrianne R Bischoff

@arbischoff

7 months

Interesting review article on the future of Artificial Placenta and Artificial Womb (APAW) technology Transferring an extremely premature infant to an extra-uterine life support system: a prospective view on the obstetric procedure

Frontiers | Transferring an extremely premature infant to an extra-uterine life support system: a...

To improve care for extremely premature infants, the development of an extrauterine environment for newborn development is being researched, known as Artific...

www.frontiersin.org

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Adrianne R Bischoff

@arbischoff

11 months

Thank you @nicupodcast for choosing to discuss our manuscript at your Journal Club! The incidence of technical failure and/or major adverse events is steadily dropping even though we are doing percutaneous PDA closure in progressively smaller babies!

The Incubator Podcast

@nicupodcast

11 months

This week on episode #156 of the podcast we review recent data on percutaneous closure of the #PDA . With 97% success rate, and <4% rates of maj adv events it isn't surprising to see how popular this technique has become over the years. Check out the latest episode of the podcast

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Adrianne R Bischoff

@arbischoff

1 year

❤️

Evidence-Based Neo

@EBNEO

1 year

@souvik_neo 's tribute commentary on Dr Regan Giesinger et al's March #AOM on the management of PDA in microprems. Full review: 500-word commentary: #neotwitter #neoEBM #EBNEOreviews @ActaPaediatrica

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Adrianne R Bischoff

@arbischoff

1 year

Low SVR/ vasodilatory shock. Primary vasopressot management (norepi or vaso or dopa). Good teaching. Not all R-L PDA is pulmonary hypertension!

Audrey Hebert

@HebertAudrey3

1 year

Term baby, septic shock. Large PDA, mainly right to left. In FiO2 0.21, minimal ventilatory setting. Whats the physiopathology that explains the right to left shunt? How do you manage? #neotwitter #neohemodynamics

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Adrianne R Bischoff

@arbischoff

1 year

#neohemodynamics

Neonatal Hemodynamics Research Centre

@NeoHemodynamics

1 year

Registration is now open for the Dr. Regan Giesinger Clinical Cardiopulmonary Physiology for the Care of the Sick Newborn Virtual course! October 20-21 2023. Check out our session topics, the full syllabus and registration page: #neotwitter

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Adrianne R Bischoff

@arbischoff

9 months

Neonatal Hemodynamics is becoming prominent at the ASE Annual Scientific Sessions! I'll be showcasing cases related to neonatal shock and hypoxemia, demonstrating the application of targeted neonatal echo for guiding effective management.

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Adrianne R Bischoff

@arbischoff

10 months

Holodiastolic flow reversal often correlates with systemic steal in PDA cases featuring a left-to-right shunt. What considerations should be taken into account when trying to reconcile the existence of holodiastolic flow reversal in the context of this specific PDA flow pattern?

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Adrianne R Bischoff

@arbischoff

8 months

Excited to share our new article that just came out on JASE! Thank you to my collaborators: @HebertAudrey3 @iowaneohd !

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Adrianne R Bischoff

@arbischoff

9 months

We use GE's automated functional imaging for Longitudinal LV Strain in the assessment of all our patients following percutaneous PDA closure. Using a multiparametric approach, this helps us guide decisions about milrinone prophylaxis for post-closure cardiac syndrome.

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Adrianne R Bischoff

@arbischoff

1 year

Exploring the island of St Lucia in the West Indies for Memorial Day weekend! #neededrest

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Adrianne R Bischoff

@arbischoff

11 months

Agree with @HebertAudrey3 . The ability of POCUS to r/o CHD is extremely limited and potentially dangerous. POCUS has a tremendous use in NICU and even potentially on neonatal transport, but the boundaries of its limitations must remain clear.

Audrey Hebert

@HebertAudrey3

11 months

@NicUof This might be an unpopular opinion, but I do not think a quick POCUS assessment should be used to rule out (or rule in) CHD. In transport, may be used for pneumothorax or qualitative and limited function assessment

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Adrianne R Bischoff

@arbischoff

9 months

@HebertAudrey3 @neo_twiter @NeoHemodynamics With this degree of LV dysfunction: epinephrine for sure. If normo ot hypertensive, would probably add milrinone too. And, depending on age of the baby, sometimes can use PGE to do single-ventricle management and promote systemic perfusion.

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Adrianne R Bischoff

@arbischoff

9 months

Approaching the end of 2023, I marked a decade since earning my medical degree. Reflecting on these photos, it's intriguing to see the growth in my professional journey, while cherishing the enduring friendships and memories from that period.

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Adrianne R Bischoff

@arbischoff

6 months

How do you reconcile (assuming image quality and acquisition were all optimal) the following? GA 40 weeks, 2 day old, moderate HIE undergoing TH RV FAC and TAPSE are within normal range for GA, but TDI RV S' is low. Does it make any sense?

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Adrianne R Bischoff

@arbischoff

7 months

⬆️388% in NICU admits at 22 wks over ~10y! Keep the data coming so we can continue to get better and better at taking care of them!

Neonatal Intensive Care Unit Resource Use for Infants at 22 Weeks’ Gestation in the US, 2008-2021

How has resource use in US neonatal intensive care units (NICUs) changed in light of updated clinical guidance about intensive care for infants born at 22 weeks’ gestation?In this serial cross-sect...

www.ncbi.nlm.nih.gov

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Adrianne R Bischoff

@arbischoff

11 months

William and I went to check one of daddy’s upcoming houses! Future owner, if your toddler goes missing: check where the tomato cans 🍅 are! There’s a secret door to the pantry 😂

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Adrianne R Bischoff

@arbischoff

1 year

Proud of this NICU-AI guru! @LindseyKnake

UI Stead Family Department of Pediatrics

@UIowaPeds

1 year

Neonatologist and biomedical informatics guru Lindsay Knake, MD ( @LindseyKnake ) authored this timely publication about AI in medicine:

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Adrianne R Bischoff

@arbischoff

7 months

SVC flow as part of TnECHO assessment? Do you use it? In which situations? @HebertAudrey3 @souvik_neo @JosephTing13 @afif_elKhuffash @CardioNeo

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Adrianne R Bischoff

@arbischoff

10 months

Another study supporting that prolonged exposure to PDA may be associated with increased risk of pulmonary vascular disease and PH in extremely preterm infants. When do you screen for chronic PH? What's the incidence in your center? What's your median duration of exposure to PDA?

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Adrianne R Bischoff

@arbischoff

1 year

Go @rachaelmhyland !!!

Neonatal Hemodynamics Research Centre

@NeoHemodynamics

1 year

The first of three case presentations for our TNE/NPE Foundations Lecture Series today has begun - Dr. Rachael Hyland from @UIowaPeds is presenting on a vein of galen malformation. #neoTwitter Registration:

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Adrianne R Bischoff

@arbischoff

10 months

@souvik_neo @neosatyan @NeoHemodynamics @NeoHeartSociety @HebertAudrey3 @CardioNeo 1) PVRi (RVET/PAAT) for cases of resistance-mediated (+ traditional PH and RV markers that come with arterial PH) 2) LVO and RVO+ volume loading markers for the flow-mediated states 3) Left atrium dilation and diastolic markers (E/A, IVRT, E/e') for the post-capillary phenotype

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Adrianne R Bischoff

@arbischoff

10 months

We are routinely obtaining blood speckle images as part of our TnECHO protocol. I look forward to finding out all the capabilities of this novel technique and how it can enhance our understanding of cardiovascular physiology.

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Adrianne R Bischoff

@arbischoff

1 year

Nice addition to echo-methodology literature in neonates! We found similar results for LV longitudinal strain when we measured with both methods. I wonder if the inability to control start/end of the cycle is one of the reasons why AFI is not as accurate

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Adrianne R Bischoff

@arbischoff

10 months

@souvik_neo Why wait for the cPH to occur if we know that a PDA of this magnitude and chronic overcirculation are likely to contribute to pulmonary vessel remodeling? Isnt a PDA potentially easier to treat than already established pulmonary vascular disease?

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Adrianne R Bischoff

@arbischoff

9 months

Can you identify what type of Echo analysis is being presented here and what each of the letters represent in the tracing? How do you use this type of analysis in your practice?

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Adrianne R Bischoff

@arbischoff

1 year

@souvik_neo @amitguptabliss @afif_elKhuffash @uihealthcare Early targeted PDA therapy and individualized physiology-based approach to cardiorrespiratory instability

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Adrianne R Bischoff

@arbischoff

6 months

@CardioNeo @NeoHemodynamics I’d also like to know what’s driving the mBP down. But assuming, also based on TNE findings, that this is more diastolic BP driven by some vasodilation. Since MAP dropped 15 points, DBP prob dropped at least same amount if not more. I’d probably give some fluid, yes.

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Adrianne R Bischoff

@arbischoff

1 year

#💙

UI Stead Family Department of Pediatrics

@UIowaPeds

1 year

Thank you, @NeoHemodynamics , for naming this course after Dr. Giesinger. We are humbled by this honor to her memory.

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Adrianne R Bischoff

@arbischoff

10 months

Thanks for the invite @HebertAudrey3 and @CardioNeo !

NeoCardioLab - Gabriel Altit

@CardioNeo

10 months

Thank you @arbischoff for sharing your knowledge and experience at our TnECHO-QC day at @chudequebec - with @HebertAudrey3 and other collaborators.

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Adrianne R Bischoff

@arbischoff

6 months

Besides specific ECMO parameters: what Echo-criteria 🫀 are you looking for (if any!) when deciding about "optimal" timing for decannulation of neonates with severe pulmonary hypertension? #neotwitter @neosatyan @CardioNeo @NeoHeartSociety @souvik_neo @NeoHemodynamics @amir_NHS

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Adrianne R Bischoff

@arbischoff

9 months

@CardioNeo @mcgillu @HME_MCH @NephroP @neo_twiter @NeoHeartSociety @NeoHemodynamics @NeoPocusCollab @pocusneo Empty…! I bet midcavity flow acceleration and a long IVRT are present, and that the pulmonary vein velocities are rather small. How do you estimate hypertrophy (not uncommon in TTTS!) when the heart is so empty? I typically don’t make that diagnosis until fluid status restored.

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Adrianne R Bischoff

@arbischoff

1 year

Looking forward to watching this!

Audrey Hebert

@HebertAudrey3

1 year

Great topic from an amazing neonatologist

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Adrianne R Bischoff

@arbischoff

8 months

@CardioNeo @neo_twiter @NeoHemodynamics @NeoHeartSociety @HebertAudrey3 @souvik_neo @amir_NHS Position 2 routine. A hybrid of 2 and 3 (at the level of the leaflets when open on PSAX) for PVRi assessment. If flow acceleration noted, we do 123 to tease out at which level there is obstruction.

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Adrianne R Bischoff

@arbischoff

8 months

@NicUof @BrianKingNeo @afif_elKhuffash @drbretty @padkaer @DrAbdulRazak_MD @amitguptabliss @nicupodcast Not the Iowa evidence :) ventilator practices are also heterogeneous. Despite our “prolonged” time on the vent, we dont experience higher rates of severe BPD even with an extremely small and young population.

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Adrianne R Bischoff

@arbischoff

8 months

@LindseyKnake and @vesoulislab have some promising topics for the future of NICU at @PASMeeting 2024 pre-conference! Too bad the event is at the same time as ours! Wish I could be in both places at the same time, but hope I have some friends to tell me all about it later!

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Adrianne R Bischoff

@arbischoff

8 months

@natetexsun , @CardioNeo and @afif_elKhuffash : Worth discussing: Kudos to the authors! However, I caution against extreme enthusiasm that this is the final answer on what to do with the PDA. Multiple factors to be accounted for before applying broadly.

Trial of Selective Early Treatment of Patent Ductus Arteriosus with Ibuprofen | NEJM

The cyclooxygenase inhibitor ibuprofen may be used to treat patent ductus arteriosus (PDA) in preterm infants. Whether selective early treatment of large PDAs with ibuprofen would improve short-ter...

www.nejm.org

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Adrianne R Bischoff

@arbischoff

9 months

@CardioNeo @souvik_neo @neo_twiter @NeoHemodynamics @NeoHeartSociety @HebertAudrey3 I’d be cautious with heart function since the PDA looks small and restrictive. While the pulm pressures are still so high, the RV could suffer if the duct closes.

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Adrianne R Bischoff

@arbischoff

6 months

Interpreting RV function parameters for patients on VA-ECMO can be challenging. While the venous cannula pulls blood from the RA, preload, and therefore the Frank-Starling mechanism, are compromised. RV systolic fx parameters are likely to be affected, but to what extent?

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Adrianne R Bischoff

@arbischoff

9 months

@swatigar @CardioNeo @neo_twiter @NeoHemodynamics @NeoHeartSociety @HebertAudrey3 @souvik_neo 😂 But hasn’t even been treated yet! I try a stepwise approach to see what therapies baby responds best. Esp since clinically seems to be ok. Not that high FiO2 and otherwise, from the info provided, seems to be CVS stable. But yes, it’s possible more therapies may be needed!

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Adrianne R Bischoff

@arbischoff

9 months

@wilcorder I have to add a 3rd.. Dopamine's effect on CO is unpredictable in prems (Zhang J et al, 1999). It increases the BP on all, no doubt. But in some, it may drop the CO. So you may be fooled into thinking you are helping (since BP improved) even though the physiology could be worse.

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Adrianne R Bischoff

@arbischoff

9 months

@draloksharma74 @NICUchris We monitor right arm BPs q4h with the baby calm and use isradipine as needed for SBP >99th ile. If the baby has proven persistent hypertension (>95th ile) our 1st line is amlodipine (enalapril if >36wks and echo features of LV diastolic dysfx). Also do renal US and Cr.

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Adrianne R Bischoff

@arbischoff

10 months

@asifpedia No. I mean that relying exclusively on pre/post-ductal SpO2 gradient (even if the PDA is open) is not reliable enough in the prediction of severe pulmonary hypertension :)

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Adrianne R Bischoff

@arbischoff

10 months

@dr_montasser @AMHeuchan We started with dobutamine and iNO. But due to persistent hypoxemia and RV dysfunction we added milrinone. Weaned off all medications within 24h!

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Adrianne R Bischoff

@arbischoff

1 year

@nicupodcast @UIowaPeds Agree that more research is needed! And definitely the improved outcomes are related to the implementation of the Neonatal Hemodynamics Program, which is much broader than strict PDA targeted therapy. #neohemodynamics #pda

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Adrianne R Bischoff

@arbischoff

6 months

@NeoHemodynamics Tissue Doppler Imaging: Utility in the NICU and pitfals today at 1PM CST with Dr. Phanikiran Yajamanyam ! Looking forward to learning more about another center's expertise using Tissue Doppler and exploring the potential future uses of this technique!

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Adrianne R Bischoff

@arbischoff

10 months

@murgastorrazza Thanks for your answer! I’m curious.. Why low dose dobutamine? Also, furosemide will increase renal production of PGE, which is counterproductive if you are trying to close the duct.

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Adrianne R Bischoff

@arbischoff

10 months

@draloksharma74 @souvik_neo @neosatyan @NeoHemodynamics @NeoHeartSociety @HebertAudrey3 @CardioNeo Clinically it can be very difficult to distinguish these patients. However the post-capillary phenotype ones are nearly always hypertensive. Hypertension alone won’t differentiate them, but it would be unlikely for a normotensive baby to have that specific phenotype

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Adrianne R Bischoff

@arbischoff

9 months

@Neo_Dr_K @Dr_RyMy Ideally. Yes. But will most neos accept enrolling their patients? Also, the planning of these will be of utmost importance. If we keep committing the same design flaws, we will continue to have imprecise answers that provide us with a fake-sense of evidence-based practice

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Adrianne R Bischoff

@arbischoff

9 months

@SapienHomo91 Focusing on what the main physiological problems are for each individual case: pulm vasodilation (exclusive if possible), inotropy (if impaired). Increase SVR as needed to maintain coronary and end-organ perfusion w/o causing excessive increases in afterload to the RV.

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Adrianne R Bischoff

@arbischoff

6 months

Today! Good segway tonour TDI discussion of the week!

Neonatal Hemodynamics Research Centre

@NeoHemodynamics

6 months

The next NHRC Site Presentation is tomorrow March 20th @ 2pm ET on Tissue Doppler Imaging: Utility in the NICU & Pitfalls. Dr. Phani Kiran Yajamanyam will be joined by Drs. Adrianne Bischoff, Samir Gupta and Phil Levy! #neotwitter

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Adrianne R Bischoff

@arbischoff

9 months

@HebertAudrey3 @pocusneo @NeoHemodynamics @ScotNeoPOCUS We have a dedicated GE machine for pocus. For. Vascular access insertion (peripheral art lines) it’s got a wonderful linear probe. For line placement assessment the curvilinear probe is not that awesome, I prefer to use our GE Vivid E90 and E95 that we use for echos

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Adrianne R Bischoff

@arbischoff

8 months

Interesting take on the intersection between neonatal echocardiogram for pulmonary hypertension assessment and AI: @LindseyKnake and @NeomindAi , thoughts? How do we move forward and progress into the future of AI and its implementation? #neohemodynamics

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Adrianne R Bischoff

@arbischoff

8 months

@adrisdoc @AAPneonatal @neo_twiter Trial of therapy that is not effective in mixed risk group of patients. Doesn’t answer the question “should the PDA be treated/closed in high risk populations?”.

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Adrianne R Bischoff

@arbischoff

9 months

@IM_Crit_ @mughal381 In neonatal ICU it’s definitely titratable!

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Adrianne R Bischoff

@arbischoff

7 months

We also don’t use it. We only pay a bit more attention in cases of VOGM as an additional trending tool for shunt physiology. 1) challenges interpreting normative data 2) error margin, particularly of annulus and/or cross sectional area measurements

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Adrianne R Bischoff

@arbischoff

8 months

@BrianKingNeo @afif_elKhuffash @drbretty @NicUof @padkaer @DrAbdulRazak_MD @amitguptabliss @nicupodcast Definition of failure is heterogeneous. In Iowa, even with relatively late extubation practices, we prob have a "low" threshold for reintubation. We use HFJV to minimize trauma of invasive MV and believe it to be less harmful vs using high NIV pressures just to keep the ETT out.

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Adrianne R Bischoff

@arbischoff

8 months

@CardioNeo @NICUchris @HebertAudrey3 @souvik_neo @JosephTing13 @neosatyan 🐓 or 🥚? Does the hypertension lead to heart dysfunction? Or does the heart dysfunction activate the RAAS to maintain perfusion pressure to some organs, especially the kidney? Sometimes the clinical hx can clarify that, but not always.

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Adrianne R Bischoff

@arbischoff

10 months

@NeoAnup Definitely! However, PIVOTAL was accepted by the overall community only for patients who are mechanically ventilated. So the question is: Would neonatologists be willing to enroll these patients in order to clarify these questions?

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Adrianne R Bischoff

@arbischoff

10 months

@TripleBadger10 @ConditPaige 100%. The PDA decision is very reliant on respiratory and enteral pathology, but other important metrics are undervalued when looking at chronic systemic hypoperfusion!

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