Neonatal Haemodynamics (Online)

Learning Outcomes

Learning Outcomes

Having successfully completed this module you will be able to:

• critically apply your knowledge and understanding to complex clinical situations
• demonstrate insight into the processes and considerations required for collaborative ethical complex clinical decision-making
• develop a critical understanding of fetal circulation, transitional changes at birth and the specific characteristics of the circulatory system at different post- conceptional ages
• increase your detailed knowledge and understanding of therapeutic interventions which are available to manage the neonatal circulatory system and neonates with circulatory compromise
• demonstrate your understanding of the detailed specialist knowledge and understanding of the anatomy and developmental physiology of the circulatory system

The following topic areas will be included:

Fetal Circulation and Early Transition

• Fetal Physiology of the Cardiovascular system
• Transitional Changes at birth (Term and Preterm infants)
• Regulation of Vascular Tone during Transition
• Consequences of early umbilical cord clamping
• The Role of Shunts in determining cardiac output
• Myocardial Function and the preterm neonatal circulation

Low Blood Flow States (Includes management of septic shock

• Relationship between arterial blood pressure and systemic blood flow
• Causes of low blood flow states in neonates
• Clinical assessment of the adequacy of the cardiovascular system
• Use of neonatal echocardiography to guide management of low blood flow states
• Approach to a preterm infant with circulatory compromise

Patent Ductus Arteriosus in the Preterm Infant

• Physiology and Pathophysiology of the Ductus Arteriosus (DA)
• Association between a patent ductus arteriosus (PDA) and morbidity/mortality.
• Haemodynamic and Clinical Effects of a PDA
• Diagnosis of a PDA (Clinical, Echocardiography and Biomarkers)
• Management of the preterm PDA (conservative, medical prophylactic/early, surgical)

Pulmonary Hypertension of the Newborn (PPHN)

• Mediators of circulatory transition at birth
• Pathophysiology of PPHN
• Aetiology and classification of PPHN
• Clinical and Echocardiography diagnosis of PPHN
• Management of PPHN (Supportive, iNO, adjuvant medical therapy)
• ECMO in PPHN
• Management of PPHN in infants with HIE
• Management of hypotension in PPHN
• Management of pulmonary hypertension in preterm infants
• Long-term outcome

Approach to an infant with suspected congenital heart disease (CHD)

• Clinical features and assessment of CHD in Neonates
• Echocardiography and term preterm CHD
• Approach to management (Term and Preterm)
• Outcome of infants with CHD
• Common neonatal arrhythmias
• Neonatal cardiomyopathies

Targeted Neonatal Echocardiography (TNE)

• Role of TNE in neonatal intensive care
• Indications of TNE
• Basic echocardiography windows and views

Teaching and learning methods

The module will take a broad-based learner centred approach to teaching and learning methods, intending to promote deeper learning whilst meeting a range of learning styles. The core theoretical material will be delivered as online text “lectures” within a “Virtual Learning Environment” (VLE) and you will be allocated to discussion groups (“Discussion Forums”) which will be tasked with reflecting on, and discussing within the VLE, clinical scenarios which relate to the theoretical material. The groups will each include about 15 participants and discussions will be directed and moderated by experienced tutors – two per group. While most of the discussions will be asynchronous – by leaving comments within the Discussion Forums - each group will also hold synchronous discussions, possibly once every two or three weeks, when they will “meet” together either online or using media such as Teams or Zoom. Where appropriate, “Plenary Sessions” will be included, which will allow you to contribute to discussions on specific topics. In addition, normally a number of renowned Guest Lecturers will present their latest research and finally a range of resource material, including links to relevant online sites, will be made available in the VLE.

Resources & Reading list

General Resources

A comprehensive online library will be available which provides access to generic resources (e.g. basic sciences, physiology, pharmacology, genetics, evidence based medicine) and specific neonatology resources..

Internet Resources

Handbook of Pediatrics and Neonatology (Cardiology Chapter 32).

Online Neonatal Cardiology Textbook.

Common Hemodynamic Problems in the Neonate. Barrington KJ Neonatology, 103:335–340.

Neonatal echoskills.

Assessment strategy

The formative strategy will enable iterative formative written feedback to be provided with regard to your online activity. This will be completed by your online tutors and the module lead half way through the module. In addition examples of the MCQ questions will be provided within the Assessment Office of the VLE.

The summative approach to assessment is designed to enable you to demonstrate your depth and breadth of neonatal cardiology knowledge as well as your ability to demonstrate your ability to use higher cognitive skills. It includes the following:

1. An unseen 2 hour online MCQ-applied knowledge assessment examination. The aim will be to assess the depth and breadth of knowledge as well as your clinical judgement. This contributes 70% of your final mark.

2. Qualitative and quantitative evaluation of your online activity and participation within your learning group. This contributes 30% of your final mark.

For successful completion of the module both elements of the assessment must be attempted and a pass mark of 50% or more must be achieved for each component

Formative

This is how we’ll give you feedback as you are learning. It is not a formal test or exam.

Summative

This is how we’ll formally assess what you have learned in this module.

Referral

This is how we’ll assess you if you don’t meet the criteria to pass this module.

Repeat

An internal repeat is where you take all of your modules again, including any you passed. An external repeat is where you only re-take the modules you failed.

Repeat Information

Repeat type: Internal & External