Neonatal Haemodynamics (Online)

Learning Outcomes

Learning Outcomes

Having successfully completed this module you will be able to:

• increase your detailed knowledge and understanding of therapeutic interventions which are available to manage the neonatal circulatory system and those neonates with circulatory compromise
• develop a critical understanding of fetal circulation, transitional changes at birth and the specific characteristics of the circulatory system at different post- conceptional ages
• demonstrate insight into the processes and considerations required for collaborative ethical complex clinical decision-making
• critically apply your knowledge and understanding to complex clinical situations
• demonstrate your understanding of the detailed specialist knowledge and understanding of the anatomy and development 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 10 participants and discussions will be directed and modulated 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 Skype. Where appropriate, “Plenary Sessions” will be included, which will allow you to share in discussions on specific topics. A range of resource material, including links to relevant online sites, will be made available on 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

Online Neonatal Cardiology Textbook.

Handbook of Pediatrics and Neonatology (Cardiology Chapter 32).

Neonatal echoskills.

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

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 and a written assignment will also be provided within the Assessment Office of the VLE.

The summative tri-partite 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 written examination comprising 30 “best-of-five” questions. This contributes 60% of your final mark.

(these questions consist of a descriptive stem, a specific lead-in question and 5 options from which one best answer must be selected).

2. Qualitative and quantitative evaluation of your online activity and participation within your learning group. This contributes 20% of your final mark.

3. An evidence-based clinically relevant written assignment of 1,500 words focused on demonstrating your ability to write at Master's level. This contributes 20% of your final mark.

All elements of the assessment must be attempted and an overall pass mark of 50% or more must be achieved for successful completion of the module.

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 Information

Repeat type: Internal & External