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Not all neonatal PH is the same. Same echo clues, different phenotypes: 1️⃣ PVR-driven 2️⃣ Flow-driven (shunts) 3️⃣ Left-heart driven Ask smarter Qs: Atrial shunt direction? Other L→R shunts? RV vs LV dysfunction? Pulmonary vein flow?

Poor agreement on RV function in neonates using qualitative echo: 🧠 Kappa for RV function = 0.3 📏 RV size = 0.14 🫠 Septal flattening = 0.2 Not all heart dysfunction is PH. Let’s advocate for TAPSE, EI, and real metrics in our NICU echo reports.

Dopamine may raise blood pressure in preterm infants, but at a cost. 🧠 It can increase both systemic and pulmonary vascular resistance, worsening RV afterload and oxygenation. ➡️ Liet et al. (2002): 50% had worsened PAP/SAP after dopamine. Ref: McNamara et al., 2022

In animal PH models, dopamine often raises PAP as much—or more—than SAP. 🐑 In lambs with PH, SAP and PAP rose equally. 🐷 In piglets, dopamine decreased the SAP/PAP ratio. No improvement in oxygenation was seen. (Lakshminrusimha et al., 2016; Manouchehri et al., 2020)

PH and norepi? In term infants with PPHN (FiO₂ ~50%), norepinephrine improved systemic pressure, pulmonary flow & oxygenation. 🩸 PAP/SAP ↓ from 0.98 → 0.87 🫁 LVO ↑ 📉 FiO₂ ↓ (Tourneux et al., 2008) Caution: results from moderate disease only.

Norepi — Not Risk-Free Norepinephrine isn’t always safe in severe PH. 📈 In lamb models, norepi raised both SAP and PAP. ⛔ High doses or FiO₂ may worsen PVR. ⚠️ Especially risky with RV dysfunction. Ref: McNamara et al., 2022; Cicalese et al., 1992

Norepinephrine and PVR—A Balancing Act Norepi may help perfusion—but in neonates with labile pulmonary beds, even small PAP rises can destabilize a failing RV. 📈 Some animal models show dose-dependent ↑ in PVR, esp. with high FiO₂. McNamara et al., 2022; Cheung et al., 2001

Dopamine raises BP in preemies — but not always cardiac output. In Osborn et al (2002), some infants ↑ CO, others ↓ CO despite ↑ MAP. That bar graph? A classic. 📉 BP ≠ perfusion 📚 J Pediatr 2002;140:183–91

New data from 🇨🇦 on iNO for acute PH in preterm neonates Early PH (≤72h) ➡️ High response rate, lower mortality A drop in FiO₂ ≥0.20 at 4h = survival signal 📉 Here’s what the numbers say. 🔽 Infographic below ⬇️ Baczynski et al. JAMA Netw Open 2025;8(2):e2458843

Thankful to have such a great group of motivated physicians at our Observership Experience this week! Learn more: gme.medicine.uiowa.edu/neonatology-he… Rachael Hyland, MD Adrianne R Bischoff Dilara Mat Numra jwrenmdphd

Same treatment, different outcomes. 🫁 Inhaled NO in preterm infants with acute PH 👉 Timing matters. #iNO works best in transitional PH (≤72h) 🧠 Less clear role in late PH Breakdown 👇 — Baczynski et al, JAMA Network Open, 2025

Just wrapped up my sessions at the Hemodynamics & POCUS Course (Gothenburg 🇸🇪) PDA echo assessment and Transcatheter closure: evidence, nuance & post-closure physiology Grateful for the chance to teach — and keep wondering: What more could we learn with better non-invasive tools?

Neonatal hemodynamics is ready for its AI moment. We’ve done so much with imperfect tools. Imagine what we could do with better ones. 👀 Watching the space of BSI, echo innovation, and AI imaging closely.

Honored to return (virtually) to my alma mater for this International Grand Round with HCPA/FAMED-UFRGS 🗓 May 28 | 11h BRT 📍 Auditório José Baldi + YouTube 🎙 Manual não oficial do bebê instável: a perspectiva hemodinâmica POA to Iowa — grateful to share the journey.

🧠Case report: LV systolic dysfunction + systemic HTN in a preterm infant with HIE following lacosamide initiation for status epilepticus. EF dropped to 42% TnECHO-guided management + drug withdrawal → full recovery Caution warranted in neonatal use. 🔗 doi.org/10.1055/a-2447…

Clinicians aren’t just end-users — we can be co-designers. I’ve started exploring how to bring neonatal hemodynamics expertise to MedTech innovation. Curious who else is walking this bridge between bedside and buildside.

🧠 New RCT: In ELGA neonates, a structured hemodynamic approach (TNE + NIRS + clinical data) didn’t change mean VVR score at day 7—but reduced BPD (41% vs 59%) and avoided VVR >53, a threshold tied to worse outcomes. 🔗 jamanetwork.com/journals/jaman…

In the NICU, we don’t just need more data—we need clearer signals to guide decisions. Structured hemodynamic monitoring (TNE + NIRS) in ELGA infants may have changed how and when teams acted. Insight drives intention. 🔗 jamanetwork.com/journals/jaman…

Neonatal hemodynamics is ready for its AI moment. We’ve done so much with imperfect tools. Imagine what we could do with better ones. 👀 Watching the space of BSI, echo innovation, and AI imaging closely.

Why does a preemie’s heart need extra support? And how do we know when it does? In Ep. 42 of @handtohold’s #NICUHeroes podcast, I share what we’ve learned about Neo-HD! 🎧 open.spotify.com/episode/7IA4ex… youtube.com/watch?v=RpsptJ… handtohold.org/resources/podc…