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Integrated cardiac care models of neonates with congenital heart disease: the evolving role of the neonatologist

Journal of Perinatology volume 41, pages 1774–1776 (2021)Cite this article

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Congenital heart disease (CHD) represents the most common birth defect in newborns [1]. Unique to the neonatal CHD population, postnatal care often requires transfer of patients between hospitals, units, and specialty services. The perioperative disposition of infants with CHD has evolved into a model whereby care may be provided in a dedicated stand-alone pediatric cardiac intensive care unit (CICU), a neonatal intensive care unit (NICU) or a combination of both, with triaging typically based on the infant’s phase of care, gestational age, birth weight, specific cardiac lesion and co-existing medical and surgical morbidities [2,3,4]. Although contemporary evidence provides conflicting results on the benefits of various models of care, more dedicated stand-alone pediatric CICUs [5] continue to open in Children’s hospitals in North America, and 25–30% of the patients in theses cardiac units are neonates [3,4,5,6,7,8]. Studies have shown that different compositions of teams trained in cardiology, critical care and/or cardiothoracic surgery have been identified as being primarily responsible for perioperative care in the CICU [6]. While these cardiac disciplines receive specialized training to care for the full spectrum of individuals with cardiac disease, there may be a lack of extensive exposure in considering implications of prematurity as well as neonatal and transitional physiology. Even as pediatric cardiac intensive care emerges as a clinical field to meet the distinct needs of individuals with congenital and acquired heart disease [5], there is an increased recognition that neonatologists should be integrated in these daily care delivery models [9, 10]; however, limited data currently exist outside of the NICU to guide such practice change. Accordingly, we aimed to investigate perioperative models of neonatology care delivery in term and preterm neonates undergoing surgery for CHD in large quaternary Children’s hospitals in North America with high-volume neonatal cardiac surgery programs.

A descriptive cross-sectional survey design was sent to site sponsors of the Children’s Hospitals Neonatal Consortium (CHNC), a multicenter collaborative of 36 Level IV NICUs in Children’s hospitals in North American dedicated to developing quality and research initiatives. The survey was developed with the Survey Monkey® platform (Survey Monkey, Portland, OR) and questions were designed with a specific focus on the determinants of the perioperative disposition to a specific unit for term and preterm neonates with CHD (including intervention for definitive closure or stenting of a patent ductus arteriosus, PDA) and the role of the neonatologist in these care models. This was a descriptive study design with no attempt to correlate to outcome measures.

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Fig. 1: Perioperative disposition of neonates with congenital heart disease.
Fig. 2: Neonatology involvement at each phase of care for neonates with congenital heart disease.

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Acknowledgements

We are indebted to the following institutions that serve the infants and their families, and these institutions also have invested in and continue to participate in the Children’s Hospital’s Neonatal Database (CHND).

Jeanette Asselin, Beverly Brozanski, David Durand (ex officio), Francine Dykes (ex officio), Jacquelyn Evans (Executive Director), Theresa Grover, Karna Murthy (Chair), Michael Padula, Eugenia Pallotto, Anthony Piazza, Kristina Reber and Billie Short are members of the Children’s Hospitals Neonatal Consortium, Inc. For more information, please contact: support@thechnc.org.

The site sponsors/contributors for the CHND include:

1. AI DuPont Hospital for Children, Wilmington, DE (Kevin Sullivan).

2. All Children’s Hospital, St. Petersburg, FL (Victor McKay).

3. American Family Children’s Hospital, Madison, WI (Jamie Limjoco).

4. Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL (Karna Murthy, Gustave Falciglia).

5. Arkansas Children’s Hospital, Little Rock, AR (Robert Lyle, Becky Rogers).

6. Brenner Children’s Hospital, Winston Salem, NC (Cherie Welch).

7. Children’s Healthcare of Atlanta, Atlanta, GA (Anthony Piazza).

8. Children’s Hospital & Research Center Oakland, Oakland, CA (Priscilla Joe).

9. Children’s Hospital Boston, Boston, MA (Anne Hansen, Philip Levy).

10. Children’s Hospital Colorado, Aurora, CO (Theresa Grover).

11. Children’s Hospital of Alabama, Birmingham, AL (Carl Coghill).

12. Children’s Hospital of Pittsburgh of UPMC, Pittsburgh, PA (Toby Yanowitz).

13. Children’s Medical Center, Dallas, TX (Rashmin Savani).

14. Children’s Mercy Hospitals & Clinics, Kansas City, MO (Eugenia Pallotto).

15. Children’s National Medical Center, Washington, DC (Billie Short, An Massaro).

16. Children’s Healthcare of Atlanta at Scottish Rite (Gregory Sysyn).

17. Children’s Hospital Los Angeles, Los Angeles, CA (Rachel Chapman).

18. Children’s Hospital of Michigan, Detroit, MI (Girija Natarajan).

19. Children’s Hospital of Omaha (Lynne Willett, Nicole Birge).

20. Children’s Hospital of Wisconsin, Milwaukee, WI (Michael Uhing, Ankur Datta).

21. Children’s Hospital Orange County, Los Angeles, CA (Michel Mikhael).

22. Cincinnati Children’s Hospital, Cincinnati, OH (Beth Haberman).

23. Connecticut Children’s Hospital, Hartford, CT (Annmarie Golioto).

24. Cook Children’s Health Care System, Fort Worth, TX (Annie Chi, Yvette Johnson).

25. Florida Hospital for Children (Rajan Wadhawan).

26. Hospital for Sick Children, Toronto, ON (Kyong-Soon Lee).

27. Le Bonheur Children’s Hospital, Memphis, TN (Ajay Talati).

28. Nationwide Children’s Hospital, Columbus, OH (Kristina Reber).

29. Primary Children’s Medical Center, Salt Lake City, UT (Con Yee Ling).

30. Rady Children’s Hospital, San Diego, CA (Mark Speziale, Laurel Moyer).

31. Riley Children’s Hospital, Indianapolis, IN (William Engle).

32. Seattle Children’s Hospital, Seattle, WA (Elizabeth Jacobsen-Misbe, Robert.

33. St. Christopher’s Hospital for Children, Philadelphia, PA (Suzanne Touch).

34. St. Louis Children’s Hospital, St Louis, MO (Rakesh Rao, Beverly Brozanski).

35. Texas Children’s Hospital, Houston, TX (Gautham Suresh).

36. The Children’s Hospital of Philadelphia, Philadelphia, PA (Michael Padula, David Munson).

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Authors and Affiliations

  1. Division of Neonatology, Emory University and Children’s Healthcare of Atlanta, Atlanta, GA, USA

    Shannon E. G. Hamrick

  2. Division of Neonatology, The Ohio State University Wexner Medical Center, Columbus, OH, USA

    Molly K. Ball

  3. Division of Neonatology, Children’s Mercy Hospital, Kansas City, MO, USA

    Ayan Rajgarhia

  4. Division of Neonatology, Cincinnati Children’s Hospital Medical Center, University of Cincinnati, Cincinnati, OH, USA

    Beth Ann Johnson

  5. Department of Pediatrics, Division of Neonatology, University of Washington School of Medicine and Seattle Children’s Hospital, Seattle, WA, USA

    Robert DiGeronimo

  6. Department of Pediatrics, Harvard Medical School and Division of Newborn Medicine, Boston Children’s Hospital, Boston, MA, USA

    Philip T. Levy

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  1. Shannon E. G. Hamrick
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  6. Philip T. Levy
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Children’s Hospital Neonatal Consortium (CHNC) Cardiac Focus Group

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Correspondence to Shannon E. G. Hamrick.

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Hamrick, S.E.G., Ball, M.K., Rajgarhia, A. et al. Integrated cardiac care models of neonates with congenital heart disease: the evolving role of the neonatologist. J Perinatol 41, 1774–1776 (2021). https://doi.org/10.1038/s41372-021-01117-3

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