During an April 22 webinar hosted by Becker’s Hospital Review and sponsored by Mallinckrodt, Amir Ashrafi, MD, cardiac neonatologist at Orange, Calif.-based Children’s Hospital of Orange County, discussed the value of teamwork and quality improvement within the neonatal intensive care unit, specifically when caring for newborns with persistent pulmonary hypertension.
Four key takeaways from the webinar:
1. Persistent pulmonary hypertension in newborns happens when heart and lung circulation fails to transition normally at birth. Occurring in about 2 of every 1,000 live births, the medical emergency requires rapid diagnosis and treatment, and has a mortality rate ranging from 4 percent to 33 percent.
2. Multiple supportive and therapeutic interventions are needed to treat PPHN. Extracorporeal membrane oxygenation is a highly complex and invasive technology that allows the infant’s heart and lungs to rest while providing adequate cardiorespiratory support to the body. Reserved as rescue therapy for severe cases, ECMO is resource-intensive and carries many risks in newborns, including stroke, clotting, other neurological complications and death. Instead, Dr. Ashrafi highlighted the use of inhaled nitric oxide as a better treatment for PPHN.
3. Inhaled nitric oxide opens up the lung’s blood vessels and improves blood flow in the lungs. Acting within 30 minutes to increase oxygen levels, iNO must be continuously administered and delivered via a specialized delivery system in conjunction with ventilatory support. iNO improves oxygenation and reduces the need for ECMO in term and near-term neonates with hypoxic respiratory failure associated with clinical or echocardiographic evidence of pulmonary hypertension in conjunction with ventilatory support and other appropriate agents.
4. The neonatal environment presents many complex safety challenges, and quality and safety considerations for both the drug and delivery system are paramount in helping to ensure appropriate administration of iNO. It’s important that iNO drug and delivery systems include manufacturer supply/service capabilities, technical assistance availability, and staff and parent training/education. Teamwork and a quality improvement approach can help identify and address organizational needs to support quality care and safety in iNO administration.
For more information on Mallinckrodt, click here.
