Colorado Fetal Care Center 2017 Overview and Outcomes CIMFH-160082376-2019-12-CFCC Outcomes Brochure-FIN | Page 21

Abnormal ventricular contractility in fetuses with
estimated weight less than the tenth centile
American Journal of Obstetrics and Gynecology, November 2019
In a retrospective study of 50 fetuses with an estimated
fetal weight in less than the tenth centile, we found high
rates of abnormal ventricular contractility — irrespective of
the Doppler findings of the pulsatility index of the umbilical
artery or cerebroplacental ratio. These findings demonstrate
that these fetuses may be considered for assessment of
ventricular contractility even when corresponding Doppler
findings are normal.
Indomethacin dosing and constriction of the
ductus arteriosus
Fetal Diagnosis and Therapy, 2018
The use of perioperative tocolytic agents such as
indomethacin is imperative to prevent preterm labor;
however, indomethacin can also cause ductus arteriosus
constriction. This retrospective observational case
series of 42 pregnant mothers who underwent open fetal
myelomeningocele repair observed ductus arteriosus
constriction in all fetuses receiving two doses of
indomethacin and in 71.4% receiving one dose. These fetuses
were all between 23-26 weeks gestation. Historically, this
effect on the ductus was felt to be dependent on gestational
age with a greater effect occurring later rather than earlier
in gestation. Perhaps the combination of fetal surgery,
anesthesia and magnesium sulfate potentiated the effect
of indomethacin on the ductus arteriosus. One dose of
indomethacin and greater magnesium sulfate dosing was
associated with reduced DA constriction.
Pain management
As one of 30 NICUs participating in the
Children’s Hospitals Neonatal Consortium, a
national quality improvement collaborative,
we launched a 2-year project in June 2019
to standardize our post-operative pain
management. We’re developing medication
algorithms for various types of surgery,
along with specific non-pharmacologic pain
management techniques, with a goal of
having no patients with unrelieved pain in
the first 72 hours.
As a result, we’ve seen dramatic
improvement in pain control and patient
and staff satisfaction thus far.
87%
Patients with well
controlled pain
93%
Of parents satisfied with baby’s
pain control after surgery
93%
Of bedside nurses satisfied with
patient’s pain control in the first
72 hours after surgery
Colorado Fetal Care Center 2019
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