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#067 - NeoHeart 2022 Conference


Amir Ashrafi neoheart incubator podcast

Hello Friends 👋

We are happy to start a series of episodes where we introduce and showcase some of the amazing conferences taking place in the field of neonatology. Our goal is to provide enough information and coverage in order to help you find out what is the scope of each conference and help you decide whether to attend. This week we talk to Dr. Amir Ashrafi who is on the Program Committee of NeoHeart 2022 and talks to us about what is planned for this year's event, how to register and how to submit abstracts.

If you know of a conference we should feature on the show, let us know by email: nicupodcast@gmail.com


 

Amir Ashrafi Bio: Dr. Amir H. Ashrafi is a cardiac neonatologist at CHOC Children’s Hospital and one of the few physicians to receive formal training in both neonatal intensive care and pediatric cardiac intensive care. Dr. Ashrafi’s primary interest is neonates with hemodynamic instability and/or congenital heart disease. He is the medical director of the neonatal ECMO program, the director of the neonatal-cardiac intensive care unit, the program director for the neonatal cardiovascular intensive care and hemodynamics fellowship at UC Irvine, the founder of the Neonatal Heart Society, and chairman of international meeting “NeoHeart: Cardiovascular Management of the Neonate”. Prior to joining CHOC Children’s, Dr. Ashrafi attended medical school at the University of Utah followed by his pediatric residency training at the Emory University in Atlanta, GA. He then completed his Neonatal Intensive Care fellowship at UCLA where he was recognized as the chief fellow. Dr. Ashrafi then went on to complete a second fellowship in Pediatric Cardiac Intensive Care at Boston Children’s Hospital.


 

The transcript of today's episode can be found below 👇


Ben 0:40

Welcome. Yeah. Hello, everybody. Welcome back to the incubator. We have a special episode for you today we are having a big team around the table team. So definitely do you want to introduce our participants?


Daphna 1:00

Well, I sure do. I'm really excited. You know, we this is something we've been talking about wanting to do. And we're really pleased to be able to be talking about the Neo Heart Conference. I know it's something I've wanted to attend But haven't you know, haven't been able to make it happen, but I am. I'm feeling like after people hear this podcast that they will be wanting to sign up. So today we have on Dr. Rooney Tom's who we've had on the show before, and and Dr. Amir Ashrafi. So we are so excited to have them both on.


Ben 1:41

Yeah, this is very exciting. Amir, thank you so much for being on the show with us.


Amir Ashrafi 1:45

Oh, it's an absolute pleasure. Thank you so much for the invitation Benedetta and


Ben 1:49

Rooney. Welcome back.


Rune 1:50

Thank you so much, guys. I appreciate


Ben 1:52

you coming. You're becoming a feature of the show, you might become a consistent host at this point.


Rune 1:57

We'll see. Yes.


Ben 2:00

So we're very excited to be able to bring to the community information about some of the conferences that are happening in and around the field of neonatology. And we wanted to do something special with new heart because there's a lot of topics related to PDA hemodynamics that everybody is talking about. And we thought that Neo heart sometimes could be perceived because of its name as like a cardiologist only conference, but it really isn't. And it's something that could be very, very relevant to our community. So Amir, can you tell us a little bit about new heart? And what is the goal of the conference? And in a few words,


Amir Ashrafi 2:35

awesome. Thank you so much, Ben. It's funny when I talked to the neonatal community, they say I think it's geared way too much towards the heart. And when I talk to the cardiology community skewed way too much towards the neonatologist, so neither side is totally happy that we probably struck the right balance. So Neo heart is exactly what it sounds, it's this amalgamation between the neonatal community and the cardiology community. Much like Rooney I trained on both sides, I've seen both sides. And neonatologist love to criticize the cvicu, the cvicu love to criticize neonatology. And this is just one of those, you know,


Daphna 3:09

fellas get stuck right in between, right? What's that? The fellows get stuck, right, and the fellows get


Amir Ashrafi 3:14

stuck in between. And in all honesty, as much as we joke about it, I think both sides have legitimacy to it. If you know, if you were to manage a typical neonate, the way the cvicu does, of course, it'd be catastrophic. And vice versa, if you manage a single ventricle, restrictive atrial septum the way most neonatal, you know, micro preemie management is, of course, it would be catastrophic as well. So I think both sides have some legitimacy. But on the other side of things, there's a lot that should and could be learned from one another, there's certain things that we do very well. And of course, vice versa. And there's a lot of things that overlap that I don't think people fully appreciate. Managing diaphragmatic hernia is much closer to managing Shawn's complex than it is to managing anything else in you know, 24 weeks, there's just so many more similarities than those two, managing a, you know, a kid who's actively being cool, there's not too much different than managing a kid that's just coming straight off of bypass who is hypothermic for, you know, reasons of, you know, chronic arrhythmias or something to that effect. There's just a lot more similarities that we don't fully appreciate. So bringing the two worlds together was really the goal of the meeting.


Ben 4:25

And so for the for the people who haven't checked out the website, can you so the conference will take place this year, between August 3 and August 6, correct?


Amir Ashrafi 4:37

That is correct. August three through six in Disneyland, California.


Ben 4:41

I love that you. I mean, you could have sent out so much more appealing.


Amir Ashrafi 4:47

We it's actually the first time we've done Disneyland we've they've tried to lower us multiple times. And I was personally the one that pushed back and said no, let's do a beach. Let's do a beach location, beach location. So it's always been in Huntington Beach or or actually are San Diego right on the water. Every time from the conference, you walk out the ocean has been right in front of you. This time we figured it's COVID, it's the summer, people are gonna want to spend time with their families, Disneyland is a good, that's a good time to do Disneyland, let people bring their families. That's a great idea. And you were talking about the website, I am embarrassed that I don't know the top of my head, but I'm pretty sure it's www.chopped.org/neal Hart, Choccy josie.org/new. York, I think that's the website. And you


Ben 5:29

have a web dots event.com page for the conference, which we will link in the description. I wanted to touch base a little bit with you about you were mentioning how you are hoping that new heart could be this place where everybody comes together. And I think you guys are doing that very, very well, because it incorporates a lot of different I guess I want to say like societies like you have a newborn brain society, you have this Pacific Coast fetal cardiology group, you have the next society. And then you have, I guess, PDA the PDA symposium is incorporated into the new heart conference now. So can you tell us a little bit about all these different? This this this, this massive collaboration between all these entities?


Amir Ashrafi 6:15

Great question, Ben. If I had to summarize Neil heart into one line, and we've said this, I can't tell you how many times have we 1000s of times, we've said this most each other break down silos, that's pretty much if I didn't narrow it down to one sentence break down silos. Originally, it was just a neonatal community versus cardiac community that had to start to expand to neonatal cardiac anesthesia surgery. But let's not forget nurses and ancillary staff like pharmacists and restaurants that are very cool, then we started to go even bigger. And you can't really talk about human analysis without, especially in neonatal hemodynamics, we are talking about long term note of mental implications. So let's break down those silos as well. And that's where the newborn brain society comes. So much of what we talked about, and human intimacy of the extremely pre term revolves around necrotizing enterocolitis, and the implications of poor perfusion to the gut. In the cvicu world, so much of their conversations are around single ventricle physiology, post op feeding algorithms and neck in those patients. So there's just no way of getting around how much these are integrated with one another. So we call the next society may said we would love to be a part of this. I think this goes for all of neonatology that, no longer can we think of fetal and neonatal as two separate entities. I think, whether you like it or not, the two are absolutely completely aligned decisions you make in the fetal world, we'll have direct ramifications in the neonatal world, there's an absolute Continuum of Care there. So bringing the fetal world in was absolutely critical, eliminating that silo. And then, of course, it's a continuum. It's an absolute continuum. And then the PDA was just a natural fit. We've been talking about this for four or five years now. chalk this up to one of the benefits of COVID I guess it just it just made it so that all of these societies, all of these groups came together for so one big large epic meeting.


Ben 8:13

Hmm. So I guess


Amir Ashrafi 8:17

let me put a plug in if you don't mind, can I put a put plug in, I think Rooney, you open people's eyes more than anybody else to the, to the notion of heart disease and necrotizing enterocolitis and single ventricle physiology. We've highlighted your paper, I think it was 2015. It's been a while now. But that paper has been highlighted and quoted dozens of times.


Rune 8:38

Yeah, that's true. And the funny story behind that, and I have to kind of give credit to the group that I worked at, at the time at UAB and children's was that we, in fact, had a discussion in our division meeting whether or not to feed babies with single ventricle. And the paradigm then was not to feed right. And I come back from Boston not too long ago, and we didn't feed single ventricle physiology patients. But I was challenged. And then I said, you know, I use that kind of box of how am I going to respond to a challenge like that? And I said, Okay, maybe maybe I'm wrong. So so it was a group effort at Children's at the time with Dr. Bernstein and Dr. Alton and with this and actually Molander and we decided okay, let's let's do a study so that we can prove that it's feasible to actually do at least our trophic feeds. And yeah, so again, something is simple discussion. Something simple then ultimately led to, to changing the preoperative management of hypoplastic left heart syndrome, which was fun.


Ben 9:48

Very cool. Rooney. Can you tell us in in your words since since we have the pleasure of having you on as well? A little bit about what you think the appeal would be for a neonatologist, for example, who is who is being pulled, I mean, let's give let's give our people some credit. We're being pulled in all sorts of directions. And so you do have to make some commitments. And maybe this year, you can go to a few conferences, and next year, you'll be able to go to another but like, Why do you think it would be compelling and relevant for neonatologist to attend? Neil Hart?


Rune 10:22

Yeah, absolutely. So I do think that there, the benefits are so so many different levels. And I kind of asked myself that too, before this, this conference, or this discussion was, you know, how does either additional training in hemodynamics of cardiac ICU for a neonatologist? How does that benefit your clinical bedside kind of management and there's no doubt that your, your mindset and your focus and how you think of hemodynamics, how you think of blood pressure, how you think of all the parameters that you're watching, kind of changes and things can be crystallized out in how you actually ultimately clinically manage and perceive the patient in in in the NICU. And I do think Neil heart gives a perfect kind of, again, a blend of all the different areas that do matter, when it comes to invasive and non invasive monitoring, a little bit of the experience from the cvicu, even from the operating room, and how certain aspects can be beneficial when it comes to even outcomes of post op patients, and how we can maybe even bring that into the NICU. And like Amir said, when it comes to, you know, intestinal perfusion, when it comes to brain perfusion when it comes to brain protection, and the correct use of isotopes. So many times, which I tell you guys often, you know, people just ask you what other tools should I use? And then, you know, that's, you know, step away from that kind of question and really focus on the clinical assessment and tie in everything that you can learn at Newhart, also, including assessment of the doctors the recent evidence, and really, and that's where having tie a kind of torn down all these silos can benefit the participants in such a congress conference, where you can kind of really just cast a broad net and, and like Amir said, I mean, it's incredible what's actually here that the lifelong implications of what you actually do in the fetal life perinatal period. And now, you know, some of one of the talks is even looking at at long term myocardial dysfunction in the form of preemies. So again, tying all these things together really broadens your perspective of what you do every single day in the NICU.


Daphna 12:43

Yeah, I was actually hoping maybe I could talk about some of the titles, some of the talks because I mean, they're, they're totally relevant. I think, and this is just a handful of, I think there must be I don't know, close to 100 different sessions more than that, over the course of a few days. But just off the off the top of the list, reperfusion injury and cardiogenic shock, which we still we see in the NICU hemodynamics and therapeutic hypothermia, preterm infants with congenital heart disease, targeted neonatal echo, neonatal pulmonary hypertension, the neonatal management, with hypoplastic, left heart syndrome. There's a whole session on Congenital Diaphragmatic Hernia, obviously, tons of lectures on the PDA, looking at it from every single angle, in addition to the PDA symposium, something close to my heart, the ICU environment, impacting neuro development, decision making during pregnancy, decision making about taking the neonate to the cath lab neck and congenital heart disease picking the right sedation and a whole session on hot topics in neonatal care. And I mean, that's not even all the lectures that I think are neonatal, you know, you know, everything's neonatal relevant, that's called me a heart. So it's really cool lineup and the faculty lineup, it is so diverse comes from all over the country, which I think is something that is often hard for, for conferences to do. So I think this is really, really neat.


Ben 14:17

Yeah, and I think that sometimes you you, I mean, I think to the credit of other conferences as well, you can you can get the right the right mix of people. But in this specific case, I mean, neonatal cardiology involves so many different specialties that to be able to have a dedicated space in time to actually have these discussions. And the lineup, as you said, Mark Weems, Patrick McNamara, among others. It's not like these are leaders of our field. So it's kind of nice to have them all in in one place at one time to have constructive discussions about the PDA hemodynamics and all that.


Amir Ashrafi 14:56

Yeah, thank you for commenting on that. Thanks for Thanks for I was deaf enough, we put a lot of attention on the speakers, I think we have, to your point 134 speakers. So it's big. It is, to your point, the who's who in their fields. Nobody here is, you know, they're all five star recruits. Basically, these, these are the who's who we spent a lot of time as the planning committee talking about diversity in this, we wanted to make sure that there's near 5050 representation of NEOs and cardio, people live in the cardiac world, we want a 5050, male to female distribution, we tried to get as many international people as we can. And in order to make that happen, we also had to build in a hybrid component. So there will be a hybrid component to this. So some of the speakers will be lot the international speakers, some will be live, some will be in person, some will be live in their in their home country. We have Australia, we have Asia, we've got Europe, Middle East, so we got speakers from it to your point all over.


Daphna 16:00

You know, I was sorry, Ben, when you talk about breaking down silos. I mean, that's really what's happening, right, we have the leaders in our quote, unquote, you know, Neo neonatologist that we that we're following, and we see them on Twitter, and we're going to see them in the conferences, but there are leaders in each of these disciplines, right, and to have them all together and have them this, a lot of the sessions are really not a lecture, they're discourse. And so to be able to see different perspectives on the same topic, I think, is really, I mean, it's revolutionary, I love it, I think it's really cool


Amir Ashrafi 16:36

to know, you exactly know the depth. And I think you and me, were probably BFFs in another life, because everything you're saying is exactly what's going through through our minds, you know, for the longest time in our plenary sessions, I think nowadays, because everybody's got access to you know, your Twitter and your iPhone, we all have the latest and greatest publication that's come out, there's no information out there that none of us have access to immediately or have already heard or read about it. And so what becomes a much more interesting, interesting conversation is the gray zone where there isn't papers. So what do I do in that difficult scenario? What do the greats do in that difficult scenario? For example, should I do nitric oxide? Or should I not do nitric oxide and diaphragmatic hernia with pulmonary hypertension? The literature is conflicting. I don't know what to do I know there's a right time and a wrong time. What do the what is the Steve admins of the world do? And how did they decide? Or the can sellers? How did they decide? The robin Stein horns? The you know, the who's who of pulmonary hypertension? How did they decide? And so what we tried to do was sort of take a take a page out of TED talks, nobody wants to hear a one hour talk, we believe you about your Drosophila work back in the day, we don't need to hear about, let's just get straight to the point. Yeah, 15 minutes and make your point. Because if you can't make it 15 minutes, nobody's interested. So quick, short talks, with about a longer amount of time dedicated towards conversation with an equal distribution of neonatologist, cardiologists, cardiac intensive care, and bedside providers, and just keeping it very high level conversation.


Ben 18:07

That's huge. I wanted to actually highlight that point next, because I'm a very curious person. But to be honest, like, I normally thought we'd be able to sit through an hour and a half discussion on a topic that I'm not so familiar with. But I think what you described making the talks like 20 to 30 minutes tops, makes this more palatable. 15 minutes. So then it's exactly right. I mean, I'm perfectly fine listening. I mean, I listen to adult medicine stuff. So I have I have a some form of attention span. But I think this is this is this is critical. And


Daphna 18:42

intensivists with the with ADD, you know, we got absolutely


Unknown Speaker 18:44

all


Ben 18:48

I wanted. Yeah, I wanted to ask you guys, maybe so first of all, let me let me get some some logistical stuff out of the way here. People can so people were able to submit abstracts for this conference. I think that has closed or not yet.


Amir Ashrafi 19:03

We were initially going to have so thank you for listening. I have a closed date of tomorrow, July 1, but I think we're going to extend it to July 15. Because so many abstracts have come in in the last couple of days, which you would expect at the deadline. So we're going to extend it till July 15.


Ben 19:16

Okay, so if you're listening to this episode, I'm not sure I mean, we're recording not live. So I'm not sure when I'm going to release this episode. But whatever time you have left, you'll have time you'll have at least


Amir Ashrafi 19:25

a part of this. If you're part of this podcast, we'll let it we'll listeners of this podcast.


Daphna 19:33

They can put it on their abstract


Ben 19:36

and have a large community Amir, you have to be careful to stick with it.


Unknown Speaker 19:39

I'll stick with it with this podcast. I'll stick with it.


Ben 19:42

And then And then in terms of registration registration, my understanding doesn't close until the day of the conference. So technically people can register all the way through until the beginning of August. People can


Amir Ashrafi 19:55

register all the way through the beginning of August and we are going to Release the virtual component of it, probably the first or second week of July. And I don't quote me on this, I'm just playing with this idea in my head. I we haven't solidified it yet. Maybe we record it and actually can sell the recording afterwards as well for people who couldn't make it because they're on summer vacation on some exotic island and they really interested but couldn't will make it. It's just ideas we're toying around with. Fair


Ben 20:24

enough. And that's also an important point because that means that so there's an in person component in Disneyland in California, not the one in Florida. And that's and and what did I want to say? And there's a there's a hybrid components, so technically, people will be able also to, to, to sign up for a virtual component of for attending the conference. So that's really important. Rooney Amir, what are the talks? you're most looking forward to?


Unknown Speaker 20:55

Go for it running?


Rune 20:56

Oh, gosh, you know, you know, from when for moderating, no, actually. Not on the panel. But that's, that's, that's actually a good thing. I will say, the combination, so I always I love diastolic dysfunction. So I love any talk on on diastolic dysfunction. And so the RB diastolic dysfunction assessment or the RB function, cardiopulmonary interactions, those are the ones that I love. But I will say as the diaphragmatic hernia hemodynamics is also very intriguing. But I do look forward to listening once again. And this time I got to take notes. I was part of the BPD conference last time that I heard it the long term myocardial dysfunction of former preemies, I look forward to that talk.


Ben 21:45

Amir, awesome.


Amir Ashrafi 21:48

There's a talk that I heard once before, so I can't say I'm looking forward to it. But I want to give you guys a plug. Kara Goss is an adult intensivist out of Dallas children's, who's made her career on long term myocardial implications of preterm births. And you kind of hear it, Nick. Okay, that's interesting. It's mind blowing, it is the most, this is one of the greatest talks, one of the top three greatest talks I've ever heard in my life, it is absolutely spectacular. And usually, when you hear a talk, there's a rare that you really learn something new. It's sort of an extension of something you already knew, or sort of refined, which you already know, this is one of those few talks that I can really say the whole thing was mind blowing. For me, the whole thing was new, the whole thing was innovative, the whole thing was interesting. I was I was literally blown away by that talk. So I'm excited to hear that again. The session that I'm most excited about to the biggest mistake I ever made, and what I learned from it again, we've got the who's who. It's actually funny, we invited a lot of people, but you can just kind of imagine some people's egos were too big to give this talk. So some people said no, but there was a bunch of people that were like, oh, yeah, sign me up deal. We're an offski. I mean, one of the you know, one of the best speakers I've ever heard was like, you know, sign up. So that's a session I'm really excited about. But the other one that I'm excited about is the scientific urine review. This is the old these are the longest talks at 20 minutes, I figured if we're gonna do a urine review, it's unfair to do in 15 minutes, so we've given them five additional minutes for 20 minutes. So Gabrielle alternate from McGill trained in both neonatology and cardiology, doing neonatal hemodynamics urine review, you got neonatal pulmonary hypertension urine review, you got Patrick McNamara talking about T sne. Urine review, we got neonatal cardiac intensive care urine review. So just looking at all the big publications, and what does it mean for us at the bedside as clinicians? What should we take back with us that we maybe missed over the last year?


Ben 23:48

I mean, I obviously have less of an insight as you guys but there's one talk by Gil, we're not offski That's called good judgment comes from experience experience comes from bad judgment. I was curious to see what she what she's gonna say.


Amir Ashrafi 24:03

So, hands down. One of the best speakers is Gilbert offski.


Rune 24:09

Good mirror. The Noonan, Neil community. You may not be quite as familiar with Jill as, as the cvicu in cardiology, give us the brief summary of kind of his past. Gil,


Amir Ashrafi 24:23

I think was the first ever or one of the first cvicu fellows out of Boston Children's then went to chop and spent his career there and now he's a nationwide. He is a huge advocate for neonatologist in the NICU. In fact, he is also leading the World Congress of cardiology and cardiothoracic surgery meeting next year, which is sort of a Olympic style once every four year meeting. And he absolutely demanded that we need a nail heart at the World Congress cardiologists need to learn from neonatologist. You guys have a lot of valuable insight. So he was actually the I had mentioned earlier that diaphragmatic hernia is more likely trauma is complex, and it is like anything else, like a 24 week or that we deal with. And that was actually him. We were at one of the hearts and I said, Hey, you know, what do you think about this? You know, what do you think we should do better? And he's like, You need a session on comparative physiology versus a few years ago. And I was like, What do you mean, he's like, we have so much more in common than we do different. And he brought this up is like diaphragmatic hernia, and Shultz complex is the same thing. We need to learn from each other. And of course, you know, when you're talking to somebody who's as renowned as Gil, you just kind of nod your head go, Oh, yeah. Oh, yeah. But I had no idea. How, what, huh? And the more and more I started thinking, I was like, Oh, my gosh, he's absolutely right. They actually are the exact same physiology once you kind of get over the, you know, the mental block that you have on it. So Gil is he's outside the box. He's done. Namic He's hilarious. He's loved by all he's pro Neo. It just an all around great, dude.


Rune 25:53

I'm very focused on neuro development. Daffy. Especially,


Daphna 25:58

I'm familiar with the knee. Yeah.


Ben 26:02

This is this is this is amazing. So for the people listening. If you are interested in the new Heart Conference, as you probably should just go register. We will have a series of special episodes every day of the conference to showcase some of the speakers a little bit of what they discussed. To give you a glimpse in case you need more to decide whether you're going to attend in 2023 or not. We have no financial ties or any other conflict of interest to this close between the incubator and and Amir and and no heart. But it is it is ISIS, I encourage everybody listening to go check out the program. It is phenomenal. I am very sad to say that there are some pretty nifty workshops as well. So nifty that most of them are sold out. So like there was a point of care ultrasound workshop, there's an echo for the ICU physician workshop, all those have sold out already. There's another workshop called artificial intelligence in the ICU. There's like a lot of stuff. So check out the program. And we'll be back with Amir and with Rooney at the beginning of August to present you some of these amazing speakers that are talking at this conference. And and we're very honored as the incubator to be able to bring to your attention, the audience, the different conferences out there and some of the content that they're presenting. So thank you very much to everybody. Thank you, Amir. Thank you, Rooney for being on with us today.


Unknown Speaker 27:30

Thank you. Thank you. Thank you, Ronnie. This is a pleasure.


Ben 27:35

This was a pleasure as well, definitely. I'll see you later this week.


Daphna 27:38

Sounds good. Bye, everybody. Bye.


Ben 27:40

Bye. Thank you



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