The Children’s PH team (L to R): Ahmad Khalil, Frank Bennett Pearce, Jodie Kanaday, Kevin Wall and Matthew Clark.
Pulmonary hypertension (PH) is a heterogenous condition stemming from numerous underlying causes, including extreme prematurity, congenital heart disease and systemic diseases like lupus. It causes dangerous increases in blood pressure in the lungs, straining the heart’s pumping ability and potentially leading to heart failure.
Care for children with PH has typically existed across silos: cardiology, pulmonology, neonatology and intensive care, said Frank Bennett Pearce, M.D., a pediatric cardiologist at Children’s of Alabama. Each discipline did its part. But clinicians increasingly recognized that the complexity of the condition and the fragility of the patients required greater coordination.
Today, a formal PH team of Pearce, pediatric cardiac critical care specialists Ahmad Khalil, M.D., and Matthew Clark, M.D., and pediatric cardiology fellow Kevin Wall, M.D., together with pediatric cardiology nurse specialist Jodie Kanaday, RN, round weekly on patients with PH to determine the best course of action for this rare but complex condition.
“We wanted to improve communication by having us all together saying the same thing to the consultant teams and to the families,” Pearce said.
That consistency matters, especially when care unfolds over weeks or months.
From a cardiology standpoint, PH has always been part of the landscape, Pearce said. “A lot of the treatment and diagnostic procedures like catheterizations and echocardiograms come through cardiology anyway,” he said. “So we end up being the treating doctors in lots of cases, or at least consultants.”
At the same time, many of the sickest patients are in neonatal and pediatric intensive care units and managed by critical care specialists.
PH is typically treated with medications like pulmonary vasodilators regardless of cause, but timing and diagnosis matter. That’s why it’s so important to have a precise anatomic diagnosis before starting medication, Pearce said. In babies with bronchopulmonary dysplasia, for instance, PH may be driven by acquired pulmonary vein stenosis—a condition that requires catheter-based or surgical intervention before medication.
Previously, decisions like these might have been made in parallel by different services. Now, they are made together.
The team manages about a dozen inpatient pulmonary hypertension cases each month on inpatients at Children’s and the University of Alabama Birmingham (UAB). But inpatient care is only part of the story.
PH does not end at discharge. Medication management, insurance approvals, symptom monitoring and urgent questions follow families home. That’s where Kanaday, who is the Pulmonary Hypertension Clinic care coordinator, shines.
“We literally couldn’t do it without her,” Pearce said. She allows the team to see more patients, stay more organized and keep up with the paperwork/regulatory side of things in the PH world, he said.
Kanaday sees herself as a conduit to the physician. “Our patients know they can contact me directly for questions about medications, symptoms or side effects. I’m able to pass those concerns along quickly, which usually means they get help faster than they otherwise would.”
Her role, she said, is “making sure the doctors have all the information that they need to best take care of the patients.”
While the team is not formally tracking outcomes yet, Pearce says he’s seen a difference. “The patients are staying on their medications more consistently. The doses are more consistent. Some of these medications require a lot of paperwork—that’s getting handled quicker.”
In addition, the improved coordination means patients get to the cath lab sooner for pulmonary vein interventions. The team is also closely tied to newer catheter-based procedures, such as closing a patent ductus arteriosus or atrial septal defects in extremely small infants.
“I think it’s really been an asset to our cardiology team in general, taking this burden off of the general cardiologists and putting these patients with a provider who readily understands the disease process, available treatment options and possible complications. I think it makes our consult service much more efficient,” Kanaday said. “It has really made an impact on the patients, their continuity of care as an inpatient, and their follow-up in the outpatient clinic. I feel like we’re really making a difference and giving these kids the best chance to have positive outcomes long term.”
