Senior Thesis: Studying Infant Care Protocol
In 2023, Brigham and Women’s Hospital (BWH) in Boston published its first standardized set of clinical practice guidelines (CPGs) for the care of infants with two high-risk forms of critical congenital heart disease (CCHD). After a stint observing the impact of the new guidelines as a research intern at Brigham over the summer of 2024, Emily Hauser ’25 decided to make the guidelines the topic of research for her senior thesis.
Due to advancements in fetal heart-monitoring technology, infants at risk for critical congenital heart disease can sometimes be diagnosed early in the mother’s pregnancy, said Hauser. “They know that the baby is going to have this illness when the mother comes into the hospital, so a lot of planning goes around the delivery,” Hauser explained. “The baby is born, resuscitated, and then run, literally, run, across this bridge [between BWH and Boston Children’s Hospital] so that they can go into emergent care at Children’s.”
Hauser’s research focuses on the first 10 to 30 minutes after delivery, when the baby is still at BWH for resuscitation and when the new guidelines are most relevant. In alignment with new discoveries on infant care, the guidelines provide information on the anatomy of the lesion caused by the CCHD, the resulting circulation of blood within the baby, and the potential problems that practitioners need to be prepared to face, among other details.
The most significant shift in care since the release of the guidelines involves a condition known as d-TGA, a heart defect where the aorta and pulmonary artery are positionally switched. The rate of intubation in d-TGA cases jumped from 40 to 60 percent following the implementation of the guidelines, and rates of administration for paralytic medications during intubation jumped from 20 to 66 percent. The paralytics “stop the body from trying to use its energy on anything other than getting oxygen to the rest of the body,” explained Hauser. “Providers were not, before the guidelines were implemented, giving this paralytic almost ever, and then we saw a big jump, so it was interesting.”
To arrive at these conclusions, Hauser compiled a database using patient charts first from 2018 to 2023, before the guidelines were implemented, and then from 2023 until 2025, after the implementation. “It’s a fantastic way to learn,” said Hauser of the hours spent poring over patient notes. “We originally started doing only two years of data, but then we were like, let’s try to push it back even more.”
Aside from her enjoyment of the research process, an interest in pediatrics also motivated Hauser to study the impact of the guidelines.
“I’m very interested in development, and infants are super interesting because they’re growing at a crazy rate compared to adults,” Hauser said. “Everything is changing very quickly and all the body systems are working very closely together. I actually learned over the summer that when you work with infants, you specialize in an age group, but you have to be a generalist in every system. There’s no infant neurologist or infant cardiologist. There are pediatric versions of those things, but when you’re a neonatologist, you ultimately have to be a specialist in every body system in order to really understand the baby.”
Hauser’s mentors at BWH are working to incorporate the 2023 BWH guidelines into the Neonatal Resuscitation Program, a nationally practiced training course designed to educate practitioners on emergency neonatal care.
"On top of how we’re working to support the babies, how we’re working with families to support the babies has been a really interesting part of my project as well,” Hauser said. “I think these guidelines will make a big difference in terms of how practitioners plan for deliveries, especially how they talk to families about what the deliveries will look like.”
A mathematics major on the pre-med track, Hauser plans to take a year to work and do more research before beginning medical school. On her future specialization, Hauser said, “I feel like it is going to be pediatrics, but of course, there’s a lot of time for me to figure out what I want to do, so I’m trying to have an open mind.”
