Program Code: SCF-DBI-NICU-CV-0001

Operational Window: Birth → NICU Discharge

Primary Objective: Preserve cardiovascular biological intelligence, maintain adaptive perfusion, prevent endothelial collapse, and support developmental cardiopulmonary maturation.

SECTION 6.1

CLINICAL POSITIONING

Traditional Cardiovascular NICU Model

Focuses on:

• Blood pressure
• Heart rate
• Oxygenation
• Echocardiography
• Cardiac output

SCF-DBI Cardiovascular Model

The neonatal cardiovascular system is viewed as an adaptive biological intelligence network linking:

Brain

Heart

Pulmonary Vasculature

Endothelium

Kidney

Metabolic Systems

Neuroendocrine Systems

Core Principle

Hemodynamic stability is defined not merely by blood pressure but by preservation of adaptive tissue perfusion and developmental signaling.

SECTION 6.2

NEUROCARDIAC INTELLIGENCE MONITORING PROGRAM

Purpose

Identify cardiovascular destabilization before overt shock develops.

Neurocardiac Surveillance Variables

Clinical

Heart Rate

Blood Pressure

Capillary Refill

Perfusion

Urine Output

Laboratory

Lactate

Base Deficit

Mixed Venous Oxygenation

Acid-Base Status

Imaging

Echocardiography

Functional Cardiac Ultrasound

Advanced SCF Variables

Heart Rate Variability

Cerebral Oxygenation

Perfusion Variability

ANMS Neurocardiac Domain

Output

Neurocardiac Resilience Score (NCRS)

SECTION 6.3

PATENT DUCTUS ARTERIOSUS (PDA) SOP

Clinical Positioning

PDA is viewed as a developmental cardiovascular adaptation imbalance.

PDA Risk Categories

Category I

Small PDA

Minimal hemodynamic significance

Category II

Moderate PDA

Potential physiologic burden

Category III

Hemodynamically Significant PDA

Affects:

Perfusion

Pulmonary circulation

Growth

Category IV

Critical PDA

Associated with:

Respiratory instability

Shock risk

End-organ compromise

PDA Surveillance Workflow

Monitor:

Echocardiography

Perfusion

Lactate

Oxygen requirement

Feeding tolerance

Growth trajectory

SCF Decision Framework

Evaluate:

Pulmonary burden

Systemic perfusion burden

Neurodevelopmental burden

Endothelial burden

SECTION 6.4

PERSISTENT PULMONARY HYPERTENSION OF THE NEWBORN (PPHN) SOP

Clinical Positioning

PPHN represents failure of cardiopulmonary adaptive transition.

Risk Indicators

Severe hypoxemia

Differential oxygen saturation

Right ventricular strain

Elevated pulmonary pressures

Monitoring Program

Clinical

Oxygenation

Perfusion

Lactate

Imaging

Echocardiography

SCF Monitoring

Endothelial Integrity Index

Neurovascular Stability Score

ANMS

Escalation Pathway

Oxygen Optimization

↓

Ventilatory Optimization

↓

Pulmonary Vasodilator Therapy

↓

Advanced Cardiovascular Support

↓

ECMO Evaluation

SECTION 6.5

NEONATAL SHOCK MANAGEMENT WORKFLOW

SCF Shock Classification

Traditional Categories:

• Hypovolemic
• Septic
• Cardiogenic
• Obstructive

Expanded SCF Categories

Neuroimmune Shock

Neurocardiac Shock

Neurovascular Shock

Neurometabolic Shock

Neuroendocrine Shock

Shock Severity Classification

Stage I

Compensated

Stage II

Threatened

Stage III

Decompensated

Stage IV

Refractory

SECTION 6.6

SHOCK DETECTION BUNDLE

Early Warning Indicators

Capillary refill prolongation

Rising lactate

Metabolic acidosis

Reduced urine output

Cerebral oxygenation decline

ANMS deterioration

Escalation Trigger

Any two of the following:

Lactate rise >20%

Perfusion decline

Oxygenation instability

ANMS decline >15%

SECTION 6.7

RHENOVA ENDOTHELIAL INTELLIGENCE PRESERVATION PROTOCOL

Strategic Position

Endothelial dysfunction frequently precedes cardiovascular collapse.

Objectives

Preserve:

Perfusion

Microcirculation

Oxygen delivery

Developmental vascular signaling

Monitoring Variables

Clinical

Perfusion

Capillary refill

Urine output

Laboratory

Lactate

Endothelial biomarkers (where available)

Imaging

Functional perfusion assessments

Endothelial Integrity Index (EII)

Classification:

Green

Stable

Yellow

Early endothelial stress

Orange

Threatened endothelial adaptation

Red

Endothelial collapse risk

SECTION 6.8

GLYCOCALYX PROTECTION BUNDLE

Cardiovascular Deployment

Core Objectives

Reduce:

Capillary leak

Pulmonary edema

Tissue hypoxia

Endothelial injury

Bundle Components

Perfusion optimization

Fluid stewardship

Oxygen stewardship

Inflammatory surveillance

Metabolic stabilization

SECTION 6.9

HEMODYNAMIC ANMS ESCALATION FRAMEWORK

Green Zone

ANMS >80

Stable cardiovascular adaptation

Yellow Zone

ANMS 60–79

Compensated stress

Increase surveillance

Orange Zone

ANMS 40–59

Threatened adaptation

Activate Cardiovascular Rescue Bundle

Red Zone

ANMS <40

High collapse risk

Immediate escalation

SECTION 6.10

CARDIOVASCULAR RESCUE BUNDLE

Activate When

Shock progression

ANMS decline

Persistent perfusion abnormalities

Core Components

Hemodynamic reassessment

Perfusion optimization

Echocardiographic reassessment

Endothelial preservation

Metabolic stabilization

SECTION 6.11

CARDIOVASCULAR RECOVERY INTELLIGENCE PROGRAM

Purpose

Guide transition from stabilization to adaptive recovery.

Recovery Domains

Neurocardiac Recovery

Endothelial Recovery

Metabolic Recovery

Growth Recovery

Developmental Recovery

Recovery Monitoring

NCRS

EII

ANMS

Growth velocity

Feeding tolerance

SECTION 6.12

DE-ESCALATION CRITERIA

Clinical

Stable perfusion

Stable oxygenation

Normalizing lactate

Appropriate urine output

SCF

ANMS >80

NCRS stable

EII stable

Developmental

Feeding progression

Growth progression

SECTION 6.13

CARDIOVASCULAR RECOVERY ENDPOINTS

Physiologic

Hemodynamic stability

Adequate perfusion

Normal oxygenation

Biological Intelligence

Stable ANMS

Stable EII

Stable NCRS

Developmental

Appropriate growth

Stable neurologic status

Feeding success

PAGE 6 COMPLETION

Next Page (Page 7):

Hypoxic-Ischemic Encephalopathy (HIE) SOP

Intraventricular Hemorrhage (IVH) Prevention Program

Neonatal Seizure Management Workflow

Neurodevelopment Preservation Bundle (Full Deployment)

Cerebral Oxygenation Surveillance System

RHENOVA Brain Protection Protocol

Neurodevelopmental ANMS Escalation Framework

MASTER REGISTRY INDEX

SCF-DBI-NICU-CV-0001 — Cardiovascular Intelligence SOP

SCF-DBI-NICU-PDA-0001 — Patent Ductus Arteriosus SOP

SCF-DBI-NICU-PPHN-0001 — Persistent Pulmonary Hypertension SOP

SCF-DBI-NICU-SHOCK-0001 — Neonatal Shock Management Workflow

SCF-NCRS-0001 — Neurocardiac Resilience Score

SCF-EII-0001 — Endothelial Integrity Index

SCF-RHENOVA-EIPP-0001 — Endothelial Intelligence Preservation Protocol

SCF-ANMS-CV-0001 — Cardiovascular ANMS Framework

SCF-NICU-GPB-CV-0001 — Cardiovascular Glycocalyx Protection Bundle

SCF-RHENOVA-NICU-CV-0001 — Project RHENOVA Neonatal Cardiovascular Intelligence Platform