The overall focus of my work relates to the use of advanced echocardiography imaging in human neonates to define normal physiology, characterize mechanisms of disease and investigate the downstream end-organ ramifications of abnormal hemodynamic states. Prior to 2003, an academic vacuum existed in the field of neonatal hemodynamics; there was limited scientific investigation and understanding of heart function and hemodynamics and their relationship to neonatal health and adverse outcomes. The program cultivates echocardiography guided clinical physiologic research that enables enhanced mechanistic understanding of neonatal cardiovascular performance and hemodynamics in health and disease. Specifically, my research has focused predominantly on the cardiovascular mechanisms and relevant physiology of patients with a hemodynamically significant patent ductus arteriosus (PDA) and strategies to modulate shunt driven end-organ morbidity including brain damage in the first postnatal week. Recently, our group has shown the early echocardiography screening leads to a reduction in severe intraventricular hemorrhage. Our group is also interested in neurohemodynamics and the relationship of abnormal hemodynamic states to abnormal cerebral neurophysiology and brain injury. Recently, we demonstrated that right ventricular dysfunction was an independent predictor of mortality, abnormal MRI and adverse neurodevelopmental outcome at 2-years in term infants with hypoxic-ischemic encephalopathy, despite therapeutic hypothermia.