It has been more than a decade since the initial interest was expressed by neonatologists in acquiring basic skills in performing echocardiography. Their plea for a formalized training program has mostly been met with resistance, driving some to learn the technique through informal self-directed learning. The recent practice guideline and consensus statement by the Writing Group of the American Society of Echocardiography in collaboration with the European Association of Echocardiography and the Association for European Pediatric Cardiologists will be welcomed by neonatologists all over the world. The poor correlation of cardiac hemodynamics with clinical findings in premature newborns is now well known, and the increasing use of echocardiography for hemodynamic information can only improve patient care. Around-the-clock availability of cardiac sonographer to perform echocardiography in the neonatal intensive care unit (NICU) is currently not feasible in most environments, and management decisions can sometimes be delayed or altered depending on the time of day. A wealth of hemodynamic information derived from functional echocardiography will also drive research in the area of cardiovascular medicine in newborns, which is still at a very early stage.
At the Boston Medical Center, two neonatologists with prior experience in echocardiography currently perform point-of-care functional echocardiography to check central line position, hemodynamic assessment of patent ductus arteriosus, and assessment of cardiac function in hypotensive newborns. The quality improvement initiative of using ultrasound to check central line positions has already resulted in a significant reduction of x-ray exposure to newborns (unpublished data). The echocardiographic images obtained by neonatologists are instantly loaded on a secure central server so that they can be read remotely by a cardiologist. All initial targeted echocardiographic studies are followed by detailed full echocardiographic assessments performed by cardiac sonographers and evaluated by pediatric cardiologists. This model can be used by other neonatologists who have acquired prior training to audit their own echocardiographic practice while providing 24-hour availability of echocardiography in the NICU.
The development of formal guidelines governing the use and monitoring of echocardiography performed by neonatologists in the NICU will refine practice in the NICU, minimize interpretational errors, and allow patient care to proceed in the presence of a safety net. An understanding of the principles of echocardiography will allow neonatologists to ask appropriate, sometimes creative questions of sonographers and cardiologists. There is no more dedicated investigator than the physician involved in direct clinical care seeking to do the best for the patient.