Guidelines offer recommendations for neonatologists using echo

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In response to the changing role of echocardiography in the neonatal intensive care unit (NICU), the American Society of Echocardiography (ASE) published guidelines Oct. 1 that address scope, appropriate use and standards. The guidelines appear in the October issue of the Journal of the American Society of Echocardiography.

Miniaturization of technology and a shift in practice patterns has led to changes in who performs echocardiography studies and for what purpose, the writing group noted. What was the domain of pediatric cardiologists using echocardiography as a diagnostic and monitoring tool for congenital heart disease (CHD) and as a screening tool for patent ductus arteriosus changed in recent years to include use by neonatologists for assessing hemodynamic instability in neonates.

“Perhaps the most significant challenge for the application of so-called functional studies is that newborns in the NICU with hemodynamic instability are at a much higher risk for having underlying CHD,” wrote lead author Luc L. Mertens, MD, PhD, of the Labatt Family Heart Center at the Hospital for Sick Children in Toronto, and colleagues. “In addition, newborns in the NICU are unique in that they are in the process of transition from fetal to postnatal circulation.”

The practice guidelines and recommendations for training are designed to ensure safe and optimal use of targeted neonatal echo (TNE) in the NICU. The guidelines are broken into three overall sections: a review of indications for TNE; recommendations for the performance of TNE; and proposed training requirements for operators who perform and interpret TNE.

Key recommendations include:

  • Familiarity with normal neonatal cardiovascular adaptations and how prematurity and disease affect the cardiovascular system;
  • Clinical assessment and comprehensive echocardiography be done by a pediatric cardiologist if CHD is suspected;
  • Optimizing ultrasound systems and taking precautions against infection and other adverse outcomes;
  • The inclusion of eight components of standard TNE;
  • A list of conditions in which to use TNE;
  • Training at a basic level that includes an ability to perform comprehensive TNE in neonates and distinguish normal from abnormal; and
  • Training at an advanced level that includes fetal echocardiography, transesophageal echocardiography, and the ability to diagnose complex diseases and supervise and train basic operators.

The ASE collaborated with representatives from the European Association of Echocardiography and the Association for European Pediatric Cardiologists on the consensus guidelines and training recommendations, which are available here.