Over recent years echocardiography has changed from a purely research tool to an essential part of adequate management of the critically ill newborn. In the hypotensive or shocked infant, there is no better way to find a treatable underlying cause of their circulatory failure such as myocardial dysfunction, a large ductal shunt, pericardial effusion, or hypertrophic cardiomyopathy in infants of mothers with diabetes. A large ductal shunt sufficient to cause severe reduction in effective cardiac output and even cardiorespiratory collapse after extubation can be clinically silent and may only be revealed by echocardiography.1 Similarly, septic vegetations or thrombi on valves or central lines can only be seen this way, and it is feasible to assess pulmonary arterial pressure non-invasively in most ill newborns.

Therefore, someone needs to be available 24 hours a day in all neonatal units to do echocardiography. There are about 60 paediatric cardiologists in the UK, about one per million of the population; this is simply not enough to provide a 24 hour service for all neonatal units, many of which are long distances from big cities. Some …