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Editor,—As to who should perform echocardiography,1 I report the experience of a neonatal intensive care unit in Townsville, 1500 km from the cardiac centre in Brisbane, Australia. Echocardiography is performed by a neonatologist using a Toshiba 140 with colour Doppler. There is ready access to the machine and it is used liberally to monitor sick babies, not merely to exclude defects.
In two years, 537 echocardiographies were performed of which 233 were considered normal. A range of structural and functional defects was found, many of which were not suspected clinically—for example, three cases of fungal endocardititis and many patent ducts. No major defects appear to have been missed, apart from a sinus venosus atrial defect, which was later diagnosed in a child who had chronic lung disease. Review of the early tapes did not disclose the lesion. No postmortem examinations have contradicted echocardiographic findings.
There are many advantages to this system: unnecessary transportations have been avoided, and others have been undertaken more wisely; cardiologists in Brisbane have been able to provide “arms length” care, until their scheduled visit; cardiac function and response to medication have been better monitored; research has been facilitated.2
Following research on the projection of fetal ultrasound images by videolink3 we are exploring its use in cardiology. It does work (at least at a band width of 384 kb/s), however, the time involved in organising the consultation, the costs, and the difficulty in getting all the paraphernalia around a ventilated baby, render it very difficult for routine use. Ultimately, the neonatologist must be able to make some independent decisions, and therefore training is fundamental. Nevertheless, for us, the advantages of having a neonatologist familiar with echocardiography are such that it is difficult to imagine how we would otherwise function.
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