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Two dimensional, M mode and Doppler echocardiography is widely used by paediatric cardiologists to evaluate cardiac structure and function in neonates, infants, and older children. Anecdotally, it is also being used increasingly by neonatologists in the early newborn period.1,2 We have recently undertaken a postal questionnaire survey of 38 neonatologists working in referral centres to review current UK practice.
Thirty seven neonatologists responded to the questionnaire. Nineteen units performed more than 15 echocardiograms per month, six performed 10–15/month, and 12 performed less than 10/month. Echocardiograms were usually performed by paediatric cardiologists and/or neonatologists, but also occasionally by echocardiographic technicians. Neonatologists performed echocardiograms in two thirds of responding units. The commonest indications for echocardiography were: diagnosis/exclusion of congenital heart disease, assessment of ductal patency and haemodynamics, assessment of myocardial function, and assessment of pulmonary hypertension.
Only 12 (32%) units had 24 hour access to paediatric cardiology service on site; of those who did not, 18 units usually had access to these services on an on-call basis. Babies were transferred out of the neonatal unit for echocardiography in 13 (35%) responding units. Indomethacin was used to treat a symptomatic persistent ductus arteriosus (PDA) following a purely clinical diagnosis in 15 (41%) units.
This survey shows that echocardiography on the neonatal unit is often performed by a neonatologist rather than a cardiologist, presumably reflecting the (lack of) availability of 24 hour on-site paediatric cardiology services, even in neonatal referral centres. In a considerable number of units babies are either transferred out of the neonatal unit for echocardiographic assessment or receive treatment for PDA without prior echocardiographic confirmation. Such situations are undesirable and reflect the need for greater access to echocardiography on the neonatal unit, a service that is likely to be provided increasingly by neonatologists themselves in the future.
Although several paediatric echocardiography courses are available, currently there is no formal accreditation process for neonatologists. We believe there is a need to evaluate the reliability of echocardiography in the hands of neonatologists in a systematic way and are currently conducting such a study.
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