Echocardiography in the neonatal unit: current status and future prospects

ABSTRACT

Introduction

Traditionally echocardiography was used by pediatric cardiologists to diagnose congenital heart defects in neonates. Formalized neonatal hemodynamic fellowships have been established where neonatologists acquire advanced echocardiographic skills to gain anatomical, physiological, and hemodynamic information in real time and utilize this information in making a timely and accurate physiology-based clinical decision.

Area covered

Differences between a comprehensive formal structural echocardiography, neonatologist performed targeted echocardiography and limited assessment on point-of-care-ultrasonography for specific indications have been covered. This article is focused at providing a comprehensive review of the status of echocardiography in the neonatal units, recent advancements and its future prospects in the neonatal intensive care units.

Expert opinion

Comprehensive guidelines providing the scope of practice, a framework for training, and robust clinical governance process for the neonatologist performed targeted echocardiography have been established. In the last decade, echocardiography has emerged as essential vital bedside diagnostic tool in providing high-quality care to the sick infants in the neonatal units, and it has proved to improve the outcomes in neonates. It is now being considered as a modern hemodynamic monitoring tool. Advances in technology, machine learning, and application of artificial intelligence in applications of echocardiography seem promising adjunct tools for rapid assessment in emergency situations.

KEYWORDS:

• Echocardiography
• neonatologist performed echocardiography (NPE)
• functional echocardiography
• target neonatal echocardiography (TNE)
• point-of-care ultrasonography (POCUS)
• hemodynamic evaluation
• neonates
• neonatal intensive care unit (NICU)

Article highlights

• This article provides a comprehensive review of the current status of echocardiography in the neonatal units.

• Echocardiography provides anatomical, physiological, and hemodynamic information in real time at bedside allowing the neonatologists to make physiology-based discussed and target-specific intervention to improve hemodynamic instability.

• Article provides scope of practice for echocardiography in the neonatal units – a clear difference between a neonatologist performed comprehensive echocardiography and a limited targeted echocardiography or cardiac point-of-care ultrasound.

• Recent advances in neonatal echocardiography and current challenges to neonatologist performed echocardiography provided.

• Future prospects of neonatal echocardiography with emphasis on advances in scientific techniques and information technology have been summarized.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewers disclosure

Peer reviewers on this manuscript have no relevant financial relationships or otherwise to disclose.

Additional information

Funding

This paper was not funded.