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Investigating the European perspective of neonatal point-of-care echocardiography in the neonatal intensive care unit—a pilot study

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Abstract

Point-of-care functional neonatal echocardiography (fnECHO) is increasingly used to assess haemodynamic status or patency of the ductus arteriosus (PDA). In Australasia, 90 % of neonatal intensive care units (NICUs) practice point-of-care fnECHO. The Australian Society of Ultrasound Medicine offers a training certificate for fnECHO. In Europe, the use and indications of fnECHO and the extent of point-of-care fnECHO training and accreditation are unknown. We aimed to assess utilisation and training of fnECHO in Europe. For this, we conducted an email survey of 45 randomly chosen tertiary NICUs in 17 European countries. The recall rate was 89 % (n = 40). Neonatologists with skills in fnECHO worked in 29 NICUs (74 %), but paediatric cardiologists would routinely perform most fnECHOs. Twenty-four-hour echocardiography service was available in 31 NICUs (78 %). Indications for fnECHO included assessment of haemodynamic volume status (53 %), presence or absence of pulmonary hypertension of the neonate (55 %), indication for and effect of volume replacement therapy (58 %), PDA assessment and monitoring of PDA treatment (80 %). Teaching of fnECHO was offered to trainees in 22 NICUs (55 %). Teaching of fnECHO was provided by paediatric cardiologists (55 %) or by neonatologists (45 %). Only six (15 %) national colleges accredited fnECHO teaching courses. Conclusion: fnECHO is widely practiced by neonatologists across Europe for a broad range of clinical questions. However, there is a lack of formal training and accreditation of fnECHO skills. This could be addressed by designing a dedicated European fnECHO training programme and by agreeing on a common European certificate of fnECHO.

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Acknowledgments

We would like to warmly thank the following colleagues from institutions all over Europe for kindly participating in our questionnaire study: Georg Schmoelzer (At), Philipp Deindl (At), Mathias Nelle (Ch), Sven Schulzke (Ch), Mario Rüdiger (De), Eckbert Herting (De), Thomas Schaible (De), Thomas Kühn (De), Axel von der Wense (De), Axel Franz (De), Hannes Hammer (De), Heili Varendi (Ee), Liis Toome (Ee), Marta Thio Lluch (Es), Marjo Metsaranta (Fi), Pierre Kuhn (Fr), Juliana Patkai (Fr), Nicoletta Iacovidou (Gr), Eugene Dempsey (Ie), Colm O’Donnell (Ie), Gianluca Lista (It), Francesco Cavigioli (It), Boris Kramer (Nl), W.B. deVries (Nl), Arjan tePas (Nl), Claus Klingenberg (No), Jan Mazela (Pl), Israel J. Macedo (Pt), Gustavo Rocha (Pt), Steffi Spohnholz (Pt), Maria Teresa Neto (Pt), Hercilia Guimaraes (Pt), Livia Sibiu (Ro), Kajsa Bohlin (Se), Ulf Schubert (Se), Kevin Ives (Uk), Fiona Wood (Uk), Ben Stenson (Uk), Charlotte Bennett (Uk) and Amanda Ogilvy-Stuart (Uk).

We acknowledge Dr. Fiona Wood for her much valued help with the questionnaire and Dr. Alan Groves for his advice on the preparation of the manuscript.

Dr. C.C. Roehr acknowledges the generous support from the European Respiratory Society for granting him the 2011 Long-Term Research Fellowship.

Conflict of interest

None of the authors has a conflict of interest to declare.

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Correspondence to Samir Gupta.

Addendum

Addendum

Use of fnECHO across Europe—questionnaire

  1. 1.

    Do neonatologists in your unit perform point-of-care echocardiography (ECHO)? yes/no

    If no, who provides this service?

    1. (a)

      Cardiologists? yes/no

    2. (b)

      Paediatric cardiologists? yes/no

    3. (c)

      Radiologists? yes/no

    4. (d)

      Echocardiographer/ECHO technician? yes/no

    5. (e)

      Other services (if so, who?):

  2. 2.

    Do you have regular access to an ultrasound machine in your unit? yes/no

  3. 3.

    Is point-of-care echocardiography available 24 h/day on your unit? yes/no

  4. 4.

    Is point-of-care echocardiography available every day of the week? yes/no

  5. 5.

    If neonatologists provide the ECHO service for your unit, in the setting of cardiovascular assessment, is ECHO used to:

    1. (a)

      Assess the volume status of a newborn? yes/no

    2. (b)

      Decide on treatment indications (volume/inotropes)? yes/no

    3. (c)

      Monitor the effect of given treatment? yes/no

    4. (d)

      Evaluate for pulmonary hypertension (PPHN)? yes/no

  6. 6.

    Regarding patent ductus arteriosus (PDA), does the neonatologist:

    1. (a)

      Assess the presence of a PDA using ECHO? yes/no

    2. (b)

      Use the findings to determine treatment required? yes/no

    3. (c)

      Use ECHO to monitor the effect of medical treatment? yes/no

  7. 7.

    Do the neonatologists routinely perform ECHO evaluation of central catheter placement? yes/no

  8. 8.

    Is point-of-care echocardiography taught to trainees in your unit? yes/no

    If so, who teaches point-of-care echo in your department?

    1. (a)

      The neonatologist? yes/no

    2. (b)

      The cardiologists? yes/no

    3. (c)

      The paediatric cardiologists? yes/no

    4. (d)

      The radiologists? yes/no

    5. (e)

      The echocardiographer/ECHO technician? yes/no

    6. (f)

      Other (please specify)

  9. 9.

    Is point-of-care echocardiography taught to trainees as part of a formal programme? yes/no

    1. (a)

      Does your professional college/national professional organization offer ECHO courses? yes/no

    2. (b)

      Are these courses acknowledged and certified by the college or national professional organization? yes/no

  10. 10.

    Please provide your additional comments or views.

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Roehr, C.C., te Pas, A.B., Dold, S.K. et al. Investigating the European perspective of neonatal point-of-care echocardiography in the neonatal intensive care unit—a pilot study. Eur J Pediatr 172, 907–911 (2013). https://doi.org/10.1007/s00431-013-1963-1

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  • DOI: https://doi.org/10.1007/s00431-013-1963-1

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