Expert consensus statement ‘Neonatologist-performed Echocardiography (NoPE)’—training and accreditation in UK

Singh, Yogen; Gupta, Samir; Groves, Alan; Gandhi, Anjum; Thomson, John; Qureshi, Shakeel; Simpson, John

doi:10.1007/s00431-015-2633-2

Cited by 87 publications

(69 citation statements)

References 19 publications

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“…The article by Singh et al [6] sets out proposed consensus guidelines for the UK around the use of ultrasound (mainly focused on cardiac ultrasound) in the neonatal unit. The authors closely model these on a comprehensive set of guidelines for training of neonatologists in echocardiography published recently from North America [5].…”

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confidence: 99%

Point of care ultrasound in the NICU—training, accreditation and ownership

Kluckow

Evans

2015

Eur J Pediatr

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The use of ultrasound by neonatologists to assist in understanding physiology and to help guide management in the NICU is rapidly expanding [4] with research demonstrating an important impact on clinical management [2]. The article by Singh et al. [6] sets out proposed consensus guidelines for the UK around the use of ultrasound (mainly focused on cardiac ultrasound) in the neonatal unit. The authors closely model these on a comprehensive set of guidelines for training of neonatologists in echocardiography published recently from North America [5]. These guidelines were heavily influenced by paediatric cardiology and highlight the differences between the traditional consultative model of ultrasound and the more recent evolution of ultrasound as an acute point of care diagnostic tool [1]. Although an important and needed initiative, this expert consensus statement for training and accreditation in the UK is limited in scope and focuses disproportionately on the exclusion of structural heart disease rather than the use of ultrasound for haemodynamic assessment, which is what most neonatal clinicians are mainly interested in.The consensus guidelines describe best practice for training and accreditation for the use of cardiac ultrasound (termed 'neonatologist performed echocardiography' or NoPE by the authors) in the neonatal intensive care unit. The authors are noted experts/opinion leaders in their field and are representative of a broader group of paediatric cardiologists and neonatologists. Several important principles are outlined including the performance of the ultrasound, care of the infant during the investigation, the aim to screen and establish gross normality on the first ultrasound (though in other statements the aim is higher than this 'to confidently exclude structural lesions at the first scan'), the need for collaboration with a supportive paediatric cardiologist, use of a reporting template, image storage and regular audit/review of images. Training for 6 months in a neonatology placement and 6 months in a paediatric cardiology unit is recommended, even though the authors acknowledge that access to these training positions will be limited.While much of this is to be lauded, there is a difference in training needs between being able to establish gross structural normality and being able to confidently exclude structural abnormality. The latter lifts the training needs close to that of a paediatric cardiologist but with the suggested training pathway well short of that required in the specialty. In our opinion, this enhances the risk of a non-cardiologist performing a cardiac ultrasound in a baby with congenital heart disease and deeming it a normal echocardiogram. Having a high training goal may also deter neonatologists from using cardiac ultrasound for a range of other non-structural heart disease purposes including acute exclusion of pericardial effusions, assessment of volume status in sepsis and on to understanding the pathophysiology of infants with hypoxic respiratory failure and right to lef...

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confidence: 99%

Point of care ultrasound in the NICU—training, accreditation and ownership

Kluckow

Evans

2015

Eur J Pediatr

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“…The role of functional echocardiography in the neonatal intensive care unit for the evaluation of infant cardiovascular well-being has significantly expanded over the last 10 years [1][2][3] . The use of echocardiography in the neonatal intensive care unit, also referred to as targeted neonatal echocardiography, has been shown to identify cardiovascular compromise earlier, guide therapeutic intervention, monitor treatment response, and improve overall outcome [4][5][6] .…”

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Novel Echocardiography Methods in the Functional Assessment of the Newborn Heart

et al. 2016

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Echocardiography in the neonatal intensive care unit has led to improvements in our ability to assess the neonatal heart in health and disease. Advances in neonatal cardiac imaging have provided the capability to obtain quantitative information that often supersedes the qualitative information provided by conventional methods. Novel quantitative measures of function include the assessment of the velocity of muscle tissue movement during systole and diastole using tissue Doppler velocity imaging, and evaluation of deformation and rotational characteristics of the myocardium utilizing speckle tracking echocardiography or tissue Doppler-derived strain imaging. A comprehensive understanding of these novel functional modalities, their predictive value, and limitations can greatly assist in managing both the normal and maladaptive responses in the newborn period. This article discusses the novel and emerging methods for assessment of left and right heart function in the neonatal population.

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“…The guidelines mandate a 6-mo period of training to be carried out in a pediatric cardiology department during core registrar or higher specialist training in neonatology (10) and another minimum of 6 mo in a neonatal center with expertise in echocardiography for hemodynamic assessment. It provides guidance for new trainees, those who are already practicing, and for maintaining competencies.…”

Section: The Current Guidelines In a European Contextmentioning

confidence: 99%

“…There are currently two published guidelines in neonatal echocardiography with recommendations for training and an accredited structured training program with accreditation in neonatal cardiac ultrasound. The practice guidelines and recommendations for the use of echocardiography (Targeted Neonatal Echocardiography (TNE)) and Expert consensus statement on Neonatologist performed echocardiography (NoPE) in the United Kingdom were published in the last 5 y (10,11). However, some aspects of these two guidelines are difficult to implement in a pan European setting.…”

Section: Introductionmentioning

confidence: 99%