Neonatologist performed echocardiography (NPE) in Italian neonatal intensive care units: a national survey

Abstract

BackgroundNeonatologist performed echocardiography (NPE) has increasingly been used to assess the hemodynamic status in neonates. Aim of this survey was to investigate the utilization of NPE in Italian neonatal intensive care units (NICUs).MethodsWe conducted an on-line survey from June to September 2017. A questionnaire was developed by the Italian neonatal cardiology study group and was sent to each Italian NICU.ResultsThe response rate was 77%. In 94% of Italian NICUs functional echocardiography was used by neonatologists, cardiologists or both (57, 15 and 28% respectively). All the respondents used NPE in neonates with patent ductus arteriosus and persistent pulmonary hypertension, 93% in neonates with hypotension or shock, 85% in neonates with perinatal asphyxia, 78% in suspicion of cardiac tamponade, and 73% for line positioning.In 30% of center, there was no NPE protocol. Structural echocardiography in stable and critically ill neonates was performed exclusively by neonatologists in 46 and 36% of center respectively.ConclusionsNPE is widely used in Italian NICUs by neonatologists. Structural echocardiography is frequently performed by neonatologists. Institutional protocols for NPE are lacking. There is an urgent need of a formal training process and accreditation to standardize the use of NPE.

Utilisation of neonatologist‐performed echocardiography in shock among neonatologists with interest in haemodynamic: International survey

“…In a survey on NPE practice in Italy, where NPE is widely used, the median number of neonatologists with the skills to perform a structural echocardiography was only 18%, thus requiring the input of cardiologists for the majority of cases. 17 Although early echocardiography is recommended by experts to enable appropriate targeted and individualised therapy, our study highlights the lack of consensus on parameters assessed in the context of neonatal shock. The European Special Interest group has published cardiac output and volume status assessment tools.…”

Legal issues in Neonatologist Performed Echocardiography. The Italian experience

“…Next, we designed a survey in order to explore the utilization of NPE in clinical practice in the Italian NICUs and to verify the actual need of a formal training process. 3 The response rate was 77% (88/114). We ascertained that, although the haemodynamic assessment by echocardiography was widely adopted in 94% of NICUs, mainly performed by neonatologists, followed by cardiol-ogists or both (57%, 15%, and 28% respectively), institutional protocols for NPE were lacking and there was a heterogeneous combination of parameters and cut-offs used.…”

“…Irma Capolupo3 , Rosa Maria Cerbo 4 , Manuela Condò 5 , Iuri Corsini6 , Daniela Doni 7 , Benjamim Ficial 8 , Stefano Fiocchi 9 , Simona La Placa 10 , Katia Rossi 11 , Sabrina Salvadori 12 , and Federico Schena 13…”

Survey of PDA management in very low birth weight infants across Italy

“…The homogeneous implementation of an ECHO-based approach is likely to have different reasons. First, the vast majority of Italian NICUs had access to NPE, as shown from our previous survey: NPE was performed in 95% of centers and in 70% of centers on a 24/7 basis [20]. Secondly, clinical signs of PDA take 2 to 3 days to appear and have poor sensitivity and specificity [21].…”

“…Considering the number of serial echo assessments required in preterm neonates, the need to integrate the ultrasound findings with clinical data and the limited access to pediatric cardiology service in Italy, echocardiographic assessment of PDA should probably remain the domain of a properly trained neonatologist, in collaboration with cardiologist whenever needed, to minimize the risk of misdiagnosis of critical CHDs [20]. In order to meet training needs and to pursue quality assurance and patient safety, our INCSG is currently designing and implementing a formalised and accredited training program in close collaboration with the Italian Society of Pediatric Cardiology (SICPED).…”