The prevalence of and attitudes toward neonatal functional echocardiography use and training in the United States: A survey of neonatal intensive care unit medical directors

Abstract

BACKGROUND: Internationally, neonatologists are increasingly performing functional echocardiography to evaluate the hemodynamic status and cardiac function in neonates. The purpose of this study was to describe the current prevalence of and attitudes toward the use and training of neonatologists in functional echocardiography in the United States. METHODS: An anonymous survey was sent to United States neonatal intensive care unit medical directors. Neonatologists scored availability of echocardiography and attitudes toward the use and training of neonatologists in functional echocardiography. RESULTS: Response rate was 43.7% (247 of 565 surveys sent) and captured 95% of the neonatal-perinatal training programs. Nine percent of units had a functional echocardiography trained neonatologist; eight percent of the neonatal-perinatal training programs offered functional echocardiography training. There was no difference in the timely ability to obtain hemodynamic status with echocardiography in units compared by the presence of functional echocardiography trained neonatologists (mean = 3.13 vs. 2.67, p = 0.08) and fellowships (mean = 2.69 vs. 2.72, p = 0.85). Overall positive attitudes (mean = 14.6 ± 3.46) towards the training of neonatologists in functional echocardiography did not correlate with the perceived timely availability of echocardiography support (mean = 2.72 ± 1.43, r = −0.11, p = 0.1). CONCLUSION: Functional echocardiography use and training is not prevalent in the United States. There are positive attitudes toward the training of neonatologists in functional echocardiography that are independent of the presence of fellowships, neonatologists with echocardiography training, and the perceived availability of echocardiography support.

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

“…In the past, lack of universally accepted guidelines of NPE practice together with the little evidence on how to integrate these data in the clinical decision-making led to differences in practice between centers [11]⁠. The latter was confirmed by our data, showing that practice of NPE was markedly heterogeneous between Italian NICUs and even within the same center.…”

“…France, Australia and New Zealand) to a minority of NICUs having f-echo capability (e.g. USA, Canada) [9, 11, 15–17]⁠. To the best of our knowledge, no data were available from Italian NICUs.…”

“…Furthermore a series of review articles discussing the current status of NPE has lately been produced by the ESPR “special interest group on NPE” on key topics of f-echo [8]⁠. Data on utilization of echocardiography in the neonatal intensive care unit (NICU) were previously reported [9–11]⁠, but, to the best of our knowledge, no data are available from Italy. Aim of our survey study was to investigate the utilization of NPE in Italian NICUs.…”

Association between early echocardiography, therapy for patent ductus arteriosus, and outcomes in very low birth weight infants

“…In a large survey of 247 neonatal ICU medical directors, the majority of respondents endorsed the utility of functional echocardiography and the need for training in this skillset. 22 Functional echocardiography may help assess cardiac function as well as systemic and pulmonary blood flow and pressures, and rule out the presence of shunts. 23 In a small cohort of 20 infants (mean gestational age 27.8 ± 5.3 weeks) in a level-3 neonatal ICU who had pulmonary hypertension associated with pre-term premature rupture of membrane, investigators found that the use of functional echocardiography led to earlier diagnosis of the need for treatment for pulmonary hypertension with improved outcomes.…”

“…There is an increasing awareness of the utility of echocardiography in critically ill neonates. In a large survey of 247 neonatal ICU medical directors, the majority of respondents endorsed the utility of functional echocardiography and the need for training in this skillset 22 . Functional echocardiography may help assess cardiac function as well as systemic and pulmonary blood flow and pressures, and rule out the presence of shunts 23 .…”