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Neonatal/infant echocardiography by the non-cardiologist: a personal practice, past, present, and future

An increasing number of neonatologists and general paediatricians with an interest in neonatology are performing echocardiography on neonates and infants. There have been several articles, a book, and a CD-ROM on the subject by specialists outlining the pros and cons of a generalist developing the skill.1–5 However, there has been little or no comment in the paediatric literature by any neonatologists or general paediatricians. This article outlines my personal experience, highlighting possible pitfalls and problems encountered while developing the skill of echocardiography.

My personal view is that echocardiography when properly performed is a very useful ultrasonographic investigation. It can influence the management and outcome of the neonate so much, especially that of the extreme preterm, that I feel that this investigation should be available within 24 hours of requirement. Once weekly or even once fortnightly scanning sessions can no longer be justified. A few paediatricians still believe that if you cannot see, feel, or hear ductal signs, then there is no patent ductus arteriosus (PDA). This is despite a large paediatric literature showing that this is incorrect.1,2,6–8 It has even been suggested that the absence of a murmur in an infant with a PDA may in fact be “a more sinister sign” haemodynamically.6,9 It is not unusual for regular scanning to detect a haemodynamically significant PDA several days (usually about three) before any signs appear.

Weekly scanning and consequent delayed diagnosis of a PDA may prove costly in terms of morbidity: worse respiratory disease, increased incidence of intraventricular haemorrhage, an increased incidence of necrotising enterocolitis, problems of renal hypoperfusion, and circulatory problems.10 Infants who develop a late murmur with or without bounding pulses may in fact have a transient peripheral pulmonary branch stenosis after closure of the duct. This may occur …