Journal article
Anatomic Concordance of Neonatologist- Performed Echocardiography as Part of Hemodynamics Consultation and Pediatric Cardiology
Journal of the American Society of Echocardiography, Vol.34(3), pp.301-307
03/01/2021
DOI: 10.1016/j.echo.2020.11.005
PMID: 33220434
Abstract
Background: Targeted neonatal echocardiography (TnECHO) performed by neonatologists as part of a hemodynamics consultation is increasingly being used in neonatal intensive care units. To minimize delays in obtaining physiologic data, first echocardiograms may be obtained by the neonatal hemodynamics team and reviewed afterward by a pediatric cardiologist. This practice has not been systematically evaluated. The aim of this study was to compare concordance between anatomic findings on TnECHO and pediatric cardiology reports.
Methods: This was a retrospective evaluation of 339 infants at low risk for congenital heart disease (CHD) admitted to two large referral centers with established neonatal hemodynamics programs who underwent comprehensive TnECHO as their first postnatal echocardiographic examinations. The protocol included comprehensive imaging of intracardiac anatomy, outflow tract concordance and integrity, aortic arch anatomy, pulmonary vein location and flow, and transitional shunts. The hemodynamics consultation note was compared with the cardiology report to determine anatomic concordance or major or minor discrepancies in all first studies.
Results: Anatomic concordance occurred in 97.9% (K = 0.862; 95% CI, 0.762-0.962; P < .001). There were seven minor discrepancies (small muscular ventricular septal defects and coronary fistulas). The index population included 23 infants (6.7%) with CHD, of whom only one (0.3%) had a ductal-dependent lesion (coarctation of the aorta) which was correctly identified by both teams.
Conclusions: The rate of major CHD in patients considered eligible for hemodynamics consultation was low, and there was high diagnostic concordance between trained neonatal hemodynamics specialists and pediatric cardiology. First echocardiograms obtained by subspecialty neonatologists may provide imaging of sufficient quality to evaluate a critically unwell neonate with low suspicion for critical CHD lesions. These results should not be extrapolated to infants in whom CHD is suspected. This study highlights the importance of formalized, rigorous, and standardized training for neonatologists with hemodynamics expertise who perform timely assessments using TnECHO.
Details
- Title: Subtitle
- Anatomic Concordance of Neonatologist- Performed Echocardiography as Part of Hemodynamics Consultation and Pediatric Cardiology
- Creators
- Adrianne Rahde Bischoff - University of TorontoRegan E. Giesinger - University of TorontoDanielle R. Rios - University of TorontoLuc Mertens - University of TorontoRavi Ashwath - University of IowaPatrick J. McNamara - University of Iowa
- Resource Type
- Journal article
- Publication Details
- Journal of the American Society of Echocardiography, Vol.34(3), pp.301-307
- Publisher
- Elsevier
- DOI
- 10.1016/j.echo.2020.11.005
- PMID
- 33220434
- ISSN
- 0894-7317
- eISSN
- 1097-6795
- Number of pages
- 7
- Language
- English
- Date published
- 03/01/2021
- Academic Unit
- Radiology; Stead Family Department of Pediatrics; Neonatology; Internal Medicine
- Record Identifier
- 9984353841402771
Metrics
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