Safety and Feasibility of Early Targeted Neonatal Echocardiography and a Focused Assessment Protocol in Neonates With Congenital Diaphragmatic Hernia

John T Wren Jr; Rachael M Hyland; Stephanie Acosta; Patrick J McNamara

doi:10.1111/echo.70189

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Safety and Feasibility of Early Targeted Neonatal Echocardiography and a Focused Assessment Protocol in Neonates With Congenital Diaphragmatic Hernia

Journal article

Open access

Peer reviewed

Safety and Feasibility of Early Targeted Neonatal Echocardiography and a Focused Assessment Protocol in Neonates With Congenital Diaphragmatic Hernia

John T Wren Jr, Rachael M Hyland, Stephanie Acosta and Patrick J McNamara

Echocardiography (Mount Kisco, N.Y.), Vol.42(5), e70189

05/2025

DOI: 10.1111/echo.70189

PMCID: PMC12072237

PMID: 40358608

Appears in UI Libraries Support Open Access

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Abstract

Congenital diaphragmatic hernia (CDH) is a complex disease with significant morbidity and mortality. The use of echocardiography, traditionally a pediatric cardiology echocardiogram (PCE), has significantly advanced the management of CDH but its availability can be limited, and there are concerns regarding clinical stability during the assessment. Neonatologist-performed targeted neonatal echocardiography (TNE) has been proposed as a supplementary modality in CDH. Herein, we evaluate the feasibility and safety of integrating early TNE and a focused assessment protocol in CDH care. This was a retrospective, single-center study of neonates with CDH who received either an initial PCE (n = 26) or complete TNE (n = 20). The timing, images, and duration of the study were collected, as well as clinical stability data. A focused TNE protocol for cases of clinical instability was similarly evaluated. Despite similar clinical risk predictors, TNE was performed sooner (mean 3.0 vs. 11.6 h, p < 0.0001) and quicker (mean 25.9 vs. 44.4 min, p = 0.0001) than a PCE. While fewer images were obtained (mean 102.0 vs. 143.2 images, p < 0.0001), no cases of congenital heart disease were missed. TNE and PCE were equally well tolerated. When indicated, a focused TNE protocol was utilized that provided actionable information with a mean duration of 7.2 min (n = 4). TNE can be performed early, quickly, and safely in neonates with CDH. A focused TNE protocol may be useful even in non-TNE centers for the acute care of critically ill neonates with CDH.

Feasibility Studies

Echocardiography - methods

Female

Hernias, Diaphragmatic, Congenital - diagnostic imaging

Humans

Infant, Newborn

Male

Retrospective Studies

UIOWA OA Agreement

Details

Title: Subtitle: Safety and Feasibility of Early Targeted Neonatal Echocardiography and a Focused Assessment Protocol in Neonates With Congenital Diaphragmatic Hernia
Creators: John T Wren Jr - Department of Pediatrics, Division of Neonatology, University of Iowa Healthcare, Iowa City, Iowa, USA
Rachael M Hyland - University of Iowa
Stephanie Acosta - University of Iowa
Patrick J McNamara - University of Iowa
Resource Type: Journal article
Publication Details: Echocardiography (Mount Kisco, N.Y.), Vol.42(5), e70189
DOI: 10.1111/echo.70189
PMID: 40358608
PMCID: PMC12072237
NLM abbreviation: Echocardiography
ISSN: 0742-2822
eISSN: 1540-8175
Publisher: Wiley
Language: English
Date published: 05/2025
Academic Unit: Cardiology; Stead Family Department of Pediatrics; Neonatology; Internal Medicine
Record Identifier: 9984823071502771

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