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Growth of targeted neonatal echocardiography in Chinese neonatal intensive care units: gaps in practice and training

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A Correction to this article was published on 11 July 2023

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Abstract

To evaluate clinical practice, neonatologists’ attitudes, and the extent of training and accreditation regarding targeted neonatal echocardiography (TnEcho) among Chinese neonatologists. A web-based questionnaire was emailed to 331 neonatologists across China who completed training in subspecialty neonatology. The survey covered various aspects of TnEcho, including the characteristics of clinical practice, attitudes towards its usefulness, and perceived barriers to implementation and training methods. Survey response rate was 68.0% (225/331). Seventy-nine (35.1%) respondents stated that TnEcho was utilized in their NICUs. Most respondents reported the use of echocardiography to evaluate hemodynamic significance of the patent ductus arteriosus (PDA, 94.9%). The eyeballing technique was most used to evaluate left (82.3%) and right (77.2%) ventricular function. Most respondents (87.3–96.2%) positively valued the role of TnEcho in providing timely and longitudinal hemodynamic information to guide cardiovascular care. Access to TnEcho was more likely in centers with on-site pediatric cardiology service (p = .003), larger bed capacity (p = .004), or level IV status (p = .003). Lack of experienced practitioners with echocardiography expertise (88.9%) and accredited training programs (85.8%) was perceived to be the major barrier to implementation. Of concern, most practitioners with TnEcho skills received training in an informal manner through workshops (60.8%) or self-directed learning (54.4%).

Conclusions: The use of TnEcho for longitudinal evaluation of infants with hemodynamic instability is growing within Chinese NICUs. There is an urgent need to develop standardized training programs and accreditation for TnEcho which are adapted to the Chinese context.

What is Known:

• Targeted neonatal echocardiography (TnEcho) is an emerging technique to aid characterization of the hemodynamics of sick neonates in the neonatal intensive care units (NICUs) around the world.

• Evidence is accumulating which supports the positive impact of TnEcho service on clinical management and patient outcomes.

What is New:

• This is the first report to show that the use of TnEcho for longitudinal evaluation of infants with hemodynamic instability is growing within Chinese NICUs.

• There is an urgent need to develop standardized training programs and accreditation for TnEcho which are adapted to the Chinese context.

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Data availability

All data are within manuscript; data are available upon reasonable request to the corresponding author.

Change history

Abbreviations

ASE:

American Society of Echocardiography

NICU:

Neonatal intensive care unit

PDA:

Patent ductus arteriosus

TnEcho:

Targeted neonatal echocardiography

References

  1. Sehgal A, McNamara PJ (2008) Does point-of-care functional echocardiography enhance cardiovascular care in the NICU? J Perinatol 28:729–735. https://doi.org/10.1038/jp.2008.100

    Article  CAS  PubMed  Google Scholar 

  2. Papadhima I, Louis D, Purna J et al (2018) Targeted neonatal echocardiography (TNE) consult service in a large tertiary perinatal center in Canada. J Perinatol 38:1039–1045. https://doi.org/10.1038/s41372-018-0130-y

    Article  PubMed  Google Scholar 

  3. El-Khuffash A, Herbozo C, Jain A, Lapointe A, Mcnamara PJ (2013) Targeted neonatal echocardiography (TnECHO) service in a Canadian neonatal intensive care unit: a 4-year experience. J Perinatol 33:687–690. https://doi.org/10.1038/jp.2013.42

    Article  CAS  PubMed  Google Scholar 

  4. Harabor A, Soraisham AS (2015) Utility of targeted neonatal echocardiography in the management of neonatal illness. J Ultrasound Med 34:1259–1263. https://doi.org/10.7863/ultra.34.7.1259

    Article  PubMed  Google Scholar 

  5. Poon WB, Wong KY (2017) Neonatologist-performed point-of-care functional echocardiography in the neonatal intensive care unit. Singapore Med J 58:230–233.https://doi.org/10.11622/smedj.2017036

  6. Groves AM, Singh Y, Dempsey E, Molnar Z, Austin T, El-Khuffash A, de Boode WP (2018) Introduction to neonatologist-performed echocardiography. Pediatr Res 84:1–12. https://doi.org/10.1038/s41390-018-0076-y

    Article  PubMed  PubMed Central  Google Scholar 

  7. Kluckow M, Seri I, Evans N (2008) Echocardiography and the neonatologist. Pediatr Cardiol 29:1043–1047. https://doi.org/10.1007/s00246-008-927

    Article  CAS  PubMed  Google Scholar 

  8. de Waal K, Kluckow M (2010) Functional echocardiography; from physiology to treatment. Early Hum Dev 86:149–154. https://doi.org/10.1016/j.earlhumdev.201

    Article  PubMed  Google Scholar 

  9. El-Khuffash AF, McNamara PJ (2011) Neonatologist-performed functional echocardiography in the neonatal intensive care unit. Semin Fetal Neonatal Med 16:50–60. https://doi.org/10.1016/j.siny.2010.05.001

    Article  PubMed  Google Scholar 

  10. Giesinger RE, McNamara PJ (2016) Hemodynamic instability in the critically ill neonate: an approach to cardiovascular support based on disease pathophysiology. Semin Perinatol 40:174–188. https://doi.org/10.1053/j.semperi.2015.12

    Article  PubMed  Google Scholar 

  11. Rahde Bischoff A, Bhombal S, Altman CA, Fraga M V., Punn R, Rohatgi RK, Lopez L, McNamara PJ (2022) Targeted neonatal echocardiography in patients with hemodynamic instability. Pediatrics 150:S1-S18. https://doi.org/10.1542/peds.2022-056415I. https://doi.org/10.1542/peds.2022-056415I

  12. Mukerji A, DIambomba Y, Lee SK, Jain A (2016) Use of targeted neonatal echocardiography and focused cardiac sonography in tertiary neonatal intensive care units. J Ultrasound Med 35:1579–1591. https://doi.org/10.7863/ultra.15.06037

    Article  PubMed  Google Scholar 

  13. Weisz D, Poon W, James A, McNamara P (2014) Low Cardiac Output Secondary to a Malpositioned Umbilical Venous Catheter: Value of Targeted Neonatal Echocardiography. Am J Perinatol Reports 4:023–028. https://doi.org/10.1055/s-0034-1368090

    Article  Google Scholar 

  14. Shah DM, Kluckow M (2011) Early functional echocardiogram and inhaled nitric oxide: usefulness in managing neonates born following extreme preterm premature rupture of membranes (PPROM). J Paediatr Child Health 47:340–345. https://doi.org/10.1111/j.1440-1754.2010.01982.x

    Article  PubMed  Google Scholar 

  15. Alammary D, Narvey M, Soni R, Elsayed Y, Louis D (2022) Targeted neonatal echocardiography service in neonatal intensive care in Manitoba, Canada. J Perinatol 42:655–659. https://doi.org/10.1038/s41372-021-01258-5

    Article  PubMed  Google Scholar 

  16. Kluckow M, Jeffery M, Gill A, Evans N (2014) A randomised placebo-controlled trial of early treatment of the patent ductus arteriosus. Arch Dis Child Fetal Neonatal Ed 99:F99–F104. https://doi.org/10.1136/archdischild-2013-304695

    Article  PubMed  Google Scholar 

  17. Jain A, Sahni M, El-Khuffash A, Khadawardi E, Sehgal A, McNamara PJ (2012) Use of targeted neonatal echocardiography to prevent postoperative cardiorespiratory instability after patent ductus arteriosus ligation. J Pediatr 160:584–589. https://doi.org/10.1016/j.jpeds.2011.09.027

    Article  PubMed  Google Scholar 

  18. Altit G, Bhombal S, Van Meurs K, Tacy TA (2017) Ventricular performance is associated with need for extracorporeal membrane oxygenation in newborns with congenital diaphragmatic hernia. J Pediatr 191:28–34. https://doi.org/10.1016/j.jpeds.2017.08.060

    Article  PubMed  Google Scholar 

  19. Mertens L, Seri I, Marek J et al (2011) Targeted neonatal echocardiography in the neonatal intensive care unit: practice guidelines and recommendations for training. Eur J Echocardiogr 12:715–736. https://doi.org/10.1093/ejechocard/jer181

    Article  PubMed  Google Scholar 

  20. Singh Y, Gupta S, Groves AM, Gandhi A, Thomson J, Qureshi S, Simpson JM (2016) Expert consensus statement ‘neonatologist-performed echocardiography (NoPE)’—training and accreditation in UK. Eur J Pediatr 175:281–287. https://doi.org/10.1007/s00431-015-2633-2

    Article  PubMed  Google Scholar 

  21. De Boode WP, Singh Y, Gupta S et al (2016) Recommendations for neonatologist performed echocardiography in Europe: consensus statement endorsed by European Society for Paediatric Research (ESPR) and European Society for Neonatology (ESN). Pediatr Res 80:465–471. https://doi.org/10.1038/pr.2016.126

    Article  PubMed  PubMed Central  Google Scholar 

  22. Finan E, Sehgal A, El Khuffash A, McNamara PJ (2014) Targeted neonatal echocardiography services: need for standardized training and quality assurance. J Ultrasound Med 33:1833–1841. https://doi.org/10.7863/ultra.33.10.1833

    Article  PubMed  Google Scholar 

  23. Corredera A, Rodríguez MJ, Arévalo P, Llorente B, Moro M, Arruza L (2014) Ecocardiografía funcional en cuidados intensivos neonatales: experiencia en una unidad española a lo largo de un año. An Pediatr 81:167–173. https://doi.org/10.1016/j.anpedi.2013.11.026

    Article  CAS  Google Scholar 

  24. Roehr CC, Te Pas AB, Dold SK, Breindahl M, Blennow M, Rüdiger M, Gupta S (2013) Investigating the European perspective of neonatal point-of-care echocardiography in the neonatal intensive care unit - a pilot study. Eur J Pediatr 172:907–911. https://doi.org/10.1007/s00431-013-1963-

    Article  CAS  PubMed  Google Scholar 

  25. Beaulieu Y (2007) Bedside echocardiography in the assessment of the critically ill. Crit Care Med 35:S235–S249. https://doi.org/10.1097/01.CCM.0000260673.66681.AF

    Article  PubMed  Google Scholar 

  26. Beaulieu Y, Marik PE (2007) Bedside ultrasonography in the ICU : part 1 critical care review bedside ultrasonography in the ICU part 1. Chest 128:881–895.https://doi.org/10.1378/chest.128.2.881

  27. Kluckow M, Seri I, Evans N (2007) Functional echocardiography: an emerging clinical tool for the neonatologist. J Pediatr 150:125–130. https://doi.org/10.1016/j.jpeds.2006.10.056

    Article  PubMed  Google Scholar 

  28. Maxwell AG, Jardine DL (2019) Introduction of portable bedside echocardiography to acute general medicine. Intern Med J 49:1025–1028. https://doi.org/10.1111/imj.14383

    Article  PubMed  Google Scholar 

  29. Romero-Bermejo FJ,  Ruiz-Bailén M, Guerrero-De-Mier M (2011) Hemodynamic monitoring in the critically ill patient. Curr Cardiol Rev 7:146–156. https://doi.org/10.2174/157340311798220485

    Article  PubMed  PubMed Central  Google Scholar 

  30. Labovitz AJ, Noble VE, Bierig M et al (2010) Focused cardiac ultrasound in the emergent setting: a consensus statement of the American Society of Echocardiography and American College of Emergency Physicians. J Am Soc Echocardiogr 23:1225–1230. https://doi.org/10.1016/j.echo.2010.10.005

    Article  PubMed  Google Scholar 

  31. Wu TW, Noori S (2021) Recognition and management of neonatal hemodynamic compromise. Pediatr Neonatol 62:S22–S29. https://doi.org/10.1016/j.pedneo.2020.12

    Article  PubMed  Google Scholar 

  32. Jain A, McNamara PJ, Ng E, El-Khuffash A (2012) The use of targeted neonatal echocardiography to confirm placement of peripherally inserted central catheters in neonates. Am J Perinatol 29:101–106. https://doi.org/10.1055/s-0031-1295649

    Article  PubMed  Google Scholar 

  33. Katheria A, Leone T (2012) Altered transitional circulation in infants of diabetic mothers with strict antenatal obstetric management: a functional echocardiography study. J Perinatol 32:508–513. https://doi.org/10.1038/jp.2011.135

    Article  CAS  PubMed  Google Scholar 

  34. Kluckow M (2011) Functional echocardiography in assessment of the cardiovascular system in asphyxiated neonates. J Pediatr 158:e13–e18. https://doi.org/10.1016/j.jpeds.2010.11.007

    Article  PubMed  Google Scholar 

  35. Aggarwal S, Natarajan G (2015) Echocardiographic correlates of persistent pulmonary hypertension of the newborn. Early Hum Dev 91:285–289. https://doi.org/10.1016/j.earlhumdev.2015.02.008

    Article  PubMed  Google Scholar 

  36. Sehgal A, Mehta S, Evans N, McNamara PJ (2014) Cardiac sonography by the neonatologist: clinical usefulness and educational perspective. J Ultrasound Med 33:1401–1406. https://doi.org/10.7863/ultra.33.8.1401

    Article  PubMed  Google Scholar 

  37. Cole GD, Dhutia NM, Shun-Shin MJ, Willson K, Harrison J, Raphael CE, Zolgharni M, Mayet J, Francis DP (2015) Defining the real-world reproducibility of visual grading of left ventricular function and visual estimation of left ventricular ejection fraction: impact of image quality, experience and accreditation. Int J Cardiovasc Imaging 31:1303–1314. https://doi.org/10.1007/s10554-015-0659-1

    Article  PubMed  PubMed Central  Google Scholar 

  38. Smith A, Purna JR, Castaldo MP et al (2019) Accuracy and reliability of qualitative echocardiography assessment of right ventricular size and function in neonates. Echocardiography 36:1346–1352. https://doi.org/10.1111/echo.14409

    Article  PubMed  PubMed Central  Google Scholar 

  39. Mertens L, Seri I, Marek J et al (2011) Targeted neonatal echocardiography in the neonatal intensive care unit: practice guidelines and recommendations for training. J Am Soc Echocardiogr 24:1057–1078. https://doi.org/10.1016/j.echo.2011.07.014

    Article  PubMed  Google Scholar 

  40. de Boode WP, Singh Y, Molnar Z, Schubert U, Savoia M, Sehgal A, Levy P, McNamara P, El-Khuffash A (2018) Application of neonatologist performed echocardiography in the assessment and management of persistent pulmonary hypertension of the newborn. Pediatr Res 84:68–77. https://doi.org/10.1038/s41390-018-0082-0

    Article  PubMed  PubMed Central  Google Scholar 

  41. Frommelt P, Gorentz J, Deatsman S, Organ D, Frommelt M, Mussatto K (2008) Digital imaging, archiving, and structured reporting in pediatric echocardiography: impact on laboratory efficiency and physician communication. J Am Soc Echocardiogr 21:935–940. https://doi.org/10.1016/j.echo.2008.02.007

    Article  PubMed  Google Scholar 

  42. Hébert A, Lavoie PM, Giesinger RE et al (2019) Evolution of training guidelines for echocardiography performed by the neonatologist: toward hemodynamic consultation. J Am Soc Echocardiogr 32:785–790. https://doi.org/10.1016/j.echo.2019.02.0

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Division of Neonatology, Children’s Hospital of Fudan University, 399 Wanyuan Street, Minghang District, Shanghai, 201102, China

    Yingping Deng

  2. Department of Neonatology, Hainan Women and Children’s Medical Center, 75 South Longkun Road, Haikou, 570312, Hainan, China

    Xiang Cao

  3. Division of Cardiology, The Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, Canada

    Luc L. Mertens

  4. Department of Pediatrics, University of Iowa, 200 Hawkins Dr, Iowa City, IA, 52242, USA

    Patrick J. McNamara

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  4. Patrick J. McNamara
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Contributions

Yingping Deng, MD: writing-original draft, gaining ethical approval, data acquisition and analysis.

Xiang Cao, MD: data acquisition and analysis. Luc L. Mertens, MD: conceptualization. Patrick J. McNamara, MD: conceptualization, revising manuscript critically for important intellectual content.

Corresponding author

Correspondence to Patrick J. McNamara.

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Ethics approval

The study described has been carried out in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study has been approved by the Research Ethics Board of Children’s Hospital of Fudan University on February 25, 2022 [REB#. (2022)14].

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The participants implied consent by completing and submitting the questionnaire.

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The authors declare no competing interests.

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Communicated by Daniele De Luca

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Yingping Deng and Xiang Cao contributed equally to this manuscript and shared the first authorship.

The original online version of this article was revised due to updated data under Methods section.

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Deng, Y., Cao, X., Mertens, L.L. et al. Growth of targeted neonatal echocardiography in Chinese neonatal intensive care units: gaps in practice and training. Eur J Pediatr 182, 3457–3466 (2023). https://doi.org/10.1007/s00431-023-05008-x

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