Pediatric Cardiology

, 29:1043 | Cite as

Echocardiography and the Neonatologist

  • M. KluckowEmail author
  • I. Seri
  • N. Evans


Pediatric echocardiography as performed and interpreted by pediatric cardiologists provides details of cardiac structure and function as well as hemodynamic data. Functional echocardiography, in contrast to echocardiography as performed by the cardiologist, is the bedside use of cardiac ultrasound to follow functional and hemodynamic changes longitudinally. Data reflecting cardiac function and systemic and pulmonary blood flow in critically ill preterm and term neonates can be monitored using this method. Functional echocardiography is being developed and driven by neonatologists as an extension of their clinical skills. A wealth of hemodynamic information can be derived from functional echocardiography used for the sick neonate, which provides clinical information different from the assumed underlying physiology. Lack of access to appropriate training programs and interdisciplinary politics is limiting the use of this potentially valuable clinical information. Without the use of functional echocardiography, clinicians are left to speculate as to the underlying pathophysiology of circulatory compromise, and the assumptions they make often are incorrect. For functional echocardiography to fulfill its clinical potential, it needs to be available at any time and at short notice in the neonatal intensive care unit (NICU). Because most NICUs do not have external diagnostic services to provide longitudinal hemodynamic follow-up assessment at the bedside, neonatologists should be able to develop appropriate echocardiographic skills in close collaboration with their cardiologist colleagues.


Cardiovascular physiology Echocardiography Education and training 


  1. 1.
    Althouse LA, Stockman JAIII (2006) Pediatric workforce: a look at pediatric cardiology data from the American Board of Pediatrics. J Pediatr 148:384–385PubMedCrossRefGoogle Scholar
  2. 2.
    Australasian Society for Ultrasound in Medicine: Certificate in Clinician Performed Ultrasound. Retrieved from
  3. 3.
    Beaulieu Y (2007) Bedside echocardiography in the assessment of the critically ill. Crit Care Med 35:S235–S249PubMedCrossRefGoogle Scholar
  4. 4.
    Beaulieu Y (2007) Specific skill set and goals of focused echocardiography for critical care clinicians. Crit Care Med 35:S144–S149PubMedCrossRefGoogle Scholar
  5. 5.
    Dorfman AL, Levine JC, Colan SD, Geva T (2005) Accuracy of echocardiography in low-birth-weight infants with congenital heart disease. Pediatrics 115:102–107PubMedGoogle Scholar
  6. 6.
    Evans N (2000) Echocardiography on neonatal intensive care units in Australia and New Zealand. J Paediatr Child Health 36:169–171PubMedCrossRefGoogle Scholar
  7. 7.
    Evans N, Kluckow M, Currie A (1998) Range of echocardiographic findings in term neonates with high oxygen requirements. Arch Dis Child Fetal Neonatal Ed 78:F105–F111PubMedGoogle Scholar
  8. 8.
    Evans N, Malcolm G (2006) Practical echocardiography for the neonatologist: Part 1. Normal 2D imaging and Doppler: an interactive multimedia CD-ROM. Royal Prince Alfred Hospital, Sydney, AustraliaGoogle Scholar
  9. 9.
    Katumba-Lunyenya JL (2002) Neonatal/infant echocardiography by the noncardiologist: a personal practice, past, present, and future. Arch Dis Child Fetal Neonatal Ed 86:F55–F57PubMedCrossRefGoogle Scholar
  10. 10.
    Kluckow M (2005) Low systemic blood flow and pathophysiology of the preterm transitional circulation. Early Hum Dev 81:429–437PubMedCrossRefGoogle Scholar
  11. 11.
    Kluckow M, Evans N (1995) Early echocardiographic prediction of symptomatic patent ductus arteriosus in preterm infants undergoing mechanical ventilation. J Pediatr 127:774–779PubMedCrossRefGoogle Scholar
  12. 12.
    Kluckow M, Evans N (1996) Relationship between blood pressure and cardiac output in preterm infants requiring mechanical ventilation. J Pediatr 129:506–512PubMedCrossRefGoogle Scholar
  13. 13.
    Kluckow M, Seri I, Evans N (2007) Functional echocardiography: an emerging clinical tool for the neonatologist. J Pediatr 150:125–130PubMedCrossRefGoogle Scholar
  14. 14.
    Levene MI, Fawer CL, Lamont RF (1982) Risk factors in the development of intraventricular haemorrhage in the preterm neonate. Arch Dis Child 57:410–417PubMedGoogle Scholar
  15. 15.
    Moss S, Kitchiner DJ, Yoxall CW, Subhedar NV (2003) Evaluation of echocardiography on the neonatal unit. Arch Dis Child Fetal Neonatal Ed 88:F287–F289PubMedCrossRefGoogle Scholar
  16. 16.
    Osborn DA, Evans N, Kluckow M (2004) Clinical detection of low upper body blood flow in very premature infants using blood pressure, capillary refill time, and central-peripheral temperature difference. Arch Dis Child Fetal Neonatal Ed 89:F168–F173PubMedCrossRefGoogle Scholar
  17. 17.
    Seri I (2004) Hemodynamics during the first two postnatal days and neurodevelopment in preterm neonates. J Pediatr 145:573–575PubMedCrossRefGoogle Scholar
  18. 18.
    Sholler G (2001) Echocardiography in congenital heart disease: diagnosis, misdiagnosis, and ownership. J Paediatr Child Health 37:321–322PubMedCrossRefGoogle Scholar
  19. 19.
    Skinner JR (1998) Echocardiography on the neonatal unit: a job for the neonatologist or the cardiologist? Arch Dis Child 78:401–402PubMedGoogle Scholar
  20. 20.
    Skinner JR, Alverson DC, Hunter S (2000) Echocardiography for the neonatologist. Churchill Livingstone, Oxford, LondonGoogle Scholar
  21. 21.
    Ward CJ, Purdie J (2001) Diagnostic accuracy of paediatric echocardiograms interpreted by individuals other than paediatric cardiologists. J Paediatr Child Health 37:331–336PubMedCrossRefGoogle Scholar
  22. 22.
    Whitehall J (1999) Echocardiography by a neonatologist. Arch Dis Child 80:580–581PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  1. 1.Department of Neonatal MedicineRoyal North Shore HospitalSydneyAustralia
  2. 2.USC Division of Neonatal Medicine, Department of Pediatrics, Children’s Hospital Los Angeles and the Women’s and Children’s Hospital, LAC+USC Medical Center, Keck School of MedicineUniversity of Southern CaliforniaLos AngelesUSA
  3. 3.Department of Neonatal MedicineRoyal Prince Alfred Hospital and University of SydneySydneyAustralia

Personalised recommendations