Expert consensus statement ‘Neonatologist-performed Echocardiography (NoPE)’—training and accreditation in UK
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Targeted echocardiographic assessments of haemodynamic status are increasingly utilised in many settings. Application in the neonatal intensive care units (NICU) is increasingly demanded but challenging given the risk of underlying structural lesions. This statement follows discussions in UK led by the Neonatologists with an Interest in Cardiology and Haemodynamics (NICHe) group in collaboration with the British Congenital Cardiac Association (BCCA) and the Paediatricians with Expertise in Cardiology Special Interest Group (PECSIG). Clear consensus was agreed on multiple aspects of best practice for neonatologist-performed echocardiogram (NoPE)—rigorous attention to infection control and cardiorespiratory/thermal stability, early referral to paediatric cardiology with suspicion of structural disease, reporting on standardised templates, reliable image storage, regular skills maintenance, collaboration with a designated paediatric cardiologist, and regular scan audit/review. It was agreed that NoPE assessments should confidently exclude structural lesions at first scan. Practitioners would be expected to screen and establish gross normality of structure at first scan and obtain confirmation from paediatric cardiologist if required, and subsequently, functional echocardiography can be performed for haemodynamic assessment to guide management of newborn babies. To achieve training, NICHe group suggested that mandatory placements could be undertaken during core registrar training or neonatal subspecialty grid training with a paediatric cardiology placement for 6 months and a neonatology placement for a minimum of 6 months. In the future, we hope to define a precise curriculum for assessments. Technological advances may provide solutions—improvements in telemedicine may have neonatologists assessing haemodynamic status with paediatric cardiologists excluding structural lesions and neonatal echocardiography simulators could increase exposure to multiple pathologies and allow limitless practice in image acquisition.
What is Known:
• Neonatologist-performed echocardiogram (NoPE) also known as targeted neonatal echocardiography (TNE) or functional ECHO is increasingly recognised and utilised in care of sick newborn and premature babies.
• There are differences in training for echocardiography across continents and formal accreditation processes are lacking.
What is New:
• This is the first document of consensus best practice statement for training of neonatologists in neonatologist-performed echocardiogram (NoPE), jointly drafted by Neonatologists with interest in cardiology & haemodynamics (NICHe), paediatric cardiology and paediatricians with expertise in cardiology interest groups in UK.
• Key elements of a code of practice for neonatologist-performed echocardiogram are suggested.
KeywordsEchocardiography Training Neonatologist Heart disease Haemodynamics Ultrasound
American Society of Echocardiography
British Association of Perinatal Medicine
British Congenital Cardiac Association
British Cardiovascular Society
Certificate in Clinician-Performed Ultrasound
European Association of Echocardiography
Neonatologists with Interest in Cardiology and Haemodynamics
Neonatal intensive care unit
Patent ductus arteriosus
Paediatricians with Expertise in Cardiology
Paediatricians with Expertise in Cardiology Special Interest Group
Persistent pulmonary hypertension of the newborn
Royal College of Paediatrics and Child Health
Targeted neonatal echocardiography
SG is founder and chair of the Neonatologists with Interest in Cardiology and Haemodynamics group (NICHe) and Conference director of Annual international Neonatal Cardiology and Haemodynamics conference (NeoCard), UK. AMG is a director of Neonatal Echo Skills, providing neonatal echocardiography training. YS is academic and educational convenor of PECSIG group, lead for training and accreditation at NICHe group and a course co-director at Yorkshire Paediatric Echocardiography Course. AG is chair of PECSIG group.
Neonatologist with Interest in Cardiology and Haemodynamics (NICHe) group: Samir Gupta, Naharmal Soni, Yogen Singh, Ajay Sinha, Siddhartha Sen, Porus Bustani, Rahul Roy, Ann Marie Heuchan, Sundeep Harigopal, Vishna Rasiah, Jonathan Wyllie, Majd-Abu Harb
Paediatricians with Expertise in Cardiology Special Interest Group (PECSIG): Anjum Gandhi, P Venugopalan, Prakash Day, Pradip Thakker, Mary Salama, Roy Sievers, Arivalangan Kannivelu, Dzung Nguyen, David Mabin, S Sivakumar, R Krishnamurthy, Sue Hobbins
British Congenital Cardiac Association (BCCA) Group: Robin Martin, David Anderson, Mike Burch, Andrew Tometzki, David Barron, Kate English, Alan Magee, Kevin Roman, Dominic Hares, David Crossland, Wilf Kelsall Sadia Quyam, Dirk Wilson, Rodney Franklin, Elizabeth Aryeetey, Karolina Bilska
Conflict of interest
There are no conflicts of interest and no financial relationship with any organisation.
All authors contributed to the manuscript. The manuscript idea was conceived by SG, AG & YS. YS wrote the first draft of the menuscript. SG & AG revised the manuscript. JS, SQ & JT advised on paediatric cardiology perspective & AG on PECSIG. The contributors facilitated discussions at NICHe, PECSIG & BCCA groups.
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