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Expert consensus statement ‘Neonatologist-performed Echocardiography (NoPE)’—training and accreditation in UK


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.

Conclusion: We propose developing training places in specialist paediatric cardiology centres and neonatal units to facilitate training and suggest all UK practitioners performing neonatologist-performed echocardiogram adopt this current best practice statement.

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.

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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


Neonatologist-performed echocardiogram


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


  1. Carmo KB, Evans N, Paradisis M (2009) Duration of indomethacin treatment of the preterm patent ductus arteriosus as directed by echocardiography. J Pediatr 155(6):819–22.e1

  2. Desandes R, Jellimann JM, Rouabah M, Haddad F, Desandes E, Boubred F et al (2011) Echocardiography as a guide for patent ductus arteriosus ibuprofen treatment and efficacy prediction. Pediatr Crit Care Med

  3. Evans N (2000) Echocardiography on neonatal intensive care units in Australia and New Zealand. J Paediatr Child Health 36(2):169–171

    Article  CAS  PubMed  Google Scholar 

  4. Evans N, Kluckow M (2012) Neonatology concerns about the TNE consensus statement. J Am Soc Echocardiogr 25(2):242

    Article  PubMed  Google Scholar 

  5. Group PwEiCSI (2008) Available from:

  6. Groves AM, Kuschel CA, Skinner JR (2006) International perspectives: the neonatologist as an echocardiographer. NeoReviews 7(8):e391–e399

    Article  Google Scholar 

  7. Intelligence CfW (2011) Medical Specialty Workforce Summary Sheet, Paediatric Cardiology. Available from:

  8. Jain A, Sahni M, El-Khuffash A, Khadawardi E, Sehgal A, McNamara PJ (2011) Use of targeted neonatal echocardiography to prevent postoperative cardiorespiratory instability after patent ductus arteriosus ligation. J Pediatr

  9. Katumba-Lunyenya JL (2002) Neonatal/infant echocardiography by the non-cardiologist: a personal practice, past, present, and future. Arch Dis Child Fetal Neonatal Ed 86(1):F55–F57

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  10. Kimura BJ, Yogo N, O’Connell CW, Phan JN, Showalter BK, Wolfson T (2011) Cardiopulmonary limited ultrasound examination for “quick-look” bedside application. Am J Cardiol 108(4):586–590

    Article  PubMed  Google Scholar 

  11. Kluckow M, Seri I, Evans N (2007) Functional echocardiography: an emerging clinical tool for the neonatologist. J Pediatr 150(2):125–130

    Article  PubMed  Google Scholar 

  12. Longjohn M, Wan J, Joshi V, Pershad J (2011) Point-of-care echocardiography by pediatric emergency physicians. Pediatr Emerg Care 27(8):693–696

    Article  PubMed  Google Scholar 

  13. Mertens L, Seri I, Marek J, Arlettaz R, Barker P, McNamara P et al (2011) Targeted Neonatal Echocardiography in the Neonatal Intensive Care Unit: practice guidelines and recommendations for training. Writing Group of the American Society of Echocardiography (ASE) in collaboration with the European Association of Echocardiography (EAE) and the Association for European Pediatric Cardiologists (AEPC). J Am Soc Echocardiogr 24(10):1057–1078

    Article  PubMed  Google Scholar 

  14. Moore CL, Copel JA (2011) Point-of-care ultrasonography. N Engl J Med 364(8):749–757

    Article  CAS  PubMed  Google Scholar 

  15. Moss S, Kitchiner DJ, Yoxall CW, Subhedar NV (2003) Evaluation of echocardiography on the neonatal unit. Arch Dis Child Fetal Neonatal Ed 88(4):F287–F289, discussion F90-1

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  16. RCPCH (2011) Curriculum for Paediatric Training Neonatal Medicine.

  17. Roehr CC, Te Pas AB, Dold SK, Breindahl M, Blennow M, Rudiger M et al (2013) Investigating the European perspective of neonatal point-of-care echocardiography in the neonatal intensive care unit—a pilot study. Eur J Pediatr 172(7):907–911

    Article  CAS  PubMed  Google Scholar 

  18. Sehgal A, McNamara PJ (2008) Does point-of-care functional echocardiography enhance cardiovascular care in the NICU? J Perinatol 28(11):729–735

    Article  CAS  PubMed  Google Scholar 

  19. Sehgal A, McNamara PJ (2009) Does echocardiography facilitate determination of hemodynamic significance attributable to the ductus arteriosus? Eur J Pediatr 168(8):907–914

    Article  PubMed  Google Scholar 

  20. Skinner JR (1998) Echocardiography on the neonatal unit: a job for the neonatologist or the cardiologist? Arch Dis Child 78(5):401–402

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  21. Weekes AJ, Quirke DP (2011) Emergency echocardiography. Emerg Med Clin North Am 29(4):759–787, vi–vii

    Article  PubMed  Google Scholar 

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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.

Authors contributions

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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Correspondence to Samir Gupta.

Additional information

Communicated by Patrick Van Reempts

Revisions received: 21 June 2015 / 29 July 2015

Document by Neonatologists with Interest in Cardiology and Haemodynamics (NICHe) Endorsed by British Congenital Cardiac Association (BCCA) and Paediatricians with Expertise in Cardiology Special Interest Group (PECSIG), UK

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Singh, Y., Gupta, S., Groves, A.M. et al. Expert consensus statement ‘Neonatologist-performed Echocardiography (NoPE)’—training and accreditation in UK. Eur J Pediatr 175, 281–287 (2016).

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