Anatomical Concordance of Neonatologist Performed Echocardiography as part of Hemodynamic Consultation and Pediatric Cardiology

Abstract Background Targeted neonatal echocardiography (TnECHO) performed by neonatologists as part of a hemodynamics consultation is increasingly being utilized in neonatal intensive care units. To minimize delays in obtaining physiological data, first echocardiograms may be performed by the neonatal hemodynamics team and reviewed afterwards by a pediatric cardiologist. This practice has not been systematically evaluated. Objective To compare concordance between the anatomic findings reported by TnECHO and pediatric cardiology reports. Methods This is a retrospective evaluation of 339 infants at low risk for congenital heart disease (CHD) admitted to two large referral centers with established neonatal hemodynamics programs who underwent comprehensive TnECHO as their first postnatal echocardiogram. The protocol included comprehensive imaging of intracardiac anatomy, outflow tract concordance and integrity, aortic arch anatomy, pulmonary vein location/flow, and transitional shunts. The hemodynamic consultation note was compared to the cardiology reports to determine anatomical concordance or major/minor discrepancies in all first studies. Results Anatomical concordance occurred in 97.9% [К 0.862 (95% CI 0.762-0.962), p Conclusion The rate of major CHD in patients considered eligible for hemodynamic consultation was low and there was high diagnostic concordance between trained neonatal hemodynamics specialists and pediatric cardiology. First echocardiograms performed by subspecialty neonatologists may provide imaging of sufficient quality to evaluate a critically unwell neonate with low suspicion for critical CHD lesions. These results should not be extrapolated to infants where CHD is suspected. This study highlights the importance of formalized, rigorous and standardized training for neonatologists with hemodynamic expertise who perform timely TnECHO assessments.