John T. Wren Jr., Rachael M. Hyland, Stephanie Acosta, Patrick J. McNamara
University of Iowa Healthcare.
United States
Echocardiography
Echocardiography 2025;
DOI: 10.1111/echo.70189
Abstract
Objective: Congenital diaphragmatic hernia (CDH) is a complex disease with significant morbidity and mortality. The use of echocardiography, traditionally a pediatric cardiology echocardiogram (PCE), has significantly advanced the management of CDH but its availability can be limited, and there are concerns regarding clinical stability during the assessment. Neonatologist-performed targeted neonatal echocardiography (TNE) has been proposed as a supplementary modality in CDH. Herein, we evaluate the feasibility and safety of integrating early TNE and a focused assessment protocol in CDH care.
Methods: This was a retrospective, single-center study of neonates with CDH who received either an initial PCE (n = 26) or complete TNE (n = 20). The timing, images, and duration of the study were collected, as well as clinical stability data. A focused TNE protocol for cases of clinical instability was similarly evaluated.
Results: Despite similar clinical risk predictors, TNE was performed sooner (mean 3.0 vs. 11.6 h, p < 0.0001) and quicker (mean 25.9 vs. 44.4 min, p = 0.0001) than a PCE. While fewer images were obtained (mean 102.0 vs. 143.2 images, p < 0.0001), no cases of congenital heart disease were missed. TNE and PCE were equally well tolerated. When indicated, a focused TNE protocol was utilized that provided actionable information with a mean duration of 7.2 min (n = 4).
Conclusion: TNE can be performed early, quickly, and safely in neonates with CDH. A focused TNE protocol may be useful even in non-TNE centers for the acute care of critically ill neonates with CDH.
Category
Class III. Pulmonary Hypertension Associated with Lung Hypoplasia
Diagnostic Testing for Pulmonary Vascular Disease. Non-invasive Testing
Age Focus: Pediatric Pulmonary Vascular Disease
Fresh or Filed Publication: Fresh (PHresh). Less than 1-2 years since publication
Article Access
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