4 Educational Impact of Targeted Neonatal Echocardiography (TNE) on Neonatal-Perinatal Medicine (NPM) Subspecialty Residents

Primary Subject area Neonatal-Perinatal Medicine Background Targeted Neonatal Echocardiography (TNE) is a real-time cardiac imaging modality used by neonatologists who have completed a minimum of one-year training in cardiovascular physiology and imaging methodology, to optimize management of neonatal cardiorespiratory compromise. TNE is provided as a clinical service, to aid in diagnosis, treatment, and monitoring of neonatal cardiovascular illness. Potential impacts of TNE on trainee education are unknown. Objectives This study aimed to describe trainees’ perspectives on existing neonatal hemodynamics education and perceived impacts of TNE on their education. Design/Methods This was a mixed quantitative and qualitative study that surveyed NPM subspecialty residents in Canada and the United States of America (USA), at centres both with and without TNE. Survey questions sought to explore current perspectives on cardiac and hemodynamics curriculum in training programs. Results 92 residents responded to the survey, of whom 24 (26%) were enrolled in a program with an active TNE service, 64 (70%) were training at a non-TNE centre, and 4 (4%) were unsure. Trainees at TNE centres were more satisfied with their overall hemodynamics training (91% vs. 69%, p=0.040; Table 1). 25% of all trainees felt they do not have sufficient hemodynamics training to prepare them for independent practice. On analysis of curriculum content, cardiac development, myocardial functioning in prematurity, and cardiac mechanics emerged as areas of knowledge gaps among all residents (Table 2). TNE centre trainees reported that bedside TNE teaching offers immediate insights into how patients respond to management decisions, while didactic TNE teaching allows for learning at a slower pace, with appropriate knowledge consolidation. Only 9% of respondents at TNE sites reported a formal process of hemodynamics review between clinical and TNE teams. 90% of respondents believed that a TNE service would positively impact their hemodynamics education by improvement in knowledge of cardiovascular physiology and management decisions. Conclusion Most trainees believed that TNE may be a valuable educational tool, with current perceived satisfaction with overall hemodynamics training higher among residents training at TNE centres. 25% of all trainees felt unprepared for transitioning to independent practice. Hence, thoughtful curriculum design for real-time and consolidation learning, with specific emphasis on content gaps, as well as working toward a formal process of hemodynamics review, should be considered.

Evaluation of pain and physiological stress during targeted neonatal echocardiography

BACKGROUND: Targeted neonatal echocardiography (Tn-Echo) is a non-invasive examination which may cause pain/discomfort and physiological instability in neonates, but there is little evidence for the same. We conducted this study to evaluate whether targeted neonatal echocardiography causes pain or physiological stress to newborn infants. METHODS: This cross-sectional study was conducted in a tertiary level NICU. Neonates undergoing targeted neonatal echocardiography were enrolled in this study. Pain was assessed using Premature Infant Pain Profile-Revised (PIPP-R) score before, during and after targeted neonatal echocardiography examination. Heart rate, oxygen saturation, perfusion index and blood pressure were also recorded at the same time points. RESULTS: A total of 88 neonates were enrolled. Mean (SD) PIPP-R score during Tn-Echo was 8.18 (2.6) versus 3.60 (1.8) and 4.24 (2.0) before and after respectively (p value < 0.001). Heart rate and respiratory rate were significantly higher during targeted neonatal echocardiography; oxygen saturation and perfusion index were significantly lower during targeted neonatal echocardiography. Preterm infants had higher PIPP-R score compared to term neonates before, during and after the Tn-Echo [8.76 (2.4) versus 6.81 (2.4); p value < 0.001]. CONCLUSION: Targeted neonatal echocardiography causes significant pain/discomfort and physiological instability in neonates.

Targeted neonatal echocardiography-guided therapy pre-embolisation for congenital hepatic vascular malformation: inhaled nitric oxide to prevent paradoxical embolisation to the systemic circulation

Arteriovenous malformations may present with significant haemodynamic compromise in the neonatal period, typically with high output cardiac failure that may be accompanied by hypoxia and right ventricular dysfunction. Targeted neonatal echocardiography performed by trained neonatologists provides an enhanced physiology-based approach that can guide treatment and minimise complications. We present a case of a large hepatic vascular malformation whose therapy was guided by targeted neonatal echocardiography to prevent paradoxical embolisation of procedural glue to the systemic circulation.