Safety and Feasibility of Early Targeted Neonatal Echocardiography and a Focused Assessment Protocol in Neonates With Congenital Diaphragmatic Hernia

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.