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• Re:Cardiac assessment using echocardiography in the sick neonate - An unmet need for a training syllabus for aspiring neonatologists
  Martin R Kluckow
  Published on: 22 March 2016
• Cardiac assessment using echocardiography in the sick neonate - An unmet need for a training syllabus for aspiring neonatologists
  John Madar
  Published on: 22 March 2016

• Published on: 22 March 2016

  Re:Cardiac assessment using echocardiography in the sick neonate - An unmet need for a training syllabus for aspiring neonatologists

  • Martin R Kluckow, Neonatologist

  Dear Editor I would like to thank Dr's Madar and Kariholu for their interest in the recent review article on use of ultrasound to assess the haemodynamic status of the sick neonate(1,2). They raise an important point that highlights the current disconnect between the recognition of the usefulness of ultrasound in general for assessment of sick neonates and the lack of availability of suitable training courses to learn th...

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  Dear Editor I would like to thank Dr's Madar and Kariholu for their interest in the recent review article on use of ultrasound to assess the haemodynamic status of the sick neonate(1,2). They raise an important point that highlights the current disconnect between the recognition of the usefulness of ultrasound in general for assessment of sick neonates and the lack of availability of suitable training courses to learn these skills. They further propose that ultrasound is an essential skill for the neonatologist and thus a training syllabus in neonatal functional cardiac assessment should be developed, and foreshadow the incorporation of this training into neonatal training programs. Neonatology is not alone in this realisation and there is a steady push to incorporate ultrasound to help guide clinical care into many specialty training programs ranging from intensive care, accident and emergency to surgery and renal medicine(3). Separation of the use of point of care ultrasound to guide clinical care from a high level consultational ultrasound to exclude structural pathology is key to gaining acceptance for the use of ultrasound in this way. In Neonatology it is important to avoid describing a focused clinical cardiac ultrasound as an echocardiogram, as this is a term that is usually interpreted as meaning a high level cardiology based examination, with different expectations and outcomes. In Australia and New Zealand we have developed a point of care ultrasound training program for both cardiac and cranial ultrasound(4). The course has a basic and an advanced module and is based on the following principles: 1] A physics and safety module 2] An initial introductory theory and hands on course 3] Self directed learning, logbooking and supervision of ultrasound in a clinical neonatal setting 4] Logbook and competency assessment 5] Reaccreditation requirements We have found that learning neonatal ultrasound in this "apprenticeship" setting, similar to that of learning neonatology generally, results in clinicians who have a clear understanding of the uses and limitations of ultrasound use in the NICU. Contrary to concerns raised by traditional users of ultrasound in the neonatal unit, we have found that not only is physiological management of the sick neonate made easier, but that significant structural cardiac defects are often identified earlier in the neonatal course than had been the case before the increased use of ultrasound to guide clinical care. We have not as yet mandated this training as part of the national neonatal training program, mainly because we are unable to guarantee access to training to all trainees. This will change as the critical mass of neonatologists using ultrasound increases. I encourage Dr's Madar and Kariholu to engage with colleagues interested in developing a neonatal ultrasound training program in the United Kingdom and make it a reality.

  (1).Kluckow M Use of ultrasound in the haemodynamic asessment of the sick neonate. Arch. Dis. Child. Fetal Neonatal Ed. 2014 99:F332-F337; doi:10.1136/archdischild-2013-304926 (2). John Madar, Ujwal Kariholu. Cardiac assessment using echocardiography in the sick neonate - An unmet need for a training syllabus for aspiring neonatologists.Arch. Dis. Child. Fetal Neonatal Ed. 2014 (3). Moore CL and Copel JA. Point of care ultrasonography. N Engl J Med. 2011 Feb 24;364(8):749-57 (4). http://www.asum.com.au/newsite/Education.php?p=CCPU-Neonatal

  Conflict of Interest:

  None declared

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  Conflict of Interest:
  None declared.

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• Published on: 22 March 2016

  Cardiac assessment using echocardiography in the sick neonate - An unmet need for a training syllabus for aspiring neonatologists

  • John Madar, Consultant Neonatologist
  • Other Contributors:
    • Ujwal Kariholu

  In the UK speciality training through the grid scheme has been in existence for about a decade with a well-defined syllabus of knowledge and skills deemed necessary for the qualified neonatologist. Although much emphasis is laid on various aspects of neonatal care and the acquisition of procedural skills including cranial ultrasound, cardiac assessment using echocardiography is still considered to be an optional skill (1)...

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  In the UK speciality training through the grid scheme has been in existence for about a decade with a well-defined syllabus of knowledge and skills deemed necessary for the qualified neonatologist. Although much emphasis is laid on various aspects of neonatal care and the acquisition of procedural skills including cranial ultrasound, cardiac assessment using echocardiography is still considered to be an optional skill (1).

  There are many reasons why this position should now be challenged. Not least the greatly enhanced armentarium of the neonatologist when considering therapy, coupled to the relative ease of access to the equipment necessary to undertake such an evaluation.

  Hence our question 'Should cardiac assessment using echocardiography be considered an essential skill for the neonatologist?'

  The recent article by Kluckow (2) highlights the value of clinician performed cardiac ultrasound in neonatal practice. The ability to undertake a timely competent functional cardiac assessment - even of limited parameters - might help optimise therapy, reduce morbidity and potentially mortality. Yet this ability is not yet deemed essential in the training of those looking after the most vulnerable babies.

  A syllabus in functional cardiac assessment for the neonatologist needs to be developed as a matter of priority, with access to structured training in order that all those aspiring to be neonatologists learn the potential of these techniques and are able to acquire the skills during their time as a trainee. It might be argued that it would be advantageous for those already working in the field but who lack these abilities to do likewise.

  References

  1. http://www.rcpch.ac.uk/training-examinations-professional- development/postgraduate-training/sub-specialty-training/neonatal

  2. Kluckow M. Use of ultrasound in the haemodynamic assessment of the sick neonate. Arch Dis Child Fetal Neonatal Ed. 2014 Apr 15. doi: 10.1136/archdischild-2013-30492

  Conflict of Interest:

  None declared

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  Conflict of Interest:
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