Echocardiography on the neonatal unit: a job for the neonatologist or the cardiologist?

A large ductal shunt sufficient to cause severe reduction in effective cardiac output and even cardiorespiratory collapse after extubation can be clinically silent and may only be revealed by echocardiography. 1 Similarly, septic vegetations or thrombi on valves or central lines can only be seen this way, and it is feasible to assess pulmonary arterial pressure non-invasively in most ill newborns. [...]someone needs to be available 24 hours a day in all neonatal units to do echocardiography. The hypotensive or shocked newborn in the first few hours of life without clinical evidence of congenital heart disease Those requiring assessment of ductal and/or interatrial shunting Those with a central line to assess its position or to exclude vegetation or thrombus Those in whom pulmonary arterial pressure or cardiac output needs to be assessed (once CHD has been excluded by a paediatric cardiologist in infants with persistent hypoxaemia).