[Echocardiography is a useful tool in neonatal intensive care settings: a Lebanese experience]

To study the role of Doppler Echocardiography (DE), its indications and results in multiple neonatal intensive care units (NICU).

Over a period of 12 months, starting November 1st, 2001, till October 31st, 2002, 1105 newborns were admitted to six different NICU centers in the city of Beirut and its southern suburb. DE was requested in 159 patients (14.4%) mainly for the suspicion of hemodynamic disorders [congenital cardiopathy (cc), pulmonary hypertension (PHT), unexplained respiratory distress, shock and cardio-respiratory arrest]. Through this examination, the following were investigated [search for cc; study of the cardiac contractility; search and study of the blood flow through the foramen ovale (FO) and the ductus arteriosus (DA) if patent; detection of mitral and tricuspid regurgitation (MR, TR); measure, if possible, of the systolic pulmonary artery pressure, and eventual estimation of the systolic pressure in the aorta].

Congenital heart disease was diagnosed in 53 newborns (33.3%), secondary PHT in 14 (8.8%), ischemic cardiomyopathy in 4, persistent fetal circulation in 3. DE was normal in 81 patients (50.9%). In 123 completely documented cases, a FO was constantly patent, TR was found in 52% allowing the measure of pulmonary artery pressure, a patent DA in 49%; the systemic arterial pressure was estimated in 35% and MR was noted in 5% of the cases.

Not to consider the cc, DE is indicated in numerous situations. This technique permits precise study of the cardiovascular functions, mainly in critical situations; it allows the follow-up of the hemodynamic modifications instantaneously under treatment. Actually, the neonatal resuscitation and the critical modifications necessary in the workup of newborns mandate the presence of a DE machine in the NICU. Furthermore, DE knowledge should be incorporated in the future training programs of physicians specializing in neonatal resuscitation.