Utilization of integrated lung ultrasound and targeted neonatal echocardiography in preterm infant follow-up: is it feasible? Assessing value and practical challenges

Lung ultrasound (LUS) and targeted neonatal echocardiography (TNE) are employed in some neonatal intensive care units throughout the hospital stay to monitor heart- and lung-related morbidities. However, preterm infants are at risk of increased rates of respiratory and cardiovascular morbidities across their lifespan. This commentary aims to define the utility of long-term TNE and LUS follow-up and to assess the challenges of incorporating these techniques into long-term practice. The cardiovascular phenotype of bronchopulmonary dysplasia (BPD) includes diverse cardiac and extracardiac anomalies. Many of these arise during hospitalization and can be detected on a multiparametric echocardiography examination. Nonetheless, several complications of prematurity related to pulmonary vascular disease arise after discharge, notably acute and chronic pulmonary hypertension and pulmonary vein stenosis. Similarly, LUS facilitates the diagnosis and prediction of several respiratory conditions affecting preterm infants during hospitalization, including respiratory distress syndrome and BPD. Limited data exist on LUS evolution after discharge. Multiple studies demonstrated that TNE significantly improves clinical and therapeutic outcomes in critically ill neonates, while evidence supporting LUS utility, though limited, continues to accumulate. Implementation of both LUS and TNE in preterm follow-up is challenged by limitations in training, resources, and institutional support.

Available evidence supports continuous ultrasound cardiopulmonary monitoring from birth through hospital discharge and into long-term follow-up. Neonatologists should look beyond immediate perinatal complications, as cardiorespiratory morbidities may remain subclinical yet emerge months to years later. Their unique integrated assessment of the cardiopulmonary system, coupled with safe and accessible tools, supports post-discharge TNE-LUS implementation without substantial barriers.

• LUS and TNE are typically utilized during the admission period, a role that is well-defined and extensively documented in the literature. • After discharge, echocardiography provides comprehensive longitudinal data, whereas LUS has been poorly investigated.

• The utilization of LUS and integrated TNE-LUS after discharge represents a significant research gap and a field of considerable potential utility in the long-term management of preterm infants. • Given their safety profile and accessibility, no substantial barriers preclude their post-discharge implementation.