Gap between guidelines and practice: echocardiography reporting in neonatal pulmonary hypertension

Objectives: Targeted neonatal echocardiography is increasingly integrated into neonatal care and plays a crucial role in the evaluation and management of persistent pulmonary hypertension of the newborn. The objective of this study was to assess the utilisation of echocardiography and quality of reporting the findings in a tertiary neonatal ICU, with reference to recent imaging guidelines. Methods: All neonates (N = 49) who required inhaled nitric oxide for persistent pulmonary hypertension at Oulu University Hospital from September 2016 to September 2021 were included in this retrospective study. Altogether, 113 echocardiography evaluations were performed during their treatment. Patient characteristics, treatment outcomes, and details of echocardiography reports were systematically collected and evaluated. Results: Transthoracic echocardiography was performed prior to the start of nitric oxide treatment in all except two critically ill neonates. Echocardiography evaluations were mostly performed by neonatologists (42%), and indications for imaging were diagnostic initial evaluation and treatment follow-up in 49% and 51% of occasions, respectively. The most commonly reported parameters were the patency of arterial duct (88%) and the pattern of ductal shunting (75%), while right ventricular function was reported in only 16% of the reports. Conclusion: Echocardiography was widely used by all specialists involved in the treatment of neonatal pulmonary hypertension but there was a large variation in quality of reports. Allocating resources for structured training and implementing simple, priority-based guidelines, supported by documentation templates and brief, systematic assessment guidance for common clinical scenarios, might improve the quality of reporting.