P0379 - Care Management of Non-emergent Echocardiographic Diagnosis inNewborns

Background: Echocardiography is the primary tool used by clinicians to identify cardiovascular problems that need immediate attention in the newborn. More commonly, neonatal echocardiography identifies issues where the need for or timing of cardiology assessment is unclear.

Objective: The aim of this study is to identify the current practices of pediatric cardiologists regarding non-emergent findings on echocardiograms performed in the standard normal newborn nursery.

Methods:
An e-mail invitation to participate in a survey on management of non-emergent neonatal echocardiographic findings was sent to the members of American Academy of Pediatrics Section on Cardiology and Cardiac Surgery and to the Pediheart on-line community. Participants were asked for their recommendation of care regarding ten non-emergent echocardiographic findings in an asymptomatic normal newborns,term newborn and whether their recommendations would change for an asymptomatic premature newborns born at 34 weeks gestation or an asymptomatic term baby, and newborns with trisomy 21. Options for follow-up included: Normal Newborn Care without further assessment (blue), Inpatient Cardiology Consultation (red), Repeat Echocardiography without Cardiology Consultation (yellow), Cardiology Consultation without Echocardiography (green), and Cardiology Consultation with Echocardiography (orange).

Results:
We received 137 responses with interpretable data. This data for term newborns is shown in figure 1. 34% of providers would change their recommendations in the setting of prematurity and 47% would change their recommendations in the setting of trisomy 21. In all settings, ongoing cardiology care was typically recommended for newborns with a 6 mm atrial septal defect, a ventricular septal defect or a bicuspid aortic valve. Ongoing care was rarely recommended for newborns with a patent foramen ovale or trivial mitral valve regurgitation.

Conclusion:
The overall findings of this survey shows variation in practitioners' recommended level care in asymptomatic-newborns. With the exception of a patent foramen ovale or trivial mitral valve regurgitation, most practitioners feel that a follow up cardiology and echocardiography are appropriate.