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Objective: To evaluate students' qualification after a six-month basic course of Neonatal Performed Echocardiography (NPEcho), adjusted by the motivational profile., Study Design: Prospective cohort of 16 neonatologists/neonatal fellows who underwent the basic NPEcho course in 2019 (18 h face-to-face theoretical classes; 36 h hands-on training) and 12 in 2020 (18 h online theoretical classes; 36 h hands-on training). Students' qualification was defined as ≥70% in post-test, video test, and practical evaluation in neonates. Academic Motivation Scale was applied., Results: Scores in 2019 vs. 2020 were: pre-test -32% vs. 40% (p = 0.029), final theoretical score -78% vs. 69% (p = 0.007), and practical evaluation -88% vs. 65% (p = 0.003), resulting in 68.8% in 2019 vs. 33.3% in 2020 qualified students. Students' motivational profile were similar in 2019 and 2020., Conclusion: The NPEcho was successful in qualifying students with face-to-face theoretical classes, but the online format was inadequate to achieve the learning goals., (© 2023. The Author(s), under exclusive licence to Springer Nature America, Inc.)

Background: The aim of this study was to assess whether neonatologist-performed echocardiography (NPE) changed the previously planned hemodynamic approach in critically ill newborn infants., Methods: This prospective cross-sectional study included the first NPE of 199 neonates. Before the exam, the clinical team was asked about the planned hemodynamic approach and the answer was classified as an intention to change or not to change the therapy. After being informed about the NPE results, the clinical management was grouped as performed as previously planned (maintained) or modified., Results: NPE modified the planned pre-exam approach in 80 cases (40.2%; 95% CI: 33.3-47.4%), and variables associated with an increased chance of this modification were exams to assess pulmonary hemodynamics (prevalent ratio (PR): 1.75; 95% CI: 1.02-3.00) and to assess systemic flow (PR: 1.68; 95% CI: 1.06-2.68) in relation to those requested for patent ductus arteriosus, pre-exam intention of changing the prescribed management (PR: 2.16; 95% CI: 1.50-3.11), use of catecholamines (PR: 1.68; 95% CI: 1.24-2.28) and birthweight (per kg) (PR: 0.81; 95% CI: 0.68-0.98)., Conclusion: The NPE was an important tool to direct hemodynamic management in a different approach from the previous intention of the clinical team, mainly for critically ill neonates., Impact: This study shows that neonatologist-performed echocardiography guides the therapeutic planning in the NICU, mainly in the more unstable newborns, with lower birthweight and receiving catecholamines. Exams requested with the intention of modifying the current approach were more likely to change the management in a different way than planned pre-exam., (© 2023. The Author(s), under exclusive licence to the International Pediatric Research Foundation, Inc.)

Objectives: Functional echocardiography is a valuable tool in the neonatal intensive care unit, but training programs are not standardized. The aim was to report an functional echocardiography training program for neonatologists and to describe the agreement of their measurements with the pediatric cardiologist., Methods: Functional echocardiography training lasted 32h. After training program, the neonatologists performed functional echocardiography in the neonatal intensive care unit and were required to measure left cardiac chambers dimensions, left ventricle systolic function, right and left ventricular output, ductus arteriosus diameter, and flow pattern. Images were recorded by the equipment and reviewed offline by the pediatric cardiologist. The Bland-Altman test was used for quantitative variables and the kappa test, for qualitative variables., Results: Twenty-two trained neonatologists performed 100 functional echocardiography exams. Ductus arteriosus identification and flow pattern had substantial agreement (kappa=0.91 and 0.88, respectively), as well as its diameter (mean difference=0.04mm). The mean difference for the aortic root was -1.2mm; left atrium, 0.60mm; left ventricle diastolic diameter, -0.90mm; left ventricle systolic diameter, -0.30mm. Shortening fraction and ejection fraction correlated well with broad limits of agreement, -2.96% (14.88; -20.82%) and --3.43% (15.54; -22.40%), respectively. Right and left ventricular output had broad limits of agreement, 16.69mL/kg/min (222.76; -189.37) and 23.57mL/kg/min (157.88; -110), respectively. There was good agreement between interpretations of normal or low cardiac output (76.7% for right ventricular output; 75.7% for left ventricular output)., Conclusion: This functional echocardiography training program enabled neonatologists to obtain adequate skills in performing the images, obtaining good agreement with the cardiologist in simple hemodynamic measurements and ductus arteriosus evaluation., (Copyright © 2019 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.)

Objective: To evaluate the feasibility of the use of spatiotemporal image correlation (STIC) as a screening program for congenital heart disease and the influence of professional experience in those examinations., Methods: This prospective cross-sectional study included 64 pregnant women at gestational age between 20 and 34 weeks, and 12 physician participants who were divided into two groups: group 1-"STIC specialist"; and group 2-"STIC nonspecialist." Volumes were analyzed to obtain the five axial views for optimal fetal heart screening: abdominal situs, four-chamber view (4CV), outflow tract views (OTV), and three vessels and trachea view (3VT). The chi-square test (χ(2) ) was used to compare the group's results and kappa coefficient to evaluate inter- and intra-observer reproducibility., Results: Spatiotemporal image correlation volume acquisition was successful in 97.3% of cases in which it was attempted (group 1: 100%; group 2:95%). A total of 197 STIC volumes were used in this study. In 71%, it was possible to demonstrate 4CV and OTV (group 1:88.9%; group 2:58.6%). 4CV, OTV, and 3VT were visualized in 55.3% of the volume dataset (group 1:74.1% and group 2:42.2%). In 49% of volumes, all five views for optimal fetal heart screening were seen (group 1:67%; group 2: 36%). A good inter-observer agreement was found in all cardiac views and a good intra-observer agreement in most of views except in OTV., Conclusion: We believe that STIC can be used as a tool to improve the cardiac screening examination of the fetus. Professional experience was the most important influence in the image quality of the STIC volume., (© 2015, Wiley Periodicals, Inc.)

Importance of the Field: Heart defects are the most frequent congenital malformations, affecting 8 in every 1000 neonates. As 90% of infants born with a congenital heart defects (CHD) have no known risk factor, screening for heart defects in every routine obstetric ultrasound is essential for antenatal diagnosis., Areas Covered in This Review: Two-dimensional echocardiography allied with three- and four-dimensional technologies such as spatio-temporal image correlation offer means for thoroughly evaluating fetal cardiac anatomy., What the Reader Will Gain: This article reviews the most relevant aspects of antenatal screening and diagnosis of CHD using sonography and echocardiography. It includes first trimester diagnosis and three- and four-dimensional techniques., Take Home Message: These antenatal diagnostic tools play an important role in optimization of obstetric care and neonatal management, thus potentially reducing perinatal mortality.

Purpose: to evaluate the areas of the atrioventricular valves (tricuspid and mitral) of normal fetuses by the use of three-dimensional ultrasound (3DUS) and the spatiotemporal image correlation (STIC) method., Methods: a cross-sectional study was conducted on 141 women between the 18th and the 33rd week of pregnancy. Cardiac volumes were measured with a volumetric transabdominal transducer attached to the Voluson 730 Expert equipment. The four chamber plane was used as reference, with the region of interest (ROI) positioned from the ventricles, and the area of the valves was obtained manually. To determine the correlation of the areas with gestational age, scatter plots were constructed and the Pearson correlation coefficient (r) was calculated. Means, medians, standard deviations (SD) and maximum and minimum values were calculated. The simple linear regression model was used to determine reference ranges of valve areas according to the gestational age by the Altman method, with the level of significance set at p<0.05. To calculate the intraobserver reproducibility, we used the intraclass correlation coefficient (ICC) and the Bland-Altman graph., Results: the mitral and tricuspid valve areas were correlated to the gestational age (r=0.80 for the tricuspid and r=0.79 for the mitral valve) and the mean value of the tricuspid and mitral valves increased from 0.22 ± 0.10 cm² and 0.23 ± 0.10 cm² on the 18th week to 0.92 ± 0.29 cm² and 1.08 ± 0.41 cm² on the 33rd of pregnancy, respectively. The intraobserver reproducibility resulted in an ICC=0.993 (95%CI 0.987; 0.996) and the mean difference was 0.01 cm² (SD ± 0.2 cm² and CI95% ± 0.4 cm²)., Conclusion: reference intervals for the areas of the mitral and tricuspid valve between the 18th and the 33rd week of gestation were determined and proved to be highly reproducible.

Purpose: We describe the first case in which a neonate with hypoplastic left heart syndrome was initially managed using a mini adjustable banding system., Description: Through a mid-sternotomy, a 5-day-old neonate underwent bilateral pulmonary artery banding using this new system, combined with placement of a main pulmonary artery to the innominate artery shunt., Evaluation: The patient had an uneventful postoperative course. Three percutaneous adjustments of the banding system were necessary to keep the arterial oxygen saturation in the 75% to 85% range. On day 48 of life, she was submitted to stent placement (6 mm) within the atrial septum to treat a restrictive atrial septal defect. Afterward, seven additional percutaneous adjustments of the banding system were necessary. The Norwood operation and the bidirectional Glenn shunt were carried out on the day 106 of life. The bands were removed with no pulmonary artery distortion., Conclusions: The clinical use of this innovative pulmonary artery banding system was feasible, safe, and effective. This allowed for customization of the pulmonary blood flow according to the underlying clinical needs, resulting in a more precise balance between the pulmonary and systemic circulations.

Objective: Hypoplastic left heart syndrome remains a challenge for worldwide surgeons. Initial palliation employing bilateral pulmonary artery banding along with ductal stent implantation and atrial septostomy has been proposed as an alternative approach. However, the surgically placed bands are fixed and may become inadequate after sternum closure or with somatic growth of the patient. We describe the first case in which a neonate with hypoplastic left heart syndrome was initially managed using a mini banding system that allows for fine percutaneous adjustments of pulmonary blood flow., Method: Through a mid sternotomy, a 5 day-old neonate underwent bilateral pulmonary artery banding using this new system combined with placement of a main pulmonary artery to innominate artery shunt., Results: The patient had an uneventful postoperative course. Three percutaneous adjustments of the banding system were necessary to keep the arterial oxygen saturation in the 75%-85% range. On the 48th day of life, she was submitted to stent placement (6 mm) within the atrial septum to treat a restrictive atrial septal defect. The Norwood operation and the bidirectional Glenn shunt were carried out on the 106th day of life. The bands were removed with no distortion of the pulmonary arteries., Conclusions: The clinical use of this innovative pulmonary artery banding system was feasible, safe and effective. It allowed for customization of the pulmonary blood flow according to the underlying clinical needs, resulting in a more precise balance between the pulmonary and systemic circulations.

Objective: To evaluate the prevalence of intracardiac echogenic foci (ICEF) and the association between ICEF and chromosomal and cardiac anomalies in Brazilian women., Methods: In a cross-sectional observational study, 373 of the 23,360 genetic sonograms performed at a private maternal-fetal medicine clinic over 5 years showed intracardiac echogenic foci (ICEF). These 373 sonograms were reviewed for chromosomal and cardiac anomalies and associations were analyzed using the chi(2) test or the Fisher exact test. P<0.05 was considered significant., Results: The prevalence of ICEF was 1.7%. Cardiac anomalies were detected in 10 sonograms (2.7%) and chromosomal anomalies in 14 (3.7%). There were cardiac defects in 6 (1.7%) of the 359 euploid fetuses with isolated ICEF. Of the 373 women who had fetuses with ICEF, 295 were younger than 35 years and 78 were 35 years or older. There were 6 fetuses (2.1%) with aneuploidy in the younger group and 8 (10.3%) in the older group., Conclusion: The prevalence of ICEF was 1.7%, and there was an association between cardiac and chromosomal anomalies. Women carrying fetuses with ICEF should be offered fetal echocardiography and karyotyping.

Objective: Assess the accuracy of the nuchal translucency (NT) measurement between 11 and 13 weeks and 6 days of gestation as a sonographic marker to screen for congenital heart defects (CHD)., Methods: This is a multi-center retrospective study in which singleton gestations of euploid fetuses were analyzed. NT measurement was performed in the first trimester examination when the fetal crown-rump length (CRL) was 45 to 84 mm, according to the criteria established by the Fetal Medicine Foundation. The cases were followed up to one month postpartum to assess the presence of CHD., Results: Three thousand six hundred and sixty four gestations were analyzed, of which twenty newborn infants had some congenital heart defect up to the first month of life (prevalence of 0.55%). The median NT in fetuses with CHD was 1.70 mm, and 1.60 mm in fetuses without CHD. However no statistically significant difference was observed between the two medians (Mann-Whitney test, p > 0.05). The NT sensitivity to detect CHD ranged from 15% to 20%, with a probability of false positive cases of 86.4% to 97.9%, depending on the cut-off point used. Odds ratio for CHD was high when compared to the classical indications for fetal echocardiography, ranging from 4.7 to 33.7, according to the cut-off point used., Conclusion: Despite the low sensitivity of the test, increased NT is an important risk factor for CHD, and should be included in the strategy of prenatal screening for these diseases.

Rhabdomyoma is the most frequent primary cardiac tumor seen during infancy. We report multiple rhabdomyomas diagnosed in twins in the neo natal period. To the best of our knowledge, this is the first instance of this happening.