One of the driving forces behind the rapid evolution of these programs is the increasing recognition that traditional metrics of cardiovascular wellbeing are limited.8 With scientific discovery and a dramatic increase in the use of sophisticated technology to maintain ventilation, fluid, and nutritional status more immature, complex, and increasingly tenuous patients have a chance at survival. Among patients where contributors to impaired circulation are diverse and may include pulmonary vascular disease, mechanical ventilation, cardiac dysfunction, intra- and extra-cardiac shunts, and abnormal systemic vascular tone among other things, the limitations of clinical assessment in isolation become palpable. The use of TnECHO to characterize cardiovascular health in neonates has now become the standard of care in many neonatal intensive care units around the word with the realization that it can provide hemodynamic information that either complements what is clinically suspected or delivers novel physiologic insight.9 The benefits of TnECHO and hemodynamic appraisal are multiple. First, as the primary care team with the most first-hand knowledge of neonatal pathophysiology, neonatal intensivists are uniquely positioned to integrate the clinical evaluation with echocardiography-derived measurements of heart function and blood flow. Second, the acquisition of real-time bedside diagnostic information facilitates longitudinal assessment of physiological change with disease evolution or treatment which modern Pediatric Cardiology programs are typically not resourced to provide given their broader mandate. Finally, the delivery of this technology into the hands of neonatal clinical investigators enables the generation of thoughtful, physiology driven research in a neonatal context. TnECHO based research has led to enhanced diagnostic insight into cardiovascular decompensation following ligation of a hemodynamically significant ductus arteriosus10 and the hemodynamic antecedents of intraventricular hemorrhage.11 It has also led to interventions to reduce pulmonary hemorrhage,12 a score to predict bronchopulmonary dysplasia,13 and identification of risk factors for morbidity among infants with congenital diaphragmatic hernia.14 Internationally, investment in high-quality academic pursuit in the area of neonatal hemodynamics utilizing TnECHO (or NPE) has, and will continue to, improve the science that is the bedrock of our field.

Despite these many potential advantages, the growth of TnECHO in the USA remains in its infancy. Historically, the perceived barriers to implementation in the USA have been challenges in defining the scope and boundaries with pediatric cardiology and concern for medicolegal liability. With the changing international landscape, however, appraisal of the views of contemporary USA leaders in Neonatology on their access to and perspective on TnECHO was prudent. Members of the US hemodynamic collaborative recently conducted a 15-question survey designed to evaluate the following domains: (i) Utilization of TnECHO in their NICU and operating procedures, if applicable; (ii) Access to equipment to perform echocardiography; (iii) Barriers to the implementation of TnECHO in their unit. We utilized an online survey platform to generate a link which was circulated via email to the USA Neonatal Division Chiefs listserv. After 2 weeks, a reminder email was sent. Responses were collected anonymously and descriptive statistics were used to evaluate the data.

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