Assessing the Utility of Targeted Neonatal Echocardiography for Congenital Heart Disease Detection: Retrospective Cohort Analysis.

Targeted neonatal echocardiography (TNE) is increasingly utilized by neonatologists to assess hemodynamics, particularly when cardiology-performed echocardiography (CPE) is unavailable. It is crucial that TNE screens and identifies structural abnormalities. This study evaluated the agreement between TNE and CPE in detecting significant congenital heart disease (CHD). This retrospective, single-center cohort study included infants who underwent TNE between 2015 and 2019 and had at least one complete CPE before discharge. Infants with a known CHD diagnosis prior to TNE were excluded. Atrial septal defects (ASD) < 3 mm, peripheral pulmonary stenosis, and patent ductus arteriosus were excluded. Agreement between TNE and CPE was assessed using correlation coefficients and kappa statistics. A total of 339 infants with 954 TNE scans were included. TNE identified CHD in 41 infants, with all but one (a false positive bicuspid aortic valve) confirmed by CPE. TNE missed CHD in 29 infants (31 lesions), mostly minor, with only one case (pulmonary stenosis) requiring intervention. The overall agreement was 91.15%, with a kappa of 0.68 (p < 0.0001). TNE demonstrated good agreement with CPE in detecting significant CHD in a low-risk neonatal population. Most missed lesions were minor, underscoring the importance of ongoing training and quality assurance.