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Which infants should be referred to the paediatric cardiologist?+ Those with clinically suspected congenital heart disease + Those ventilated for severe persistent hypoxaemia, particularly if extracorporeal membrane oxygenation is being considered + Those in whom an adequate echocardiogram is not obtained by the neonatologist or where echocardiography reveals previously unsuspected CHD.Which infants can reasonably be assessed by a trained neonatologist echocardiographer?+ The hypotensive or shocked newborn in the first few hours of life without clinical evidence of congenital heart disease + Those requiring assessment of ductal and/or interatrial shunting + Those with a central line to assess its position or to exclude vegetation or thrombus + Those in whom pulmonary arterial pressure or cardiac output needs to be assessed (once CHD has been excluded by a paediatric cardiologist in infants with persistent hypoxaemia). ConclusionsEchocardiography is an essential part of modern neonatal intensive care.Its use should not be limited to cardiologists in the diagnosis and assessment of CHD but should be extended to the routine care of critically ill neonates.As with any investigative tool, echocardiography should be used in combination with clinical acumen and not as a replacement.Paediatric cardiologists should not be worried about neonatologists learning echocardiography, rather they should encourage, support and supervise them-live video links may even help to avoid unnecessary transfer to cardiac centres of cyanotic infants without CHD.Being involved in establishing guidelines for the safe practice of neonatal echocardiography is surely better than ignoring it.