BackgroundCoarctation of aorta is a very common congenital heart malformation occurring in 6%–8% of all congenital heart diseases. However in neonates coarctation may be missed or underestimated by echocardiography, especially with patent ductus arteriosus or severe concurrent illness. The carotid-subclavian artery index has been proposed in previous studies for establishing the diagnosis of coarctation of the aorta.MethodsEchocardiographic evaluations was retrospectively reviewed in patients with coractation of the aorta as well as control group admitted at a tertiary cardiac centre in the period between January 2010 to December 2014. All patients admitted with coarctation of aorta either had surgery or catheter intervention which confirmed the diagnosis. 39 patients with Coarctation as well as 20 patients in controls were included in the study. End systolic measurements were obtained from 6 different sites of the aortic arch.ResultsThe median age of diagnosis was 5 days (Range 0–24 days) with presence of Bicuspid aortic valve in 9 patients (21%). In all patients the arch was left sided and ductus artersious was patent at the time of evaluation. The distance between the origins of the great vessels were longer in patients with coarctation than in controls and the dimension of the proximal transverse arch(Z score: median 4.21, range 0.28 to 7) and distal transverse arch (Z score: median 3.4, range 2.8 to 9) were significantly smaller in the coarctation group. Carotid-subclavian artery index: The ratio of the aortic arch diameter at the left subclavian artey to the distance between left carotid artery and the left subclavian artery was significantly smaller (Mean 0.65, Range 0.35 2.05) with Index <1 in 92% in patients with coarctation.ConclusionThe carotid-subclavian artery index is a simply obtainable noninvasive screening parameter, showing high sensitivity and specificity for coarctation and may be useful in unstable patients or in those with a patent ductus artersious in which coarctation may be overlooked. Neonates with large patent ductus artersious and any of these findings need close observation until the patent ductus ateriosus closes.

BackgroundThe Royal College of Paediatrics and Child Health (RCPCH) list interpretation of basic cardiological investigations as an essential skill in the neonatal curriculum. The authors postulate however that trainees lack confidence in interpretation of the neonatal electrocardiogram (ECG), which is central to the management of newborn babies with heart murmurs, arrhythmias and complex congenital abnormalities. Literature search identifies only one UK study in paediatric ECG interpretation and none for neonatal ECGs. There was therefore a need to evaluate competence amongst clinicians, and identify whether further formal training would be of benefit.ObjectiveTo establish the current level of competency, confidence and need to develop formal training in neonatal ECG interpretation.Design/MethodsPaediatric and neonatal trainees, consultants, nurse practitioners and clinical fellows were surveyed throughout the UK by questionnaire. Confidence and perceived training needs were addressed with 5 initial questions: level of training, perceived confidence interpreting neonatal ECGs, frequency of interpretation, available teaching, and value of further training. A further 10 question quiz assessed current competence with neonatal ECG examples and 5-part multiple choice questions. The survey was distributed nationally through Deanery administrators contacted via the RCPCH. Results were returned via the online system Survey Monkey.Results154 responses were received, of whom 102 (66%) also completed the quiz. 121 (78%) rated their confidence in neonatal ECG interpretation as 3 or below out of 5 (5 being most confident); only 2% rated 5. 30% stated they never receive neonatal ECG teaching, with a further 61% only rarely receiving teaching. Only 9% of the 102 answered all the questions correctly: most at ST 7–8 level, all of whom rated their confidence at 3 or 4.ConclusionsOur study is the first, of which the authors are aware, to evaluate nationally competence in neonatal ECG interpretation. Results showed that confidence was rated low amongst trainees throughout all training grades, and the vast majority received no or infrequent dedicated teaching. Our results indicate that development of formal neonatal ECG training would be beneficial and welcomed amongst clinicians, and as an essential skill in neonatal clinical practice, should form a high priority.