We thank Drs McAdams and Milhoan for their interest and comments on our paper. The circumstances that they describe in which pediatric cardiologists are not readily available in the neonatal intensive care unit are what we had in mind as we embarked on our pilot study. To clarify some of their questions regarding the study design, the study cardiologist reviewed all of the studies performed by the neonatologist on the Acuson Cypress (Siemens USA, Malvern, PA, USA), the portable ultrasound device.1 The cardiologist was aware that they were all performed by the neonatologist. He did not review the studies or reports of the echocardiograms done by the cardiology service until after review of the neonatologists’ exams. He then reviewed selected ultrasounds performed by the cardiology service on the Acuson Sequoia (Siemens USA). Comparison of measured ductal size determinations would indeed be of interest for future studies, but this was not the primary outcome of our analysis. Estimated ductal size is not routinely recorded by our cardiology service, and was not recorded by the study neonatologist.
Our study was not an evaluation of the Acuson Cypress versus the Acuson Sequoia. Although having the cardiology service perform an additional exam using the Cypress could have provided additional information, it would have necessitated a third echocardiogram and involved an additional technologist or physician for each case to maintain masking. As we stated in our paper, there were several factors that may have decreased the accuracy of the exams on the Cypress, most notably the length of training of the neonatologist. Quality discrepancies between the machines may have been one of those factors. However, to answer the specific question of accuracy of the Cypress compared with the Sequoia would require another study. This could certainly be an area of further investigation for neonatal intensive care units considering the purchase of an ultrasound machine.
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