Neonatal Hemodynamics - Targeted Neonatal Echocardiography
Teaching Curriculum

Royal College NH-TNE AFC Objectives and Competencies

NH-TNE Fellowship Teaching Curriculum 2026-2027

This teaching series supports fellows in developing the knowledge, technical skills, and clinical judgment required for neonatal hemodynamics and targeted neonatal echocardiography (TNE). Sessions are aligned with the Royal College of Physicians and Surgeons of Canada Competency Training Requirements for the Area of Focused Competence in Neonatal Hemodynamics and Targeted Neonatal Echocardiography (2022). Unless otherwise indicated, all times are Eastern Time. Fellows are encouraged to review the linked program resources before each session and to bring clinical questions for discussion. Timetable and objective matching prepared by Dr Sarah Spénard. 

Please fill feedback from for each session.

July 2026

• Tuesday, July 30, 2026, 4:00-5:00 PM

  • Twin-Twin Transfusion Syndrome: Cardiovascular Physiology and Hemodynamic Assessment

  • Presenter: Sarah Spénard

  • Learning objectives - By the end of this session, fellows will be able to:

    • Describe key determinants of cardiac output, including preload, contractility, and afterload (Medical Expert 1.3.2).

    • Explain the physiology of intra- and extra-cardiac shunts relevant to twin-twin transfusion syndrome (Medical Expert 1.3.4).

    • Recognize abnormal cardiac structures and function in neonatal disease states using echocardiography (Medical Expert 1.3.20).

    • Readings: Twin Twin Transfusion Syndrome - Cardiovascular, Case January 2024 - TTTS, Case - January 2025 - RVOT obstruction in TTTS 

August 2026

• Thursday, August 13, 2026, 1:00-2:00 PM

  • Open NH-TNE Case Discussion

  • Presenter: Gabriel Altit

  • Learning objectives - By the end of this session, fellows will be able to:

    • Integrate echocardiographic findings with the clinical assessment and other hemodynamic monitoring data (Medical Expert 2.2.3).

    • Formulate a differential and most likely diagnosis from relevant clinical and imaging findings (Medical Expert 2.2.4).

    • Communicate a structured, clinically useful assessment and recommendation to the care team (Medical Expert 1.4).

• Monday, August 31, 2026, 2:00-3:00 PM

  • Cardiovascular Physiology: Blood Pressure, Heart Rate, SVR, and PVR

  • Presenter: Gabriel Altit

  • Learning objectives - By the end of this session, fellows will be able to:

    • Describe the components and determinants of cardiac output (Medical Expert 1.3.2).

    • Explain blood-pressure and volume regulation, including neurohormonal control, cardiac reflexes, and baroreceptors (Medical Expert 1.3.5.1).

    • Explain Starling forces and fluid exchange in the microcirculation (Medical Expert 1.3.6.1).

    • Interpret biomarkers of cardiac volume and pressure loading in clinical context (Medical Expert 1.3.10.2).

    • Readings: Physiology Definitions 

September 2026

• Thursday, September 24, 2026, 10:00-11:00 AM

  • Critical Congenital Heart Disease Not to Miss on TNE

  • Presenter: Sarah Spénard

  • Learning objectives - By the end of this session, fellows will be able to:

    • Recognize echocardiographic appearances of abnormal cardiac structures and cardiac function in disease states (Medical Expert 1.3.20).

    • Formulate a differential and most likely diagnosis based on the relevant clinical and echocardiographic findings (Medical Expert 2.2.4).

    • Identify when pediatric cardiology consultation is needed and recommend its appropriate timing (Medical Expert 4.1.2).

    • Readings: Total anomalous pulmonary venous return & other pulmonary venous anomalies; Transposition of Great Arteries ("d-TGA"); Coarctation and Interrupted Aortic Arch; Circular Shunt Physiology  

October 2026

• Friday, October 9, 2026, 2:00-3:00 PM

  • Diastolic Function in the Newborn: Significance and Echocardiographic Assessment

  • Presenter: Gabriel Altit

  • Learning objectives - By the end of this session, fellows will be able to:

    • Describe pulmonary venous hypertension due to left-ventricular diastolic and/or systolic dysfunction (Medical Expert 1.3.9.3.2 and 1.3.9.3.2.1).

    • Perform and interpret echocardiographic measurements relevant to neonatal hemodynamic assessment (Medical Expert 3.2.3 and 3.2.4).

    • Integrate echocardiographic findings with the clinical assessment to inform management (Medical Expert 2.2.3).

    • Readings: Left Ventricular Function, Cardiac Hypertrophy and Systemic Hypertension, Pulmonary Hypertension and Right Ventricular Function 

• Wednesday, October 21, 2026, 3:00-4:00 PM

  • Neonatal Sepsis and Associated Cardiovascular Compromise

  • Presenter: Sarah Spénard

  • Learning objectives - By the end of this session, fellows will be able to:

    • Describe the etiology and pathophysiology of shock unrelated to congenital heart disease (Medical Expert 1.3.9.2).

    • Explain myocardial oxygen supply and demand in critically ill neonates (Medical Expert 1.3.3).

    • Interpret biochemical measures of end-organ perfusion, including central venous blood gases (Medical Expert 1.3.10.1).

    • Perform targeted echocardiography for evaluation of hypotension or shock (Medical Expert 2.2.2.1).

    • Readings: Neonatal Septic Shock and Hemodynamic Physiology 

November 2026

• Wednesday, November 18, 2026, 3:00-4:00 PM

  • Acute Pulmonary Hypertension: Phenotypes and Management

  • Presenter: Gabriel Altit

  • Learning objectives - By the end of this session, fellows will be able to:

    • Describe acute pulmonary hypertension secondary to parenchymal lung disease, including pulmonary hypoplasia (Medical Expert 1.3.9.3.1).

    • Describe idiopathic pulmonary arterial hypertension (Medical Expert 1.3.9.3.4).

    • Perform targeted echocardiography for hypoxia or hypoxic respiratory failure (Medical Expert 2.2.2.3).

    • Readings: Pulmonary Hypertension and Right Ventricular Function ; Example of acute PH / PPHN and Prematurity ; Case June 2024 - Premature closure of the ductus arteriosus and acute PH 

• Tuesday, November 24, 2026, 1:00-2:00 PM

  • Advanced Neonatal Echocardiographic Imaging: Strain, Tissue Doppler, and 3D Echocardiography

  • Presenter: Gabriel Altit

  • Learning objectives - By the end of this session, fellows will be able to:

    • Use computer applications and post-processing tools to optimize imaging analysis (Medical Expert 3.2.2).

    • Perform measurements and calculations of echocardiographic indices (Medical Expert 3.2.3).

    • Interpret hemodynamic findings derived from advanced echocardiographic imaging (Medical Expert 3.2.4).

    • Readings: 2D and 3D Speckle Tracking Echocardiography, Apical views, Left Ventricular Function 

December 2026

• Tuesday, December 8, 2026, 1:00-2:00 PM

  • Advanced Evaluation of Pulmonary Hypertension

  • Presenter: Gabriel Altit

  • Learning objectives - By the end of this session, fellows will be able to:

    • Interpret invasive catheter measurements, including diagnostic and therapeutic cardiac catheterization data (Medical Expert 1.3.12).

    • Integrate echocardiographic findings with other hemodynamic studies and monitoring data (Medical Expert 2.2.3).

    • Formulate a differential and most likely diagnosis based on relevant clinical and imaging findings (Medical Expert 2.2.4).

    • Readings: Catheter Hemodynamics; Understanding PDA Spectral Doppler; Atypical Pulmonary Hypertension in the Newborns 

• Wednesday, December 16, 2026, 1:00-2:00 PM

  • Chronic Pulmonary Hypertension: Assessment and Management

  • Presenter: Sarah Spénard

  • Learning objectives - By the end of this session, fellows will be able to:

    • Describe chronic pulmonary hypertension due to left-heart disease, pulmonary disease, or increased pulmonary blood flow from cardiac shunts (Medical Expert 1.3.9.4).

    • Integrate neonatal hemodynamics, cardiovascular anatomy, and imaging to provide consultative advice for chronic pulmonary hypertension (Medical Expert 2.4.1.4).

    • Provide management recommendations, including appropriate initiation or titration of pulmonary vasodilators (Medical Expert 2.4.2.2.5).

    • Readings: PH in bronchopulmonary dysplasia; Case - February 2025 - BPD Pulmonary Hypertension 

January 2027 - Exact date and time to be confirmed.

• Shock, Steroid Use, and Vasoactive Support

  • Presenter: Sarah Spénard

  • Learning objectives - By the end of this session, fellows will be able to:

    • Describe the pathophysiology of shock unrelated to congenital heart disease (Medical Expert 1.3.9.2).

    • Interpret biochemical measures of end-organ perfusion, including central venous blood gases (Medical Expert 1.3.10.1).

    • Explain the mechanisms of action and indications for inotropic medications, vasopressors, and volume expanders (Medical Expert 1.3.24.1, 1.3.24.2, and 1.3.24.6).

    • Perform targeted echocardiography for the evaluation of hypotension or shock (Medical Expert 2.2.2.1).

    • Readings: Inotropes - Vasopressors - Cardiovascular Medications; Inotropes, Vasopressors and Cardiovascular Medications App 

• Transitional Physiology in Term and Preterm Infants: Acute Pulmonary Hypertension Phenotypes

  • Presenter: Sarah Spénard

  • Learning objectives - By the end of this session, fellows will be able to:

    • Describe normal transition from fetal to postnatal life, including the normal increase in pulmonary blood flow (Medical Expert 1.3.7.1 and 1.3.7.1.1).

    • Explain the pathophysiology of impaired postnatal pulmonary blood flow and potential therapeutic targets (Medical Expert 1.3.7.2).

    • Recognize acute pulmonary hypertension secondary to parenchymal lung disease, pulmonary venous hypertension, shunt lesions, or idiopathic pulmonary arterial hypertension (Medical Expert 1.3.9.3).

    • Readings: Physiology Definitions; Case April 2026 - Transitional Physiology at 22 weeks; Case April 2026 - Transitional Physiology at 22 weeks; Pulmonary Hypertension and Right Ventricular Function 

February 2027 -Exact dates and times to be confirmed.

• PDA Physiology, Hemodynamic Significance, and Management Strategies

  • Presenter: Sarah Spénard

  • Learning objectives - By the end of this session, fellows will be able to:

    • Describe the pathophysiology of patent ductus arteriosus in preterm neonates (Medical Expert 1.3.9.1).

    • Explain the physiology of intra- and extra-cardiac shunts as it applies to PDA directionality and hemodynamic significance (Medical Expert 1.3.4).

    • Perform targeted echocardiography for PDA assessment (Medical Expert 2.2.2.4).

    • Integrate imaging and clinical data to provide consultative advice for PDA management (Medical Expert 2.4.1.1).

    • Readings: Patent Ductus Arteriosus; PDA Scoring Systems App; Left to right unrestrictive ductus example; PDA in Prematurity: Rethinking a Decades-Old Debate in 2025 

• PDA Pharmacotherapy, Closure, and Post-Closure Care

  • Presenter: Sarah Spénard

  • Learning objectives - By the end of this session, fellows will be able to:

    • Describe post-PDA closure syndrome (Medical Expert 1.3.9.1.1).

    • Explain the indications for conservative, pharmacologic, device, and surgical PDA management (Medical Expert 1.3.25 and 2.4.2.4).

    • Integrate clinical and echocardiographic assessment when recommending PDA therapy or post-closure follow-up (Medical Expert 2.2.3).

    • Readings: Case May 2026 - Post-Ligation Syndrome; Case November 2025 - PDA and Ligation at 35 weeks; Case March 2024 - Post-Ligation Syndrome; Trans-Catheter PDA Closure 

March 2027 - Exact dates and times to be confirmed.

• Hemodynamic Consequences of Perinatal and Postnatal Hypoxic-Ischemic Encephalopathy

  • Presenter: Sarah Spénard

  • Learning objectives - By the end of this session, fellows will be able to:

    • Describe the systemic and pulmonary hemodynamic consequences of perinatal and postnatal hypoxic-ischemic encephalopathy (Medical Expert 1.3.9.6).

    • Perform targeted echocardiography to assess cardiac function in hemodynamically unstable neonates (Medical Expert 2.2.2.2).

    • Integrate echocardiographic findings with clinical and other hemodynamic data to inform management (Medical Expert 2.2.3).

    • Readings: Hemodynamics in HIE

• Congenital Heart Disease, Part 1: Recognition and Initial Hemodynamic Assessment

  • Presenter: Pediatric Cardiology

  • Learning objectives - By the end of this session, fellows will be able to:

    • Recognize abnormal cardiac structures and cardiac function in neonatal disease states (Medical Expert 1.3.20).

    • Describe acute pulmonary hypertension due to cardiac or shunt lesions with increased pulmonary blood flow (Medical Expert 1.3.9.3.3.1).

    • Formulate a differential diagnosis and identify when pediatric cardiology consultation is needed (Medical Expert 2.2.4 and 4.1.2).

    • Readings: Morphological approach; Morphological Approach App

April 2027 - Exact dates and times to be confirmed.

• Neonatal Point-of-Care Ultrasound: Lung, Central Lines, and Head Applications

  • Presenter: Nina Nouraeyan

  • Learning objectives - By the end of this session, fellows will be able to:

    • Recognize the appearance and positioning of central arterial and venous catheters (Medical Expert 1.3.21).

    • Perform targeted echocardiography to assess central arterial or venous catheter position when indicated (Medical Expert 2.2.2.5).

    • Apply an integrated clinical and imaging approach to neonatal point-of-care ultrasound assessments (Medical Expert 2.2.3).

    • Neonatal POCUS Curriculum; Head ultrasound - Echographie transfontanelle;  Lung ultrasound - Ultrason pulmonaire; Neonatal Vascular Access 

• Post-Capillary Pulmonary Hypertension, Left-Ventricular Dysfunction, Interatrial Shunting, and Pulmonary Vein Stenosis

  • Presenter: Gabriel Altit

  • Learning objectives - By the end of this session, fellows will be able to:

    • Describe pulmonary venous hypertension due to left-ventricular diastolic and/or systolic dysfunction (Medical Expert 1.3.9.3.2 and 1.3.9.3.2.1).

    • Explain the hemodynamic implications of interatrial shunting and pulmonary venous disease (Medical Expert 1.3.4).

    • Integrate neonatal hemodynamics, cardiovascular anatomy, and imaging to provide consultative advice for pulmonary venous hypertension (Medical Expert 2.4.1.3.2).

    • Readings: Pulmonary Vein Stenosis; Crab view - Pulmonary veins; Pulmonary Hypertension and Right Ventricular Function

• Neonatal Systemic Hypertension

  • Presenter: Joseph Mancini

  • Learning objectives - By the end of this session, fellows will be able to:

    • Describe systemic hypertension and hypotension in neonates (Medical Expert 1.3.9.7).

    • Explain blood-pressure and volume regulation, including neurohormonal control, cardiac reflexes, and baroreceptors (Medical Expert 1.3.5.1).

    • Integrate clinical, hemodynamic, and echocardiographic data to guide consultation and management (Medical Expert 2.2.3 and 2.4.1.7).

    • Readings: Cardiac Hypertrophy and Systemic Hypertension 

May 2027 - Exact dates and times to be confirmed.

• Cardiogenic and Obstructive Shock: Pericardial Effusion, Tamponade, and Pericardiocentesis

  • Presenter: Gabriel Altit

  • Learning objectives - By the end of this session, fellows will be able to:

    • Describe pericardial effusion and tamponade physiology (Medical Expert 1.3.9.5).

    • Perform targeted echocardiography for the evaluation of hypotension or shock (Medical Expert 2.2.2.1).

    • Integrate imaging findings with clinical assessment to establish a patient-centred management plan (Medical Expert 2.2.3 and 2.4).

    • Readings: Effusion, Hemodynamics in Prematurity 

• Congenital Diaphragmatic Hernia: Cardiopulmonary Hemodynamics and TNE Assessment

  • Presenter: Gabriel Altit

  • Learning objectives -  By the end of this session, fellows will be able to:

    • Describe acute pulmonary hypertension secondary to pulmonary hypoplasia (Medical Expert 1.3.9.3.1).

    • Explain the influence of positive-pressure ventilation on systemic and pulmonary hemodynamics (Medical Expert 1.3.8).

    • Perform targeted echocardiography for hypoxia or hypoxic respiratory failure and integrate findings into management (Medical Expert 2.2.2.3 and 2.2.3).

    • Readings: Cardiovascular Phenotypes in CDH, Cardio-Respiratory Interactions in the Newborn 

• Hypertrophy, Infant of a Diabetic Mother, and Diastolic Dysfunction

  • Presenter: Sarah Spénard

  • Learning objectives - By the end of this session, fellows will be able to:

    • Recognize abnormal cardiac structures and function in disease states, including myocardial hypertrophy (Medical Expert 1.3.20).

    • Describe left-ventricular diastolic and/or systolic dysfunction contributing to pulmonary venous hypertension (Medical Expert 1.3.9.3.2.1).

    • Perform and interpret echocardiographic measurements and hemodynamic findings relevant to ventricular function (Medical Expert 3.2.3 and 3.2.4).

    • Readings: Case 2023 - Infant of Diabetic Mother, Case August 2025 - IDM Cardiac Hypertrophy, Example case of hypertrophic cardiomyopathy (HOCM) 

• Cardiac Morphology Session with Dr Marie Béland in Morphology at the MAMM

  • Morphological review of the heart with Dr Marie Beland, pediatric cardiologist, at the Maude Abbott Medical Museum on McGill campus.

  • Segmental approach to cardiac anatomy

  • Review of live cardiac specimens (normal and abnormal heart).

June 2027 - Exact dates and times to be confirmed.

• Pulmonary Hemorrhage: Physiology and Management

  • Presenter: Sarah Spénard

  • Learning objectives - By the end of this session, fellows will be able to:

    • Describe the pathophysiology of PDA in preterm neonates and its potential contribution to pulmonary overcirculation (Medical Expert 1.3.9.1).

    • Explain the influence of positive-pressure ventilation on systemic and pulmonary hemodynamics (Medical Expert 1.3.8).

    • Integrate echocardiographic findings with the clinical assessment to guide management (Medical Expert 2.2.3).

    • Readings: Pulmonary Hemorrhage; Pulmonary Hemorrhage Cases examples; Case January 2026 - Acute PH and Pulmonary Hemorrhage 

• Cerebrovascular Hemodynamics, NIRS in the NICU, and Neuro-TNE Integration

  • Presenter: Sarah Spénard

  • Learning objectives - By the end of this session, fellows will be able to:

    • Describe systemic and cerebral autoregulation in preterm and term neonates (Medical Expert 1.3.6.2).

    • Interpret near-infrared spectroscopy in neonatal hemodynamic assessment (Medical Expert 1.3.13).

    • Integrate regional perfusion data with clinical and echocardiographic findings (Medical Expert 2.2.3).

    • Readings: Near Infrared Spectroscopy - NIRS, Physiology Definitions, Head ultrasound - Echographie transfontanelle 

• Neonatal Extracorporeal Membrane Oxygenation

  • Presenter: CHU Sainte-Justine PICU

  • Learning objectives -By the end of this session, fellows will be able to:

    • Explain the influence of mechanical circulatory and respiratory support on systemic and pulmonary hemodynamics (Medical Expert 1.3.8).

    • Perform and interpret targeted echocardiography for cardiac function in critically ill neonates (Medical Expert 2.2.2.2).

    • Integrate echocardiographic and clinical findings to support ongoing care and reassessment recommendations (Medical Expert 2.2.3 and 4.1.1).

    • Readings: Neonatal ECMO, Cardiopulmonary Bypass in Neonatal Cardiac Surgery 

• Pulmonary Hemodynamics and the Impact of Ventilation

  • Presenter: Sarah and Ben

  • Learning objectives - By the end of this session, fellows will be able to:

    • Describe neonatal pulmonary circulation and its normal postnatal transition (Medical Expert 1.3.7).

    • Explain the influence of positive-pressure ventilation on systemic and pulmonary hemodynamics (Medical Expert 1.3.8).

    • Apply principles of respiratory-support titration in neonates with hemodynamic instability (Medical Expert 1.3.26 and 2.4.2.5).

    • Readings: Cardio-Respiratory Interactions in the Newborn 

July 2027 - Exact dates and times to be confirmed.

• Neonatal ECG and Arrhythmias: Heart Block, Pacing, Defibrillation, and Cardioversion

  • Presenter: Pediatric Cardiology

  • Learning objectives - By the end of this session, fellows will be able to:

    • Integrate relevant diagnostic investigations with the clinical assessment to formulate a diagnosis and management plan (Medical Expert 2.2).

    • Recognize when hemodynamic instability requires urgent assessment, intervention, or consultation (Medical Expert 2.1.1 and 4.1.2).

    • Communicate a structured assessment and recommendation to the clinical team (Medical Expert 1.4).

    • Readings: ECG, Congenital Heart Block  

• Vein of Galen Malformation and Hepatic Arteriovenous Malformation

  • Presenter: Sarah Spénard

  • Learning objectives - By the end of this session, fellows will be able to:

    • Describe acute pulmonary hypertension due to arteriovenous malformations (Medical Expert 1.3.9.3.3.2).

    • Describe the components and determinants of cardiac output in high-output states (Medical Expert 1.3.2).

    • Integrate echocardiographic findings with the clinical assessment and other hemodynamic monitoring data (Medical Expert 2.2.3).

    • Readings: Vein of Galen Malformation, Case - February 2025 - Hepatic Hemangioma 

August 2027 - Exact dates and times to be confirmed.

• Congenital Heart Disease, Part 2: Advanced Hemodynamic Assessment and Consultation

  • Presenter: Pediatric Cardiology

  • Learning objectives - By the end of this session, fellows will be able to:

    • Recognize abnormal cardiac structures and cardiac function in disease states (Medical Expert 1.3.20).

    • Explain the physiology of intra- and extra-cardiac shunts (Medical Expert 1.3.4).

    • Determine the need for and timing of pediatric cardiology consultation (Medical Expert 4.1.2).

    • Readings: Morphological approach 

• Establishing a Targeted Neonatal Echocardiography Program

  • Presenter: Gabriel Altit

  • Learning objectives - By the end of this session, fellows will be able to:

    • Develop, implement, and maintain a quality-assurance program for NHTNE (Leader 3.1.7).

    • Review and create or optimize TNE scanning protocols (Leader 3.1.6).

    • Manage and maintain targeted echocardiography equipment, including considerations for replacement and acquisition (Leader 3.1.5).

    • Develop institutional policy and infrastructure to support NHTNE consultation and reporting (Leader 3.1.2 and 3.1.4).

    • Readings: TnECHO Echocardiography Protocol; TnECHO Report App 

September 2027 - Exact dates and times to be confirmed.

• Pharmacology of Pulmonary Vasodilators

  • Presenter: Sarah Spénard

  • Learning objectives - By the end of this session, fellows will be able to:

    • Explain the mechanism of action and indications for pulmonary vasodilators, including inhaled nitric oxide (Medical Expert 1.3.24.5).

    • Provide management recommendations that include the appropriate initiation or titration of pulmonary vasodilators (Medical Expert 2.4.2.2.5).

    • Integrate echocardiographic and clinical findings to monitor therapeutic response (Medical Expert 2.2.3).

    • Readings: Inotropes - Vasopressors - Cardiovascular Medications; Pulmonary Hypertension and Right Ventricular Function 

• Twin-Twin Transfusion Syndrome: Advanced Case Review

  • Presenter: Sarah Spénard

  • Learning objectives - By the end of this session, fellows will be able to:

    • Describe key determinants of cardiac output in donor and recipient twins (Medical Expert 1.3.2).

    • Explain shunt physiology and its relevance to the hemodynamic assessment of twin-twin transfusion syndrome (Medical Expert 1.3.4).

    • Recognize abnormal cardiac structures and function using echocardiography (Medical Expert 1.3.20).

    • Twin Twin Transfusion Syndrome - Cardiovascular; Case January 2024 - TTTS; Case - January 2025 - RVOT obstruction in TTTS 

NH-TNE Schedule and detailed objectives for 2025-2026 sessions

Please read on the topic prior to the session using the resources provided by the program. I have provided links to guide you in your reading. 

June 13, 2025 - Neonatal ECMO (Dr Karen Harrington - CHU Sainte Justine PICU/ECMO specialist)

• Recognize indications and contraindications of neonatal ECMO

• Understand differences in VA, VV and VAV ECMO

• Comprehend the ECMO circuit, flows, sweep gaz, clamp tests

June 26, 2025 — Orientation to NH-TNE program Part 1 by Dr Altit

• Introduce the structure, expectations, and competencies of the NH-TNE curriculum.

• Review the core principles of neonatal hemodynamics and TNE integration in clinical care.

• Familiarize fellows with key resources, logbooks, and assessment tools.

June 27, 2025 — Orientation to NH-TNE program Part 2  by Dr Altit

• Discuss the EPAs and milestones for performance evaluation in the TNE program.

• Provide practical guidance on case selection, documentation, and feedback.

• Review protocols for image acquisition, storage, and case submission.
  
  

July 8, 2025 — Ultrasound Physics, Knobology and Image Optimization  by Dr Altit

• Explain the basic physics principles of ultrasound relevant to TNE.

• Identify the impact of probe settings and machine controls on image quality.

• Demonstrate techniques for optimizing 2D, M-mode, and Doppler images.

July 22, 2025 — Cardiovascular Physiology Concepts  by Dr Altit

• Review determinants of blood pressure, heart rate, systemic and pulmonary resistance.

• Discuss fetal-to-neonatal circulatory transition and autonomic regulation.

• Correlate physiological parameters with echocardiographic findings.

August 5, 2025 — TNE Protocol and Standard Views - Part 1  by Dr Altit

• Master standard TNE imaging planes and anatomical landmarks.

• Learn how to perform and document a comprehensive TNE exam.

• Understand the importance of consistency and reproducibility in views.

August 12, 2025 — TNE Protocol and Standard Views - Part 2  by Dr Altit

• Apply standardized measurement techniques with reference to normative data.

• Develop skills in report generation and diagnostic synthesis.

• Review common errors in measurement and reporting.

August 19, 2025 — Right Ventricle: Geometry and Function  by Dr Altit

• Describe RV anatomy, shape, and adaptation in neonatal disease.

• Perform and interpret RV dimensional and functional parameters (TAPSE, FAC, RVO, TDI).

August 26, 2025 — Left Ventricle: Geometry and Function, Mass  by Dr Altit

• Analyze LV systolic and diastolic function in the neonatal population.

• Understand geometric assumptions and their limitations in neonates.

• Use echocardiography to assess volume loading and contractility.
  
  

September 2, 2025 — Shock: Hypovolemia, Distributive Shock, Sepsis, NEC  by Dr Altit

• Recognize the echocardiographic features of different shock phenotypes.

• Integrate clinical and imaging data for timely diagnosis and management.

• Understand the cardiovascular impact of systemic inflammation and NEC/sepsis.
  
  

September 16, 2025 — Pharmacotherapy  by Dr Altit

• Review the mechanisms and uses of common vasopressors, inotropes, PGE, pulmonary vasodilators, PDA modulation, antihypertensive.

• Recognize echocardiographic responses to PGE, milrinone, and vasodilators.

• Discuss risks, dosing, and weaning strategies.
  
  

September 23, 2025 — Hypertrophy, IDM, Diastolic Dysfunction - also here, here, here, here - By Dr Spenard

• Identify echocardiographic patterns of hypertrophy in neonates.

• Understand the physiology of impaired relaxation and filling.

• Review cases of IDM and their management implications.
  
  

September 30, 2025 - Teaching with Dr. Charles Rohlicek - Basics of cardiac contractility and relaxation

• Bers, Donald M., and Barry A. Borlaug. "Mechanisms of cardiac contraction and relaxation." Braunwald's Heart Disease: a Textbook of Cardiovascular Medicine: 2 Vol Set, 12th Edition. Elsevier, 2021. 889-912. - Click Link for McGill Library

• Powerpoint Slides by Dr Rohlicek

October 8, 2024 - ECMO by Dr Samara Zavalkof

October 31, 2025 — Post-Capillary PH, LV Dysfunction, PVS with Edmonton by Dr Altit. 

• Differentiate post-capillary from pre-capillary PH on TNE.

• Assess LA pressure and pulmonary venous flow patterns.

• Recognize signs of pulmonary vein stenosis in preterms.

November 10, 2025 — Transition Physiology, Acute PH - see also here - By Dr Spenard

• Review circulatory changes during transition in term and preterm infants.

• Identify acute PH phenotypes and mechanisms of maladaptation.

• Discuss implications for ventilation, oxygenation, and support.

November 25, 2025 — Cardiogenic and Obstructive Shock by Dr Altit

• Diagnose structural and acquired causes of cardiogenic shock

• Identify pericardial effusion and tamponade physiology.

• Review indications and technique for pericardiocentesis.

November 27, 2025 — Neonatal Systemic Hypertension by Dr Joey Mancini (Nephrology)

• Recognize the clinical presentation and diagnostic criteria for systemic hypertension in neonates. 

• Identify structural, renal, and iatrogenic causes of neonatal hypertension, including renovascular and parenchymal abnormalities. 

• Understand the hemodynamic impact of systemic hypertension on cardiac function and end-organ perfusion (LV function; LV hypertrophy).

• Interpret key diagnostic tools (e.g., Doppler ultrasound, echocardiography, renal imaging) in the evaluation of hypertensive neonates. 

• Review the principles of pharmacologic management and monitoring strategies for acute and chronic neonatal hypertension.

• Review articles: 

  • https://www.ncbi.nlm.nih.gov/books/NBK563223/

  • https://pmc.ncbi.nlm.nih.gov/articles/PMC6261698/ 

  • https://jpnim.com/index.php/jpnim/article/download/080207/620 

  • https://obgynkey.com/neonatal-hypertension/ 

December 2, 2025 — BPD-Associated PH and here - By Dr Spenard

• Understand the pathophysiology of vascular remodeling in BPD.

• Learn how to screen and monitor PH in infants with evolving BPD.

Integrate TNE and clinical markers for disease severity and progression.

December 9, 2025 — Advanced Imaging: Strain, TDI, 3D by Dr Altit

• Introduce strain imaging and tissue Doppler in neonatal TNE.

• Understand principles and limitations of deformation analysis.

• Explore the role of 3D echo in structural and volumetric assessment.

December 10, 2025 -  Pulmonary Hypertension with PICU (G. Altit)

• Review etiologies and clinical presentations of PH in the neonatal and pediatric setting

• Review main echocardiographic findings in infants with PH

• Review WHO classification of PH and the potential pediatric diagnosis

January 13, 2026 — PDA physiology, caveats, directionality and here by Dr Spenard

• Classify PDA hemodynamic significance using TNE.

• Recognize patterns of PDA: bidirectional, right to left, and the information it provides.

January 14, 2026 — Congenital Diaphragmatic Hernia and here by Dr Altit. Read in priority Cardiovascular Phenotypes in CDH 

• Understand the hemodynamic impact of CDH on cardiac function.

• Review RV/LV interaction and PVR assessment in CDH infants.

• Discuss TNE utility in management of CDH

January 21 and 22, 2026 - TnECHO Quebec Day 2026

• Teaching and credentialing in Neonatal Hemodynamics

• AFC, practice eligibility route

• Integrating POCUS and Hemodynamics in your unit
  
  

January 23, 2026 — PDA Pharmacotherapy, Ligation, Trials by Dr Spenard

• Understand the pharmacodynamics of ibuprofen, indomethacin, and acetaminophen.

• Review TNE before and after ligation or cath-based closure.

• Discuss evidence from PDA trials and evolving conservative approaches.

February 10, 2026 - Hemodynamic consequences of perinatal and postnatal HIE by Dr Spenard

•  Understand cardiac effects of perinatal hypoxic-ischemic injury. 

• Identify echocardiographic signs of postnatal hemodynamic compromise. 

• Review management strategies for HIE-related cardiovascular dysfunction.

February 23, 2026 — Cerebrovascular Hemodynamics, NIRS by Dr Spenard

• Describe cerebral circulation and autoregulation in neonates.

• Review NIRS principles, placement, and interpretation.

• Integrate neuro-TNE findings in infants at risk of brain injury.
  
  

March 12, 2026 — Neonatal ECG and Arrhythmias, Lupus/Heart Block, Pacing, Defibrillation, Cardioversion by Dr Altit

• Interpret neonatal ECGs, heart block patterns, and QTc.

• Recognize arrhythmias and correlate with hemodynamic compromise.

• Review pacing, cardioversion, and defibrillation indications.
  
  

March 30, 2026 — Vein of Galen / Hepatic AVM by Dr Spenard

• Recognize echocardiographic clues to AVMs (high output states).

• Understand shunting physiology and multisystem involvement.

Discuss postnatal management and timing of embolization.

April 17, 2026 — Pulmonary Hypertension - Atypical, Cath, Genetics by Dr Altit

• Identify genetic and syndromic causes of neonatal PH.

• Discuss cath-based diagnostic strategies and AVT testing.

• Understand challenges in classifying mixed PH phenotypes.

April 20, 2026 - Cardiac Embryology with Dr Stephanie Ford

April 30, 2026 — Establishing a TNE Program by Dr Altit

• Review the components needed for a sustainable TNE service.

• Discuss training, credentialing, and QA processes.

• Explore institutional pathways and research integration.
  
  

May 4, 2026 — Cyanotic Cardiac Conditions by Dr Altit

• Review the physiology of cyanosis and differential diagnoses.

• Recognize ductal-dependent lesions on TNE.

• Plan stabilization and referral strategies using echo findings.

May 12, 2026 — Open Session by Dr Altit

• Case-based review and discussion.

• Opportunity for fellows to present and receive feedback.

• Address troubleshooting and uncommon scenarios in TNE.

• Peer-to-peer learning and reflection on clinical application.
  
  

May 29, 2026 — Session with Dr Beland at MAMM

• Morphological review of the heart with Dr Marie Beland, pediatric cardiologist, at the Maude Abbott Medical Museum on McGill campus.

• Segmental approach to cardiac anatomy

• Review of live cardiac specimens (normal and abnormal heart).
  
  

June 4, 2026 — Pulmonary Hemorrhage: Physiology and Management by Dr Altit (See case and case here)

• Understand pathophysiology and echocardiographic clues to pulmonary hemorrhage.

• Distinguish hemorrhage from cardiogenic pulmonary edema.

• Review ventilatory and pharmacologic strategies.

June 17, 2026 - Neonatal ECMO (Dr Karen Harrington - CHU Sainte Justine PICU/ECMO specialist)

• Recognize indications and contraindications of neonatal ECMO

• Understand differences in VA, VV and VAV ECMO

• Comprehend the ECMO circuit, flows, sweep gaz, clamp tests
  
  

June 19 ( by Dr Spenard) - Twin-Twin Transfusion Syndrome

• Understand pathophysiology of twin-twin transfusion syndrome. 

• Recognize cardiovascular adaptations in donor and recipient twins. 

• Review echocardiographic assessment and hemodynamic management.

June 23, 2026 — Pharmacology of Pulmonary Vasodilators by Dr Spenard

• Review sildenafil, bosentan, and inhaled NO in neonates.

• Understand TNE markers of response and safety monitoring.

• Integrate pharmacologic strategies with other supportive therapies.

----- End of 2025-2026 Curriculum -----

Teaching Topics

• Introduction to NH-TNE - orientation

• Ultrasound Physics, Knobology and Image Optimization

• Cardiovascular Physiology concepts.

• Blood Pressure, Heart Rate, SVR and PVR Physiology

• TNE Protocol and Standard Views

• Standardized Measurements and Normative Data, Reporting

• Advanced Imaging: Strain (2D), TDI, 3D Echocardiography

• Right Ventricle: Geometry and Function

• Left Ventricle: Geometry and Function

• Hypertrophy, IDM, Diastolic dysfunction

• Shock: Hypovolemia, Distributive Shock, Sepsis, NEC

• Cardiogenic and Obstructive Shock, Pericardiocentesis

• Pharmacotherapy (cardiovascular agents, pulmonary vasodilators, PGE, antihypertensive agents)

• Transition Physiology in Term and Preterm, acute PH and phenotypes

• BPD-Associated PH

• Post-Capillary PH, LV dysfunction, Inter-atrial shunting & Pulmonary Vein Stenosis

• Atypical PH Syndromes, Understanding a PH Cath Report

• Cardiac Morphology Session at Maude Abbott Museum

• CDH and PH

• PDA physiology, management strategies, caveats, directionality

• Post-ligation/Cath syndrome, Conservative Management of PDA

• Cerebrovascular Hemodynamics, NIRS in the NICU, Neuro-TNE Integration

• Neonatal ECG and Arrhythmias, Lupus/Heart Block, Pacing, Defibrillation, Cardioversion.

• Growth Restriction, Placental Dysfunction, Effect of PPROM, Pulmonary Hypoplasia

• Hypertensive Crisis and Cardiorenal Interactions, Twin-Twin Transfusion Syndrome

• Vein of Galen Malformation or Hepatic Arteriovenous malformation

• Establishing a TNE Program, Research and Career Planning.

• Ethical considerations, safety, multidisciplinary work in Neonatal Hemodynamics

• Cardiac MRI and Advanced Diagnostics

• Pulmonary Hemorrhage

• ECMO: Physiology and Clinical Application