Targeted Neonatal Echocardiography (TnECHO) is a bedside assessment by trained neonatal intensive care specialists of cardiovascular physiology using echocardiography.  The techniques and measurements are being used to improve care of sick babies across the world.  The aim is to obtain real-time physiological data to support clinical decision-making and monitor changes over time in response to treatment or disease evolution.  This approach does not aim to replace the detailed structural assessments provided by consultative services such as cardiology.  But instead, is usually directed and focused towards a specific clinical problem and is significantly shorter than traditional echocardiography, thereby minimizing patient handling. 
 
In our app, we illustrate how TnECHO can be used to comprehensively evaluate shunt volume across a patent ductus arteriosus and evaluate heart function and pulmonary blood flow among neonates with acute pulmonary hypertension.  These are particularly important due to the variable ability of the premature myocardium to adapt to changes in loading conditions and the complexity of transitional circulation.  This app forms a companion to the website www.tnecho.com. It may be used as part of a comprehensive training program as a supplement to supervised hands-on practice and core neonatal physiology training.  TnECHO.2 should augment but not replace training according to published guidelines.