Use of Point-of-Care Ultrasonography in the NICU for Diagnostic and Procedural Purposes

Abstract

Point-of-care ultrasonography (POCUS) refers to the use of portable imaging performed by the treating clinician at the bedside for diagnostic, therapeutic, and procedural purposes. POCUS may be considered an extension of the physical examination but not a substitute for diagnostic imaging. Use of POCUS in emergency situations can be lifesaving in the NICU if performed in a timely fashion for cardiac tamponade, pleural effusions, pneumothorax, etc, with potential for enhancing the quality of care and improving outcomes. In the past 2 decades, POCUS has gained significant acceptance in clinical medicine in many parts of the world and in many subspecialties. Formal accredited training and certification programs are available for neonatology trainees, as well as for many other subspecialties in Canada, Australia, and New Zealand. Although no formal training program or certification is available to neonatologists in Europe, POCUS is also widely available to providers in NICUs. A formal institutional POCUS fellowship is now available in Canada, and recently, the Royal College of Physicians and Surgeons (Canada) recognized targeted neonatal echocardiography performed by the neonatologist as area of focus competency for certification. In the United States, many clinicians have the skills to perform POCUS and have incorporated it in their daily clinical practice. However, appropriate equipment remains limited, and many barriers exist to POCUS program implementation. Recently, the first international, evidence-based POCUS guidelines for the use in neonatology and pediatric critical care were published. Considering the potential benefits, a recent national survey of neonatologists confirmed that the majority of clinicians were inclined to adopt POCUS in their clinical practice if the barriers could be resolved. This clinical report describes the current landscape of neonatal POCUS, outlines barriers for implementation, and provides a suggested educational framework and overall strategy for successful implementation of a POCUS program. Diagnostic and procedural applications of POCUS in the NICU will be explored in detail in the accompanying technical report, which can be found in this issue of Pediatrics.