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Preterm infant

AAP details framework, strategy for point-of-care neonatal ultrasound program

November 28, 2022

Since the introduction of point-of-care ultrasound (POCUS) into clinical medicine more than two decades ago, its use in adult medicine has been widespread. Its use in pediatric emergency medicine, pediatric critical care, neonatal-perinatal medicine and general pediatrics also has experienced significant growth.

POCUS has emerged as the most recent addition to the modern doctor’s medical bag and has been incorporated into many medical school curricula.

Evidence-based medicine supports the use of POCUS across pediatric disciplines. Data suggest that it improves patient safety and provider procedural performance, introduces new clinical data, expedites and changes management, and may improve outcomes.

New AAP clinical and technical reports describe the current landscape of neonatal POCUS, outline barriers for translation into clinical practice, and suggest an educational framework and strategy for implementing a POCUS program.

The reports, Use of Point-of-Care Ultrasonography in the NICU for Diagnostic and Procedural Purposes, from the Committee on Fetus and Newborn and the Section on Radiology, are available at https://doi.org/10.1542/peds.2022-060052 and https://doi.org/10.1542/peds.2022-060053 and will be published in the December issue of Pediatrics.

As technology continues to advance, POCUS may be considered an extension of the physical examination but not a substitute for diagnostic imaging.

Many U.S. clinicians have acquired the skills to perform POCUS and have incorporated it into their daily clinical practice without completing training requirements specific to neonatology. The AAP proposes establishing a POCUS training program to facilitate safety and proficiency in the neonatal intensive care unit.

POCUS can be lifesaving, if performed in a timely fashion for conditions such as cardiac tamponade, pleural effusions and pneumothorax. It has the potential to enhance the quality of care and improve outcomes. POCUS has been shown to be useful for evaluating and monitoring lung pathology (e.g., pulmonary edema, pneumonia, surfactant deficiency, transient tachypnea of the newborn, atelectasis), cardiovascular abnormalities (e.g., hypotension, pulmonary hypertension, patent ductus arteriosus), gastrointestinal disease (e.g., necrotizing enterocolitis) and central nervous system abnormalities, especially intraventricular hemorrhage.

In addition, POCUS is being used increasingly for procedures like endotracheal intubations, peripherally inserted central line placement, umbilical catheter placement, lumbar punctures and suprapubic bladder taps.

However, appropriate equipment remains limited, and many barriers exist to POCUS program implementation, including individual hospital credentialing and appropriate accreditation.

The AAP guidance maintains that successful program implementation requires a collaborative liaison with pediatric cardiology and pediatric radiology along with quality assurance programs.

Dr. Stewart is a lead author of the clinical and technical report. He is a former member of the AAP Committee on Fetus and Newborn.

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