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Abdominal Point-of-Care Ultrasound in Neonatal and Pediatric Populations

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Point-of-Care Ultrasound for the Neonatal and Pediatric Intensivist

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Abstract

Abdominal point-of-care ultrasound (POCUS) can be used to evaluate a number of clinical conditions in neonatal and pediatric populations. Similar to other methods of ultrasound assessment, abdominal POCUS allows providers the opportunity to evaluate real-time physiology and, alongside other clinical markers and context, guide diagnostic and therapeutic decisions. This chapter discusses abdominal POCUS applications relevant to neonatal and pediatric intensivists.

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Authors and Affiliations

  1. Section of Neonatology, Department of Pediatrics, University of Manitoba, Winnipeg, MB, Canada

    Yasser Elsayed

  2. Royal College of Physicians and Surgeons, Ottawa, ON, Canada

    Yasser Elsayed

  3. Division of Pediatric Critical Care, University of Alabama at Birmingham, Birmingham, AL, USA

    Vidit Bhargava

Authors
  1. Yasser Elsayed
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  2. Vidit Bhargava
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Corresponding author

Correspondence to Yasser Elsayed .

Editor information

Editors and Affiliations

  1. Department of Pediatrics, Division of Neonatology, Loma Linda University School of Medicine, California, CA, USA

    Yogen Singh

  2. Pediatric Cardiology, Hirslanden Clinique des Grangettes, Chene-Bougeries/Geneva, Switzerland

    Cécile Tissot

  3. Department of Pediatrics, Division of Neonatology, Children’s Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA

    María Victoria Fraga

  4. Department of Anesthesiology and Critical Care Medicine, Perelman School of Medicine, The University of Pennsylvania, Philadelphia, PA, USA

    Thomas Conlon

Appendix: Intestinal Ultrasound Findings in Bowel Injury or Ischemia

Appendix: Intestinal Ultrasound Findings in Bowel Injury or Ischemia

Intestinal ultrasound

Ultrasound finding

Technique

Special considerations

Image

Pneumatosis intestinalis (arrow)

Use a linear probe in all 4 abdominal quadrants. Sweep in 2 perpendicular planes

It is sometimes difficult to differentiate pneumatosis intestinalis from artifact luminal air bubbles

Portal venous gas (arrow)

Use a convex probe in the subcostal position. Sweep in 2 perpendicular planes

Usually seen only in early neonatal enterocolitis and may disappear within 24–48 h

Thickened bowel wall

Use a linear probe in all 4 abdominal quadrants. Sweep in 2 perpendicular planes

Experience is required to differentiate small from large bowel

Thinned bowel wall

Use a linear probe in all 4 abdominal quadrants. Sweep in 2 perpendicular planes

Experience is required to differentiate small from large bowel

Peritoneal ascitic fluid (arrow)

Use a linear probe in all 4 abdominal quadrants. Sweep in 2 perpendicular planes

Simple peritoneal fluid is commonly present in preterm infants

Peristalsis

Use a linear probe in all 4 abdominal quadrants. Sweep in 2 perpendicular planes

One minute of observation in all 4 quadrants is needed to diagnose absence of peristalsis

(The image is of normal looking bowel with color Doppler)

Intestinal signature (arrow)

Use a linear probe in all 4 abdominal quadrants. Sweep in 2 perpendicular planes

Different layers of bowel wall can be differentiated by zooming in on any loop. There are a total of 5 layers: 3 echogenic and 2 hypoechoic (the mucosa and muscularis)

Hyperemia

Use a linear probe in all 4 abdominal quadrants with color Doppler box 2 × 2 cm with low gain

Mild hyperemia as an isolated feature could be normal, especially if speckle in shape

Ischemia

Use a linear probe in all 4 abdominal quadrants with a color Doppler box with low gain

Ischemia could be a sign of neonatal enterocolitis or secondary to circulatory arrest

Dilated loops

Use a linear probe in all 4 abdominal quadrants. Sweep in 2 perpendicular planes

This finding could represent intestinal obstruction

Pneumoperitoneum

Air reverberation artifact between the abdominal wall and liver in the decubitus position

Ultrasound is not the modality of choice for this marker

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Elsayed, Y., Bhargava, V. (2023). Abdominal Point-of-Care Ultrasound in Neonatal and Pediatric Populations. In: Singh, Y., Tissot, C., Fraga, M.V., Conlon, T. (eds) Point-of-Care Ultrasound for the Neonatal and Pediatric Intensivist. Springer, Cham. https://doi.org/10.1007/978-3-031-26538-9_14

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