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The evolution of cardiac point of care ultrasound for the neonatologist

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A Correspondence to this article was published on 05 July 2021

Abstract

Cardiac point of care ultrasound (POCUS) is increasingly being utilized in neonatal intensive care units to provide information in real time to aid clinical decision making. While training programs and scope of practice have been well defined for other specialties, such as adult critical care and emergency medicine, there is a lack of structure for neonatal cardiac POCUS. A more comprehensive and advanced hemodynamic evaluation by a neonatologist has previously published its own clinical guidelines and specific rigorous training programs have been established to achieve competency in neonatal hemodynamics. However, it is becoming increasingly evident that access and training for basic cardiac assessment by ultrasound enhances bedside clinical care for specific indications. Recently, expert consensus POCUS guidelines for use in neonatal and pediatric intensive care endorsed by the European Society of Pediatric and Neonatal Intensive Care (ESPNIC) have been published to guide the clinicians in using POCUS for specific indications, though the line between cardiac POCUS and advanced hemodynamic evaluation remains somewhat fluid.

Conclusion: This article is focused on neonatal cardiac POCUS and its evolution, value, and limitations in the modern neonatal clinical practice. Cardiac POCUS can provide physiological and hemodynamic information in making clinical decisions while dealing with neonatal emergencies. However, it should be applied only for the specific indications and should be performed by a clinician trained in cardiac POCUS. There is an urgent need of developing cardiac POCUS curriculum and certification to support a widespread and safe use in neonates.

What is Known:

• International training guidelines and curriculum have been published for neonatologist-performed echocardiography (NPE) or targeted neonatal echocardiography (TNE).

• International evidence-based guidelines for use of point of care ultrasound (POCUS) in neonates and children have been recently published.

What is New:

• Cardiac POCUS is increasingly being incorporated in neonatal practice for emergency situations. However, one must be aware of its specific indications and limitations, especially for the neonatal clinical practice.

• Cardiac POCUS and NPE/TNE are continuum of cardiac imaging with different indications and training requirements.

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Abbreviations

POCUS:

Point of care ultrasound

TNE:

Targeted neonatal echocardiography

NPE:

Neonatologist-performed echocardiography

CCPU:

Certificate of Clinician Performed Ultrasound

ESPNIC :

European Society of Paediatric and Neonatal Intensive Care

CHD:

Congenital heart disease

NICU:

Neonatal intensive care unit

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Authors and Affiliations

  1. Department of Pediatrics - Neonatology and Pediatric Cardiology, Addenbrooke’s Hospital, Cambridge University Hospitals, Box 402, NICU, Biomedical Campus, Hills Road, Cambridge, CB2 0QQ, UK

    Yogen Singh

  2. Departmet of Pediatrics, Division of Neonatology, Loma Linda University School of Medicine, Loma Linda, CA, USA

    Yogen Singh

  3. Department of Pediatrics, Division of Neonatal and Behavioral Medicine, Stanford University School of Medicine, Stanford, CA, USA

    Shazia Bhombal

  4. Department of Neonatology, Sharp Mary Birch Hospital for Women & Newborns, San Diego, CA, USA

    Anup Katheria

  5. Centre de Pediatrie, Clinique des Grangettes, 7 ch des Grangettes, 1224 Chêne-Bougeries, Geneva, Switzerland

    Cecile Tissot

  6. Department of Pediatrics, Division of Neonatology, Children’s Hospital of Philadelphia and Perelman School of Medicine, Philadelphia, USA

    María V. Fraga

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YS conceptualized the idea. YS, SB and MVF prepared the initial draft and all authors (YS, SB, AK, CT and MVF) critically reviewed the manuscript for important intellectual content, edited and approved it in its final version.

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Correspondence to Yogen Singh.

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Communicated by Daniele De Luca

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Singh, Y., Bhombal, S., Katheria, A. et al. The evolution of cardiac point of care ultrasound for the neonatologist. Eur J Pediatr 180, 3565–3575 (2021). https://doi.org/10.1007/s00431-021-04153-5

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