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Point-of-care ultrasound for non-vascular invasive procedures in critically ill neonates and children: current status and future perspectives

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Abstract

Point-of-care ultrasound (POCUS) has been established as an essential bedside tool for real-time image guidance of invasive procedures in critically ill neonates and children. While procedural guidance using POCUS has become the standard of care across many adult medicine subspecialties, its use has more recently gained popularity in neonatal and pediatric medicine due in part to improvement in technology and integration of POCUS into physician training programs. With increasing use, emerging data have supported its adoption and shown improvement in pediatric outcomes. Procedures that have traditionally relied on physical landmarks, such as thoracentesis and lumbar puncture, can now be performed under direct visualization using POCUS, increasing success, and reducing complications in our most vulnerable patients. In this review, we describe a global and comprehensive use of POCUS to assist all steps of different non-vascular invasive procedures and the evidence base to support such approach.

Conclusion: There has been a recent growth of supportive evidence for using point-of-care ultrasound to guide neonatal and pediatric percutaneous procedural interventions. A global and comprehensive approach for the use of point-of-care ultrasound allows to assist all steps of different, non-vascular, invasive procedures.

What is Known:

• Point-of-care ultrasound has been established as a powerful tool providing for real-time image guidance of invasive procedures in critically ill neonates and children and allowing to increase both safety and success.

What is New:

• A global and comprehensive use of point-of-care ultrasound allows to assist all steps of different, non-vascular, invasive procedures: from diagnosis to semi-quantitative assessment, and from real-time puncture to follow-up.

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Abbreviations

CSF :

Cerebrospinal fluid

ETT :

Endotracheal tube

IP :

In-plane

LP :

Lumbar puncture

LUS :

Lung ultrasound score

NGT :

Nasogastric tube

NICU :

Neonatal intensive care unit

OP :

Out-of-plane

PICU :

Pediatric intensive care unit

POCUS :

Point-of-care ultrasound

SPA :

Suprapubic aspiration

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The authors declare that no funds, grants, or other support were received for the preparation of this manuscript.

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Authors and Affiliations

  1. Children’s Hospital of Philadelphia, Philadelphia, USA

    Thomas W. Pawlowski & María V. Fraga

  2. ‘Tor Vergata’ University Hospital, Rome, Italy

    Roberto Polidoro

  3. Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA

    María V. Fraga

  4. Department of Clinical Science and Translational Medicine, ‘Tor Vergata’ University of Rome, Rome, Italy

    Daniele Guerino Biasucci

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Contributions

D.G.B. and M.V.F. contributed to the review conception, structure, and design. Literature search and material preparation were performed by T.W.P. and R.P. The first draft of the manuscript was written by T.W.P. and R.P. D.G.B. and M.V.F. supervised the entire work providing insightful and intellectual contents, commented on, and revised previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Daniele Guerino Biasucci.

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D.G.B. received one single consultation fee from Vygon SAS.

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Communicated by Daniele De Luca

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Pawlowski, T.W., Polidoro, R., Fraga, M.V. et al. Point-of-care ultrasound for non-vascular invasive procedures in critically ill neonates and children: current status and future perspectives. Eur J Pediatr 183, 1037–1045 (2024). https://doi.org/10.1007/s00431-023-05372-8

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