Neonatal and paediatric point-of-care ultrasound review

Abstract

Purpose: Point-of-care ultrasound (POCUS) examinations for children and newborns are different from POCUS exams for adults due to dissimilarities in size and body composition, as well as distinct surgical procedures and pathologies in the paediatric patient. This review describes the major paediatric POCUS exams and how to perform them and summarizes the current evidence-based perioperative applications of POCUS in paediatric and neonatal patients.

Method: Literature searches using PubMed and Google Scholar databases for the period from January 2000 to November 2021 that included MeSH headings of [ultrasonography] and [point of care systems] and keywords including "ultrasound" for studies involving children aged 0 to 18 years.

Results: Paediatric and neonatal POCUS exams can evaluate airway, gastric, pulmonary, cardiac, abdominal, vascular, and cerebral systems.

Discussion: POCUS is rapidly expanding in its utility and presence in the perioperative care of paediatric and neonatal patients as their anatomy and pathophysiology are uniquely suited for ultrasound imaging applications that extend beyond the standard adult POCUS exams.

Conclusions: Paediatric POCUS is a powerful adjunct that complements and augments clinical diagnostic evaluation and treatment.

Keywords: POCUS; children; neonate; paediatric; point‐of‐care ultrasound.

Figure 1

Airway ultrasound. (I) The patient is supine. Placement of the ultrasound transducer with the orientation marker (o) towards the patient's right side with the neck in extension for the transverse views of the airway examination such as (a) vocal cord assessment, (b) endotracheal tube placement assessment to assess for the ‘railroad sign’, and (c) measurement of the tracheal diameter for appropriate endotracheal tube size. (II) The patient is supine. Placement of the ultrasound transducer with the orientation marker (o) towards the patient's head with the neck in extension for the longitudinal view of the airway examination such as (d) in cricothyrotomy to view the ‘string of pearls’ where the arrow designates the cricothyroid mem.

Figure 2

Gastric ultrasound. (I) The patient is either in the sitting position, right lateral decubitus position, or supine. Placement of the ultrasound transducer with the orientation marker towards the head. The transducer is placed below the xiphoid in the midline with a slight tilt towards the patient's left side. (a) Empty antrum. (b) Antrum filled with solid or thick fluid. (c) Antrum filled with clear fluid. (d) Nasogastric tube present within an empty antrum.

Figure 3

Pulmonary ultrasound and focussed assessed transthoracic echocardiography (FATE) examination. The top panel shows the pulmonary examination for a healthy infant without B lines. Note the almost continuous pleural line beneath the ribs that have not developed complete ossification yet. The bottom panel shows the FATE examination for a healthy infant. The basic views of the FATE examination can be seen as follows: (a) subcostal four‐chamber view through the liver, (b) apical four‐chamber, (c) parasternal long axis, and (d) parasternal short axis.

Figure 4

Focussed assessment with sonography for trauma (FAST) examination and inferior vena cava (IVC) examination. (I) The patient is supine. Placement of the transducer, with orientation marker (o) either towards the patient's head or to the patient's right, can be seen in the three positions for the FAST examination as follows: (a) right upper quadrant to assess Morrison's pouch or the hepatorenal recess, the liver tip or right paracolic gutter, and the lower right thorax; (b) left upper quadrant to assess the subphrenic space, splenorenal recess, spleen tip or left paracolic gutter, and the lower left thorax; (c) pelvis to assess the rectovesical pouch in males and rectouterine or pouch of Douglas in females. (II) The patient is supine. Placement of the transducer in the transverse position below the xiphoid process in the midline. (d) IVC examination in a teenager, which is similar to an adult examination where the IVC is measured about 3–5 cm from the right atrial junction. (e) IVC examination in an infant where the IVC to descending aorta (Ao) ratio allows for a more accurate volume estimation.

Figure 5

Neonatal examinations. (I) The patient is supine. The ultrasound transducer is placed transversely on the anterior fontanelle with the orientation marker pointing towards the patient's right side. The transducer is then slowly tilted towards the patient's nose to evaluate the (a) frontal horns of the lateral ventricles. (II) The patient is supine. The linear ultrasound transducer is placed in the midsagittal position over the upper sternum with the baby's head rotated slightly to one side. (b) The hypoechoic aorta and trachea can be very similar in their appearance and artifactually contiguous. Visualisation of the hyperechoic endotracheal tube and utilisation of colour Doppler can help to discriminate the aortic arch from the trachea, as well as demarcate their anatomical locations. The carina will be located inferior and caudal to that demarcation.