Research discussion and conclusion: standardizing use of POCUS with guidelines aids research and training
The use of POCUS in neonatal and pediatric critical care is increasing and is a valuable addition to other clinical tools. Clinician use of POCUS is different than a specialist’s in-depth diagnostic study, because it can be performed and interpreted by the same non-specialized provider, be rapidly implemented in the current clinical setting, and repeated to identify any changes. POCUS can provide information that can be combined with clinical and laboratory data to enable timely and accurate decisions.
Panelists disagreed on two indications regarding endocarditis and hypertrophic pyloric stenosis, which should be diagnosed by a detailed ultrasonography and performed by an expert pediatric cardiologist or radiologist. The role of POCUS for these indications is not clear, but in general, the role of ultrasound remains important.
There are still variations in clinical practice regarding indications, training and clinical governance. The guidelines subdivided POCUS recommendations based on estimated training required for their use. The scope of practice for these guidelines were developed for the targeted use of ultrasound in neonatal and pediatric critical care units by neonatologists or pediatric intensivists, as well as by emergency providers. All ages of neonates and children are covered for most of the diagnostic (heart, lungs, brain and abdomen) and procedural (line placement and fluid drainage) applications.
For cardiac POCUS in neonates, it should not be used as a screening or diagnostic tool for congenital heart defects. Patients suspected of critical congenital heart defects should be quickly referred to a pediatric cardiologist. Nonetheless, in an emergency setting, it can still identify some life-threatening conditions, enabling the provider to deliver real-time lifesaving interventions.
The guidelines are not prescriptive, but can help standardize clinical practice across acute care settings. While not a training statement, the guidelines may help develop POCUS curriculum and structured training programs.
POCUS was already increasingly being used despite the lack of published evidence-based guidelines for use in neonatal and pediatric critical care. These new guidelines provide the basis for use in this setting and guide future research and may help standardize clinical practice and strengthen clinical governance.