Neonatal Cardiac POCUS

Neonatal Cardiac POCUS 

By Dr Nina Nouraeyan for the McGill University – Neonatal Perinatal Medicine Residency - Updated December 21st, 2025

• Required pre-reading below.

• Probe Selection: Phased array probe (preferred for all cardiac views) 

• Mode / System Setup

  • Select the Cardiac preset on your ultrasound machine.

  • Ensure the EKG adapter is connected to the monitor before beginning.

  • Place EKG leads on the infant’s shoulders and abdomen to leave adequate chest space for imaging. 

Introduction 

Before beginning Cardiac POCUS training, it is essential to understand the differences between: 

• Cardiac POCUS

• TnECHO (Targeted Neonatal Echocardiography)

• Pediatric Cardiology Consultation and Comprehensive Echocardiography 

• This curriculum focuses only on Cardiac POCUS. For details on TnECHO, refer to the appropriate sections of the NeoCardioLab website.

Image Interpretation – Cardiac POCUS Objectives

By the end of this rotation, learners should be able to:

1. Identify pericardial effusion and assess for tamponade physiology

2. Assess volume status

3. Evaluate gross left ventricular systolic function

4. Identify intracardiac line malposition

Course Preparation

Before starting hands-on scanning, please review:

• Required readings below

• Video recordings

Landmarks & Required Cardiac POCUS Views

Cardiac POCUS requires acquisition of several key views. Below are the four core views, with probe instructions formatted to match the lung curriculum layout.

1. Apical Four-Chamber (A4C) View

• Probe Location:

  • Place the phased array probe horizontally on the left chest, just below the nipple line along the mid-axillary line.

  • Marker toward the left side of the patient.

• Technique:

  • Sweep slowly toward the right chest until all four chambers are visualized.

  • Optimize depth, gain, and chamber centering.

2. Parasternal Short Axis (PSAX) View

• Probe Location:

  • Just left of the sternum at the 3rd–4th intercostal space.

  • Marker toward the left shoulder.

• Technique:

  • Ensure correct 90° rotation from the long-axis view.

  • Tilt to visualize aortic, mitral, or papillary muscle levels.

3. Parasternal Long Axis (PLAX) View

• Probe Location:

  • Same intercostal space as PSAX (3rd–4th ICS), just left of the sternum.

  • Marker toward the right shoulder.

• Technique:

  • Adjust until LV, LA, LVOT, mitral valve, and aortic root are clearly visible.

  • To obtain PSAX, rotate probe 90° toward the left shoulder.

4. Subcostal (Subxiphoid) View

• Probe Location:

  • Place the probe just below the xiphoid.

  • Marker toward the left side.

• Technique:

  • Angle cranially and leftward to visualize RA, atrial septum, and IVC entry.

  • Use light pressure to avoid artifact from abdominal compression.

Further visual aids and video demonstrations here.

Important References