Point-of-Care Ultrasound in Neonatology – An Overview

Point-of-Care Ultrasound in Neonatology – An Overview 

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

Effective integration of point-of-care ultrasound (POCUS) in Neonatology requires an understanding of its strengths, limitations, and appropriate clinical applications. Before attending the POCUS course, participants are expected to review key literature and complete the mandatory video overview linked below:

Thank you to the family who generously volunteered to participate in video recordings, helping us create educational content that will be shared with our community of learners.

Using POCUS to Answer Targeted Clinical Questions

A core principle of POCUS is that imaging should never be performed without clearly identifying the diagnostic questions beforehand. This ensures appropriate use of the modality and helps avoid over-interpretation beyond its scope.

Example 1: Fresh neonate with rising oxygen requirements

Your targeted questions may include:

1. Is there significant respiratory distress syndrome, and does this neonate require surfactant?

2. Is there a pneumothorax contributing to hypoxia?

3. Is there consolidation or a pleural effusion that explains the clinical picture?

Clearly defining these questions frames your scan, helps avoid unnecessary views, and ensures your interpretation remains aligned with POCUS capability.

Understanding the Limits of POCUS

POCUS should not be used to diagnose conditions requiring specialized imaging expertise.

Example 2: Crashing neonate with thready pulses

In this scenario, POCUS should not be used to evaluate for coarctation. Assessing aortic arch flow and ductal dependency requires pediatric cardiology expertise.

Instead, appropriate POCUS questions would be:

1. Is cardiac output adequate?

2. What is the volume status?

3. Is there a pericardial effusion compromising output?

4. Is there a malpositioned line within the heart causing hemodynamic instability?

If the clinical picture suggests a ductal-dependent lesion, POCUS must not be used to determine whether to initiate prostaglandin therapy. This is a clinical decision, and the infant requires immediate transfer to a center with pediatric cardiology services.

POCUS Interpretation Must Always Be Clinical

POCUS findings cannot be interpreted in isolation—they must be integrated with the neonate’s gestational age, clinical course, and evolving physiology.

Example 3: Three-week-old infant with rising oxygen needs

If POCUS shows increasing B-lines and a high lung score:

• Surfactant is not expected to be helpful at this age.

• More likely considerations include evolving bronchopulmonary dysplasia or over-circulation from a patent ductus arteriosus.

This reinforces the need to interpret POCUS within the correct clinical context, rather than applying algorithms designed for immediate postnatal care.

Key Principles to Remember

●      POCUS answers focused questions—it is not a comprehensive diagnostic tool.

●      Always identify your diagnostic questions before placing the probe.

●      Know the limitations of POCUS for each organ system.

●      Interpret all findings within the clinical context.

●      Use subspecialty consultation (Radiology, Cardiology) when questions fall outside POCUS capability.

References