Point of care ultrasound: a core competency for the neonatologist?Nick Evans: Newborn Care, RPA Hospital and University of Sydney, Sydney, Australia.
Introduction Protagonists of point of care clinician performed ultrasound (CPU) point to the value of 24/7 immediate diagnosis, antagonists point to limited formal accreditation and risk of misdiagnosis. Implementation of CPU should embrace the benefits while minimising the risk of harms.
Cardiac ultrasound Permits a window on haemodynamic pathophysiology where there are few alternatives. There is a range of acute care indication and with systematic use of ultrasound, the extent to which clinical and vital signs have misled us has become apparent.
Other organ ultrasound Beyond the heart, NPU extends to acute head ultrasound to exclude cerebral haemorrhage. Abdominal and thoracic ultrasound to diagnose abnormal fluid. Bladder ultrasound to confirm urine prior to supra-pubic aspiration. Screening of the entry points of the IVC and SVC into the heart can exclude an intra-cardiac tip position. Ultrasound allows real time localisation of UVC tip position during insertion. There is evolving use of lung ultrasound to diagnose a range of pulmonary conditions and gut ultrasound for NEC.
Training and accreditation It’s hard to see that ultrasound skills are not going to become a core competency for neonatologists. There is a need for formal training and accreditation structures. We have such a structure in Australasia in the form of the Certificate of Clinician Performed Ultrasound (CCPU). The training needs in neonatology should be determined by neonatologists, not by other specialties.