Table 1 Summary of recommendations on the use of POCUS in the neonatal and paediatric critical care
No. | Recommendation | Level of agreement | Quality of evidence |
|---|---|---|---|
1. | POCUS should not be used as a screening tool for diagnosing congenital heart defects in neonates and children, unless neonatologists/paediatric intensivists have received an advanced echocardiography training specifically for this purpose | Strong agreement | A |
2. | POCUS may be helpful to assess cardiac filling (preload assessment) and intravascular volume status in neonates and children | Strong agreement | D |
3. | POCUS may be helpful to assess fluid responsiveness in neonates and children | Strong agreement | D |
4. | POCUS may be helpful for qualitative assessment of cardiac function on visual inspection in neonates and children | Strong agreement | D |
5. | POCUS is helpful for semi-quantitative assessment of cardiac function in neonates and children [however, a detailed functional assessment should be performed by a person with advanced echocardiography training] | Agreement | C |
6. | POCUS is helpful for assessment of pulmonary artery systolic pressure in pulmonary hypertension in neonates and children | Strong agreement | B |
7. | POCUS is helpful for semi-quantitative assessment of pulmonary hypertension in neonates and children | Strong agreement | B |
8. | POCUS is helpful to diagnose pericardial effusion in neonates and children | Strong agreement | B |
9. | POCUS is helpful to guide pericardiocentesis in neonates and children | Strong agreement | B |
10. | POCUS should be used to assess the patency of ductus arteriosus in neonates and children | Strong agreement | A |
11. | POCUS may be used to detect vegetation to make or exclude the diagnosis of endocarditis [however, a definitive diagnosis requires a detailed assessment by a paediatric cardiologist]. | Disagreement | D |
12. | POCUS is helpful to distinguish between respiratory distress syndrome (RDS) and transient tachypnoea of the neonate (TTN) | Agreement | B |
13. | POCUS is helpful to detect pneumonia in neonates and children | Agreement | B |
14. | POCUS is helpful to semi-quantitatively evaluate lung aeration and help the management of respiratory intervention in acute respiratory distress syndrome (ARDS) in neonates and children | Agreement | B |
15. | POCUS is helpful to recognise meconium aspiration syndrome (MAS) | Agreement | C |
16. | POCUS is helpful for descriptive purposes in viral bronchiolitis but cannot provide a differential aetiological diagnosis | Strong agreement | C |
17. | POCUS is helpful to accurately detect pneumothorax in neonates and children | Strong agreement | B |
18. | POCUS is helpful to insert chest tube or perform needle aspiration in neonatal tension pneumothorax | Strong agreement | B |
19. | POCUS is helpful to detect pleural effusions in neonates and children | Strong agreement | B |
20. | POCUS is helpful to guide thoracentesis in neonates and children | Strong agreement | B |
21. | POCUS is helpful to evaluate lung oedema in neonates and children | Agreement | C |
22. | POCUS is helpful in detecting anaesthesia-induced atelectasis in neonates and children | Agreement | C |
23. | POCUS-guided technique should be used for internal jugular vein (IJV) line placement in neonates and children | Strong agreement | A |
24. | POCUS-guided technique is helpful for subclavian vein line placement in neonates and children | Strong agreement | B |
25. | POCUS-guided technique is helpful for femoral line placement in neonates and children | Strong agreement | B |
26. | POCUS-guided technique is helpful for arterial catheters placement in children | Agreement | B |
27. | POCUS-guided technique is helpful for peripherally inserted central catheters in children | Agreement | B |
28. | POCUS is helpful to locate catheter tip position in neonates and children | Strong agreement | C |
29. | POCUS is helpful to detect cerebral blood flow changes in neonates and children | Agreement | B |
30. | POCUS should be used to detect germinal matrix and intraventricular haemorrhage (IVH) in neonates | Strong agreement | A |
31. | POCUS is helpful to detect cerebral blood flow patterns suggesting the presence of cerebral circulatory arrest in children with fused skull bones | Agreement | C |
32. | POCUS is helpful to detect cerebral blood flow changes secondary to vasospasm in patients with traumatic brain injury and non-traumatic intracranial bleeding. | Agreement | C |
33. | POCUS is helpful to detect changes in optic nerve sheath diameter (ONSD) indicative of raised ICP in children with fused skull bones | Agreement | B |
34. | POCUS is helpful to detect cerebral midline shift in neonates and children | Agreement | C |
35. | POCUS is helpful for detection of free intra-abdominal fluid in neonates and children | Strong agreement | C |
36. | POCUS may detect parenchymal changes of abdominal organs in neonates and children [although for a definitive diagnosis a detailed assessment should be performed by a paediatric radiologist] | Agreement | D |
37. | POCUS may detect obstructive uropathy in neonates and children [although for a definitive diagnosis a detailed assessment should be performed by a paediatric radiologist] | Agreement | D |
38. | POCUS may assess bowel peristalsis in neonates and children | Agreement | D |
39. | POCUS may recognise hypertrophic pyloric stenosis [although for a definitive diagnosis a detailed assessment should be performed by a paediatric radiologist] | Disagreement | D |
40. | POCUS my guide peritoneal drainage or aspiration of peritoneal fluid in neonates and children | Strong agreement | D |
41. | POCUS is helpful to detect signs of necrotising enterocolitis [although for a definitive diagnosis a detailed assessment should be performed by a paediatric radiologist or a person with specific advanced ultrasound training] | Agreement | C |