Tips and Tricks in Neonatal POCUS: A Comprehensive Bedside Handbook for the Neonatologist
Vlad Dima *
Primary Care Physician Neonatology, Filantropia Clinical Hospital, Bucharest, Romania.
Adrian-Ioan Toma
Primary Care Physician Neonatology, Medlife Memorial Hospital, Bucharest, Romania.
*Author to whom correspondence should be addressed.
Abstract
Background: Point-of-Care Ultrasound (POCUS) has emerged as one of the most transformative advances in neonatal intensive care, offering radiation-free, real-time, bedside diagnostic and procedural guidance across all organ systems. The rapid expansion of neonatal POCUS applications—from cranial ultrasonography and lung assessment to targeted neonatal echocardiography (TnECHO) and ultrasound-guided vascular access—has created an urgent need for practical, evidence-based clinical resources that translate current guidelines into actionable bedside techniques.
Objectives: This handbook aims to provide a comprehensive, system-based, practical guide to neonatal POCUS for clinicians at all experience levels. It distills complex sonographic principles and protocols into reproducible “tips and tricks” derived from accumulated clinical experience and current evidence-based literature, including the 2025 NRP Guidelines, the 2024 ASE TNE Guidelines Update, and the ESPNIC POCUS recommendations.
Content Summary: The book is organised into nine thematic sections encompassing 22 chapters: Section I covers ultrasound physics, transducer selection, and artefact recognition; Section II addresses neuro-POCUS including GM-IVH, white matter injury, and post-haemorrhagic ventricular dilatation; Section III details lung POCUS protocols for RDS, air leak syndromes, and BPD; Section IV covers targeted neonatal echocardiography for PDA assessment and pulmonary hypertension; Section V encompasses abdominal, renal, and spinal POCUS; Section VI addresses ultrasound-guided vascular access; Section VII presents the SAFE-R multisystem evaluation protocol and delivery room POCUS integration; Section VIII addresses ethics, AI integration, quality management, common pitfalls, and standard operating procedures; and a Bonus Chapter covers musculoskeletal POCUS. A Quick-Reference Appendix provides normative values and scanning protocols for rapid bedside consultation.
Clinical Relevance: This handbook serves as a bedside companion for neonatologists, neonatal fellows, paediatric intensivists, and allied health professionals engaged in neonatal POCUS. By bridging the gap between published guidelines and practical implementation, it aims to improve diagnostic accuracy, enhance procedural safety, standardise scanning protocols, and support the continuous quality improvement of POCUS practice in the NICU.
Evidence Grading: Key clinical recommendations throughout this handbook are graded using a simplified evidence classification aligned with the GRADE methodology as employed by ESPNIC and ILCOR: Level A (Strong)—supported by high-quality randomised controlled trials or meta-analyses; Level B (Moderate)—supported by well-designed observational studies, systematic reviews, or expert consensus statements; Level C (Expert Opinion)—based on clinical experience, physiological rationale, and case series. This grading is provided to guide the reader in critically appraising the strength of evidence underlying each recommendation.
Keywords: Ultrasonography, neonatology, POCUS, NICU, practice, quality improvement