Survey of Point-of-Care Ultrasound Uptake in Indian Neonatal Intensive Care Units: Results and Recommendations

Abstract

Objectives: Point-of-care ultrasonography (POCU) refers to the process of ultrasound performed at the bedside by treating physicians, for the ongoing assessment of disease, evaluation of response to treatment, and assistance in procedures. This study was conducted to assess the current utilization, training, and barriers to the implementation of neonatologist-performed POCU (NP-POCU) in Indian neonatal intensive care units (NICUs).

Methods: A survey questionnaire was disseminated to practicing neonatologists in India via an online survey tool from July 2017 to September 2017. The questionnaire addressed the information related to the availability of NP-POCU services, indications for its use, perception among neonatologists about its usefulness, training for NP-POCU, and access to pediatric cardiology and radiology services.

Results: The overall response rate was 78%. A total of 72% respondents reported having access to NP-POCU services in their units. Neonatologist-performed POCU (NP-POCU) was used most frequently for cranial ultrasound (97%), functional echocardiography (90%), and evaluating line position (67%). Majority (92%) of the units had no training program for NP-POCU. The most common reasons cited for not having NP-POCU services were non-availability of trained personnel to perform POCU (50%) and strict Pre-conception and Prenatal Diagnostic Techniques (PC-PNDT) Act (50%).

Conclusions: Neonatologist-performed point-of-care ultrasonography is being increasingly utilized in Indian NICUs. However, there is a lack of structured training and guidelines for its use. Non-availability of trained personnel and strict PC-PNDT Act are major barriers to its implementation. We recommend that accredited training programs and standardized guidelines be established for the safer use of NP-POCU in India.

Keywords

Cranial ultrasound functional echocardiography neonatal point-of-care ultrasonography training

Get full access to this article

View all access options for this article.

References

Sohoni

Bosley

Miss

Bedside ultrasonography for obstetric and gynecologic emergencies. Crit Care Clin . 2014 Apr; 30(2): 207−26.

Whitson

Mayo

PH.

Ultrasonography in the emergency department. Crit Care . 2016; 20(1): 13.

Srinivasan

Cornell

TT.

Bedside ultrasound in pediatric critical care: a review. Pediatr Crit Care Med . 2011; 12(6): 667−74.

Moore

Gregg

Lambert

Performance, training, quality assurance, and reimbursement of emergency physician-performed ultrasonography at academic medical centres. J Ultrasound Med . 2004 Apr; 23(4): 459−66.

McLario

Sivitz

Point-of-care ultrasound in pediatric clinical care. JAMA Pediatr . 2015 Jun; 169(6): 594−21.

Kluckow

Use of ultrasound in the haemodynamic assessment of the sick neonate. Arch Dis Child Fetal Neonatal Ed . 2014; 99(4): F332−337.

Rath

Suryawanshi

Point of care neonatal ultrasound—Head, lung, gut and line localization. Indian Pediatr . 2016: 53(10): 889–99.

de Waal

Kluckow

Functional echocardiography; from physiology to treatment. Early Hum Dev . 2010; 86(3): 149–54.

Evans

Gournay

Cabanas

Point-of-care ultrasound in the neonatal intensive care unit: international perspectives. Semin Fetal Neonatal Med . 2011 Feb; 16(1): 61–8.

10.

Finan

Sehgal

Khuffash

McNamara

Targeted neonatal echocardiography services. J Ultrasound Med . 2014; 33(10): 1833–41.

11.

Roehr

te Pas

Dold

Investigating the European perspective of neonatal point-of-care echocardiography in the neonatal intensive care unit—a pilot study. Eur J Pediatr . 2013; 172(7): 907–11.

12.

Sehgal

Mehta

Evans

McNamara

Cardiac sonography by the neonatologist. J Ultrasound Med . 2014; 33(8): 1401–06.

13.

de Boode

Singh

Gupta

Recommendations for neonatologist-performed echocardiography in Europe: Consensus Statement endorsed by European Society for Paediatric Research (ESPR) and European Society for Neonatology (ESN). Pediatr Res . 2016; 80(4): 465–71.

14.

Banait

Suryawanshi

Malshe

Nagpal

Lalwani

. Cardiac blood flow measurements in stable full term small for gestational age neonates. J Clin Diagn Res . 2013 Aug; 7(8): 1651–54.

15.

Khamkar

Suryawanshi

Maheshwari

Functional neonatal echocardiography: Indian experience. J Clin Diagn Res . 2015 Dec; 9(12): SC11–14.

16.

Deshpande

Suryawanshi

Chaudhary

Maheshwari

Cardiac output in late onset neonatal sepsis. J Clin Diagn Res . 2017 Nov; 11(11): SC25–28.

17.

Evans

Echocardiography on neonatal intensive care units in Australia and New Zealand. J Paediatr Child Health . 2000; 36(2): 169–71.

18.

Liu

Cao

Wang

Xiao

The significance and the necessity of routinely performing lung ultrasound in the neonatal intensive care units. J Matern Fetal Neonatal Med . 2016; 29(24): 4025–30.

19.

Nguyen

Amirnovin

Ramanathan

Noori

The state of point-of-care ultrasonography use and training in neonatal–perinatal medicine and pediatric critical care medicine fellowship programs. J Perinatol . 2016; 36(11): 972–76.

20.

Australasian Society for Ultrasound in Medicine. Certificate in clinician performed ultrasound. https://www.asum.com.au/education/ccpu-course/neonatal-ccpu-course. Accessed April 14, 2018.

21.

Mertens

Seri

Marek

Targeted Neonatal Echocardiography in the Neonatal Intensive Care Unit: Practice Guidelines and Recommendations for Training: Writing group of the American Society of Echocardiography (ASE) in collaboration with the European Association of Echocardiography (EAE) and the Association for European Pediatric Cardiologists (AEPC). Eur J Echocardiogr . 2011; 12(10): 715–36.

22.

Singh

Gupta

Groves

Expert consensus statement “Neonatologist-performed Echocardiography (NoPE)”-training and accreditation in UK. Eur J Pediatr . 2016; 175(2): 281–7.

23.

de Boode

Singh

Gupta

Recommendations for neonatologist performed echocardiography in Europe: consensus statement endorsed by European Society for Paediatric Research (ESPR) and European Society for Neonatology (ESN). Pediatr Res . 2016; 80(4): 465–71.

24.

Patnaik

Kejriwal

GS.

A perspective on the PCPNDT Act. Indian J Radiol Imag . 2012; 22(2): 137–40.

25.

Webb

Waugh

Grigsby

Impact of telemedicine on hospital transport, length of stay, and medical outcomes in infants with suspected heart disease: a multicenter study. J Am Soc Echocardiogr . 2013; 26(9): 1090–98.

26.

Singh

Bansal

Maheshwari

American Society of Echocardiography: remote echocardiography with web-based assessments for referrals at a distance (ASE-REWARD) study. J Am Soc Echocardiogr . 2013; 26(3): 221–33.