Introduction of point-of-care neonatal lung ultrasound in a developing country

Despite neonatal lung ultrasound (LU) being diffused worldwide, its introduction in limited-resource areas has not been formally investigated. We conceived a project to introduce it in a level 3 NICU of a developing country and verify if, after a short protocolized training, clinicians may efficaciously use LU. Inter-rater agreement between ultrasound trainees and trainers was analyzed within both the local test and the diffusion phases of the project. High inter-rater agreements were found between expert trainers and the two neonatologists who were trained in a skilled European center (Cohen’s Kappa, 0.951; 95%CI, 0.882–0.999), as well as between the two and the second round of locally trained colleagues (Cohen’s Kappa, 0.896; 95%CI, 0.797–0.996). Moreover, a high agreement was found between the clinical respiratory diagnosis (used as the “gold standard”) and the LU diagnosis given by the first two trainees (intraclass correlation, 0.992; 95%CI, 0.987–0.996) and the locally trained physicians (intraclass correlation, 0.97; 95%CI, 0.95–0.98). A final survey demonstrated that the project was perceived as efficacious and that LU was going to be integrated into routine clinical practice.

Conclusions: А short LU training provided sufficient proficiency and allowed the LU introduction in clinical practice in the neonatal intensive care unit in a developing country.