Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

The state of point-of-care ultrasonography use and training in neonatal–perinatal medicine and pediatric critical care medicine fellowship programs

Subjects

Abstract

Objective:

The current state of point-of-care ultrasonography (POCUS) use and education in neonatal–perinatal medicine (NPM) and pediatric critical care medicine (PCCM) is unknown. Our aim was to quantify POCUS use, training and perceptions regarding education and barriers among the United States NPM and PCCM fellowship programs.

Study Design:

A 14-question survey was emailed to the fellowship directors of all the United States NPM and PCCM fellowship programs.

Results:

The response rate was 55% (52/95) and 59% (39/66) for NPM and PCCM programs, respectively. Over 90% of respondents in both groups believe that fellows and attendings should receive POCUS training. PCCM programs, compared with NPM, had greater access to POCUS machines (97% vs 63%, P<0.001), and more often used POCUS for diagnoses and management (76% vs 29%, P<0.001) and procedural guidance (95% vs 37%, P<0.001). The most common indications were cardiac/hemodynamics, pulmonary pathology and vascular access in both specialties. PCCM reported more training to fellows (90% vs 29%, P<0.001). Both group perceived lack of time to learn, lack of equipment/funds, liability concerns, lack of personnel to train physicians and cardiology/radiology resistance as significant barriers to POCUS implementation.

Conclusions:

Both NPM and PCCM fellowship programs believe in the benefits of POCUS and that their physicians should receive the necessary training. Compared with PCCM, NPM fellowships programs have less access to POCUS machines and less frequently use POCUS and train their fellows and attendings. There remain significant barriers to utilization of POCUS, especially in NPM.

This is a preview of subscription content, access via your institution

Access options

Buy this article

Prices may be subject to local taxes which are calculated during checkout

Figure 1

Similar content being viewed by others

References

  1. Moore CL, Copel JA . Point-of-care ultrasonography. N Engl J Med 2011; 364: 749–757.

    Article  CAS  Google Scholar 

  2. McLario DJ, Sivitz AB . Point-of-care ultrasound in pediatric clinical care. JAMA Pediatr 2015; 169: 594–597.

    Article  Google Scholar 

  3. Noori S, Seri I . Does targeted neonatal echocardiography affect hemodynamics and cerebral oxygenation in extremely preterm infants? J Perinatol 2014; 34: 847–849.

    Article  CAS  Google Scholar 

  4. Srinivasan S, Cornell TT . Bedside ultrasound in pediatric critical care: A review. Pediatr Crit Care Med 2011; 12: 667–674.

    Article  Google Scholar 

  5. Lambert RL, Boker JR, Maffei FA . National survey of bedside ultrasound use in pediatric critical care*. Pediatr Crit Care Med 2011; 12: 655–659.

    Article  Google Scholar 

  6. Evans N, Gournay V, Cabanas F, Kluckow M, Leone T, Groves A et al. Point-of-care ultrasound in the neonatal intensive care unit: international perspectives. Semin Fetal Neonat Med 2011; 16: 61–68.

    Article  Google Scholar 

  7. Nguyen J . Ultrasonography for central catheter placement in the neonatal intensive care unit—a review of utility and practicality. Am J Perinatol 2016; 33: 525–530.

    Article  Google Scholar 

  8. Bohnhorst B . Usefulness of abdominal ultrasound in diagnosing necrotising enterocolitis. Arch Dis Child Fetal Neonatal Ed 2013; 98: F445–F450.

    Article  Google Scholar 

  9. Liu J . Lung ultrasonography for the diagnosis of neonatal lung disease. J Matern Fetal Neonatal Med 2013; 27: 856–861.

    Article  Google Scholar 

  10. Southern California Clinical and Translational Science Institute. Available at https://redcap.sc-ctsi.org; accessed 2 November 2015.

  11. FREIDA Online. Available at http://www.ama-assn.org/ama/pub/education-careers/graduate-medical-education/freida-online.page? (accessed 2 November 2015).

  12. ERAS 2016 Participating Specialties & Programs. Available at https://services.aamc.org/eras/erasstats/par/; accessed 2 November 2015.

  13. Section on Neonatal-Perintal Medicine. Available at https://www2.aap.org/sections/perinatal/ (accessed 2 November 2015).

  14. Eisen LA, Leung S, Gallagher AE, Kvetan V . Barriers to ultrasound training in critical care medicine fellowships: a survey of program directors. Crit Care Med 2010; 38: 1978–1983.

    Article  Google Scholar 

  15. Ramirez-Schrempp D, Dorfman DH, Tien I, Liteplo AS . Bedside ultrasound in pediatric emergency medicine fellowship programs in the United States: little formal training. Pediatr Emerg Care 2008; 24: 664–667.

    Article  Google Scholar 

  16. Marin JR, Zuckerbraun NS, Kahn JM . Use of emergency ultrasound in united states pediatric emergency medicine fellowship programs in 2011. J Ultrasound Med 2012; 31: 1357–1363.

    Article  Google Scholar 

  17. Sehgal A, Mehta S, Evans N, McNamara PJ . Cardiac sonography by the neonatologist: clinical usefulness and educational perspective. J Ultrasound Med 2014; 33: 1401–1406.

    Article  Google Scholar 

  18. Finan E, Sehgal A, Khuffash AE, McNamara PJ . Targeted neonatal echocardiography services: need for standardized training and quality assurance. J Ultrasound Med 2014; 33: 1833–1841.

    Article  Google Scholar 

  19. Evans N . Echocardiography on neonatal intensive care units in Australia and New Zealand. J Paediatr Child Health 2000; 36: 169–171.

    Article  CAS  Google Scholar 

  20. Roehr CC, Pas te AB, Dold SK, Breindahl M, Blennow M, Rüdiger M et al. Investigating the European perspective of neonatal point-of-care echocardiography in the neonatal intensive care unit—a pilot study. Eur J Pediatr 2013; 172: 907–911.

    Article  CAS  Google Scholar 

  21. Arntfield RT, Millington SJ . Point of care cardiac ultrasound applications in the emergency department and intensive care unit—a review. Curr Cardiol Rev 2012; 8: 98–108.

    Article  Google Scholar 

  22. Beaulieu Y . Bedside echocardiography in the assessment of the critically ill. Crit Care Med 2007; 35: S235–S249.

    Article  Google Scholar 

  23. Breitkreutz R, Price S, Steiger HV, Seeger FH, Ilper H, Ackermann H et al. Focused echocardiographic evaluation in life support and peri-resuscitation of emergency patients: a prospective trial. Resuscitation 2010; 81: 1527–1533.

    Article  Google Scholar 

  24. Salinas FV, Hanson NA . Evidence-based medicine for ultrasound-guided regional anesthesia. Anesthesiol Clin 2014; 32: 771–787.

    Article  Google Scholar 

  25. Scalea TM, Rodriguez A, Chiu WC . Focused assessment with sonography for trauma (FAST): results from an international consensus conference. J Trauma 1999; 46: 466–472.

    Article  CAS  Google Scholar 

  26. Levy JA, Noble VE . Bedside ultrasound in pediatric emergency medicine. Pediatrics 2008; 121: e1404–e1412.

    Article  Google Scholar 

  27. El-Khuffash AF, McNamara PJ . Neonatologist-performed functional echocardiography in the neonatal intensive care unit. Semin Fetal Neonatal Med 2011; 16: 50–60.

    Article  Google Scholar 

  28. Wyllie J . Neonatal echocardiography. Semin Fetal Neonatal Med 2015; 20: 173–180.

    Article  Google Scholar 

  29. Cohen JS, Teach SJ, Chapman JI . Bedside ultrasound education in pediatric emergency medicine fellowship programs in the United States. Pediatr Emerg Care 2012; 28: 845–850.

    Article  Google Scholar 

  30. Marin JR, Lewiss RE American Academy of Pediatrics, Committee on Pediatric Emergency Medicine, Society for Academic Emergency Medicine, Academy of Emergency Ultrasound, American College of Emergency Physicians, Pediatric Emergency Medicine Committee, World Interactive Network Focused on Critical Ultrasound. Point-of-care ultrasonography by pediatric emergency medicine physicians. Pediatrics 2015; 135: e1113–e1122.

    Article  Google Scholar 

  31. Marin JR, Abo AM, Doniger SJ, Fischer JW, Kessler DO, Levy JA et al. Point-of-care ultrasonography by pediatric emergency physicians. Ann Emerg Med 2015; 65: 472–478.

    Article  Google Scholar 

  32. Mosier JM, Malo J, Stolz LA, Bloom JW, Reyes NA, Snyder LS et al. Critical care ultrasound training: a survey of US fellowship directors. J Crit Care 2014; 29: 645–649.

    Article  Google Scholar 

  33. Pershad J, Myers S, Plouman C, Rosson C, Elam K, Wan J et al. Bedside limited echocardiography by the emergency physician is accurate during evaluation of the critically ill patient. Pediatrics 2004; 114: e667–e671.

    Article  Google Scholar 

  34. Longjohn M, Pershad J . Point-of-care echocardiography by pediatric emergency physicians. Clin Pediatr Emerg Med 2011; 12: 37–42.

    Article  Google Scholar 

  35. Spurney CF, Sable CA, Berger JT, Martin GR . Use of a hand-carried ultrasound device by critical care physicians for the diagnosis of pericardial effusions, decreased cardiac function, and left ventricular enlargement in pediatric patients. J Am Soc Echocardiogr 2005; 18: 313–319.

    Article  Google Scholar 

  36. Dinh VA, Chrissian AA, Giri PC, Rathinavel I, Nguyen E, Hecht D et al. Impact of a 2-day critical care ultrasound course during fellowship training: a pilot study. Crit Care Res Pract 2015; 2015: 1–8.

    Article  Google Scholar 

  37. Nguyen J, Cascione M, Noori S . Analysis of lawsuits related to point-of-care ultrasonography in neonatology and pediatric subspecialties. J Perinatol 2016 doi:10.1038/jp.2016.66.

  38. Mertens L, Seri I, Marek J, Arlettaz R, Barker P, McNamara P et al. 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: 715–736.

    Article  Google Scholar 

  39. Singh Y, Gupta S, Groves AM, Gandhi A, Thomson J, Qureshi S et al. Expert consensus statement ‘Neonatologist-performed Echocardiography (NoPE)’—training and accreditation in UK. Eur J Pediatr 2015; 175: 281–287.

    Article  Google Scholar 

  40. Kluckow M, Evans N . Point of care ultrasound in the NICU—training, accreditation and ownership. Eur J Pediatr 2015; 175: 289–90.

    Article  Google Scholar 

  41. Evans N, Kluckow M . Neonatology concerns about the TNE consensus statement. J Am Soc Echocardiogr 2012; 25: 242–243.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to J Nguyen.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Additional information

Author contributions

JN and SN conceptualized and designed the study and data collection instrument, carried out the analysis, drafted the initial manuscript and approved the final manuscript as submitted; RA and RR aided in study design and the data collection instrument, reviewed and revised the manuscript, and approved the final manuscript as submitted.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Nguyen, J., Amirnovin, R., Ramanathan, R. et al. The state of point-of-care ultrasonography use and training in neonatal–perinatal medicine and pediatric critical care medicine fellowship programs. J Perinatol 36, 972–976 (2016). https://doi.org/10.1038/jp.2016.126

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/jp.2016.126

This article is cited by

Search

Quick links