Neonatal Ultrasound in Transport A study of the feasibility and utility of portable ultrasound during retrieval of sick term and preterm infants

Abstract

Aim: To determine the feasibility and utility of clinician performed ultrasound (CPU) during the stabilisation and retrieval of critically ill preterm, late preterm and term neonates. Methods: A preliminary study was conducted in the NICU to establish ultrasound skills and the ability integrate ultrasound assessment into clinical care to enhance outcomes – targeting indomethacin to haemodynamically significant PDA established an important dose minimisation strategy. Subsequently, a neonatologist with certified ultrasound skills and with a portable ultrasound accompanied newborn retrievals to perform cardiac and cerebral ultrasound before and after transportation. Results: The Neonatal Ultrasound in Transport study demonstrates the feasibility and utility of ultrasound assessment prior to and during the stabilisation and admission of critically ill newborns who are requiring interfacility transport to a higher level of care. It is feasible to carry a laptop ultrasound with the transport team without hindering flight or retrieval processes. The NUIT study demonstrated that many term babies had evidence of clinically unsuspected haemodynamic compromise. Other babies had clinically unsuspected abnormal heart structure allowing for redirection of transport toward paediatric cardiology centres. This has clinical, financial and social benefits. The preterm cohort revealed many babies with clinically unsuspected low systemic blood flow and importantly for transport clinicians – stable head ultrasound findings pre-and post transport. This has implication for therapeutic targeting of treatment and for counselling parents. Page | ii Conclusion: CPU during the retrieval of neonates confirms a high incidence of haemodynamic pathology. Ultrasound in retrieval is feasible, allows the accurate triage of babies to cardiac centres and may allow more accurate and earlier targeting of fluid and inotropic support. Keywords: Neonate, preterm, term, ultrasound, retrieval, transport