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Kolnik SE, Sahota A, Wood TR, German K, Puia-Dumitrescu M, Mietzsch U, Dighe M, Law JB. Cranial Point-of-Care Ultrasound for Neonatal Providers: A Feasibility Study. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2024; 43:1089-1097. [PMID: 38404126 DOI: 10.1002/jum.16437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 02/08/2024] [Accepted: 02/11/2024] [Indexed: 02/27/2024]
Abstract
OBJECTIVE Despite strong evidence for its utility in clinical management and diagnosis of intracranial hemorrhage (ICH), the use of neonatal cranial point-of-care ultrasound (POCUS) has not been standardized in neonatal intensive care units (NICUs) in the United States. The primary aim of this study was to evaluate the feasibility of training NICU providers to perform cranial POCUS by tracking the quality of image acquisition following training. METHODS Observational single-center cohort study of cranial POCUS images obtained by trained neonatal practitioners (attendings, fellows, and advanced practice providers) using a protocol developed by a radiologist and neonatologist. Exams were performed on infants born ≤1250 g and/or ≤30 weeks gestation within the first 3 days after birth. A survey to assess attitudes regarding cranial POCUS was given before each of three training sessions. Demographic and clinical data collection were portrayed with descriptive statistics. Metrics of image quality were assessed by a radiologist and sonographer independently. Analysis of trends in quality of POCUS images over time was performed using a multinomial Cochran-Armitage test. RESULTS Eighty-two cranial POCUS scans were performed over a 2-year period. Infant median age at exam was 14 hours (IQR 7-22 hours). Metrics of image quality depicted quarterly demonstrated a significant improvement in depth (P = .01), gain (P = .048), and quality of anatomy images captured (P < .001) over time. Providers perceived increased utility and safety of cranial POCUS over time. CONCLUSION Cranial POCUS image acquisition improved significantly following care team training, which may enable providers to diagnose ICH at the bedside.
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Affiliation(s)
- Sarah E Kolnik
- Department of Pediatrics, Division of Neonatology, University of Washington/Seattle Children's Hospital, Seattle, Washington, USA
| | - Annika Sahota
- Department of Pediatrics, Division of Neonatology, University of Washington/Seattle Children's Hospital, Seattle, Washington, USA
| | - Thomas R Wood
- Department of Pediatrics, Division of Neonatology, University of Washington/Seattle Children's Hospital, Seattle, Washington, USA
- Center on Human Development and Disability, University of Washington, Seattle, Washington, USA
| | - Kendell German
- Department of Pediatrics, Division of Neonatology, University of Washington/Seattle Children's Hospital, Seattle, Washington, USA
- Center on Human Development and Disability, University of Washington, Seattle, Washington, USA
| | - Mihai Puia-Dumitrescu
- Department of Pediatrics, Division of Neonatology, University of Washington/Seattle Children's Hospital, Seattle, Washington, USA
| | - Ulrike Mietzsch
- Department of Pediatrics, Division of Neonatology, University of Washington/Seattle Children's Hospital, Seattle, Washington, USA
| | - Manjiri Dighe
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Janessa B Law
- Department of Pediatrics, Division of Neonatology, University of Washington/Seattle Children's Hospital, Seattle, Washington, USA
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Mohsen N, Yeung T, Fadel NB, Abdul Wahab MG, Elsayed Y, Nasef N, Mohamed A. Current perception and barriers to implementing lung ultrasound in Canadian neonatal intensive care units: a national survey. Eur J Pediatr 2024:10.1007/s00431-024-05591-7. [PMID: 38787415 DOI: 10.1007/s00431-024-05591-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 04/18/2024] [Accepted: 04/28/2024] [Indexed: 05/25/2024]
Abstract
Despite the growing body of literature supporting the use of point-of-care lung ultrasound (POC-LU) in neonates, its adoption in Canadian neonatal intensive care units (NICUs) remains limited. This study aimed to identify healthcare providers' perceptions and barriers to implementing POC-LU in Canadian NICUs. We conducted an electronic survey targeting neonatologists, neonatal fellows, neonatal nurse practitioners, and registered respiratory therapists in 20 Canadian NICUs. The survey comprised a 28-item questionnaire divided into four sections: (1) participants' demographics and availability of POC-LU equipment, (2) experience and interest in POC-LU learning, (3) perception of POC-LU as a diagnostic tool, and (4) barriers to POC-LU implementation in NICUs. A total of 194 participants completed the survey, with neonatologists comprising the majority (45%). Nearly half of the participants (48%) reported prior experience with POC-LU. The most prevalent indications for POC-LU use were diagnosis of pleural effusion (90%), pneumothorax (87%), and respiratory distress syndrome (76%). Participants identified the primary barrier to POC-LU adoption as the lack of trained providers available for both training and clinical integration. Notably, most respondents (87%) expressed keen interest in learning neonatal POC-LU. A subgroup analysis based on the responses collected from NICU-directors of 12 institutions yielded results consistent with those of the overall participant pool. Conclusion: This survey underscores the perceived importance of POC-LU among NICU healthcare providers. A Canadian consensus is required to facilitate the development of widespread training programs as well as standardized clinical practice guideline for its implementation. What is Known: • In recent years, point-of-care lung ultrasound (POC-LU) has emerged as an important tool in neonatology, revolutionizing the assessment and management of critically ill infants. However, its adoption in Canadian Neonatal Intensive Care Units remains limited. What is New: • Most Canadian healthcare providers showed high level of interest in learning POC-LU techniques. Additionally, POC-LU was perceived as a useful tool for diagnosis and guiding intervention in various neonatal respiratory diseases. Nonetheless, the lack of expertise emerged as the primary barrier to its adoption and practice across different groups of participants regardless of their clinical experience level.
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Affiliation(s)
- Nada Mohsen
- Department of Pediatrics, Sinai Health System, University of Toronto, Toronto, Canada
- Department of Pediatrics, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Telford Yeung
- Section of Neonatology, Windsor Regional Hospital, University of Windsor, Windsor, Canada
| | - Nadya Ben Fadel
- Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Canada
| | | | - Yasser Elsayed
- Department of Pediatrics, University of Manitoba, Winnipeg, Canada
| | - Nehad Nasef
- Department of Pediatrics, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Adel Mohamed
- Department of Pediatrics, Sinai Health System, University of Toronto, Toronto, Canada.
- Department of Pediatrics, Mount Sinai Hospital, 600 University Avenue, Toronto, ON, M5G 1X5, Canada.
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Sammour I, Karnati S, Othman H, Heis F, Peluso A, Aly H. Trends in Procedures in the Neonatal Intensive Care Unit. Am J Perinatol 2024; 41:e494-e500. [PMID: 35858651 DOI: 10.1055/a-1905-5245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVE The aim of the study is to identify the rates and trends of various procedures performed on newborns. STUDY DESIGN The Healthcare Cost and Utilization Project (HCUP) database for the years 2002 to 2015 was queried for the number of livebirths, and various procedures using International Classification of Diseases, Ninth Revision (ICD-9) codes. These were adjusted to the rate of livebirths in each particular year. A hypothetical high-volume hospital based on data from the last 5 years was used to estimate the frequency of each procedure. RESULTS Over the study period, there was a decline in the rates of exchange transfusions and placement of arterial catheters. There was an increase in the rates of thoracentesis, abdominal paracentesis, placement of umbilical venous catheter (UVC) lines, and central lines with ultrasound or fluoroscopic guidance. No change was observed in the rates of unguided central lines, pericardiocentesis, bladder aspiration, intubations, and LP. Intubations were the most performed procedures. Placement of UVC, central venous lines (including PICCs), arterial catheters, and LP were relatively common, whereas others were rare such as pericardiocentesis and paracentesis. CONCLUSION Some potentially lifesaving procedures are extremely rare or decreasing in incidence. There has also been an increase in utilization of fluoroscopic/ultrasound guidance for the placement of central venous catheters. KEY POINTS · Advances in neonatal care have impacted the number of procedures performed in the NICU.. · It is unclear whether invasive procedures occur at rates sufficient for adequate training and maintenance of skills.. · Understanding the NICU procedural trends is important in designing simulation and competency-based medical education programs..
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Affiliation(s)
- Ibrahim Sammour
- Department of Neonatology, Cleveland Clinic Children's, Cleveland, Ohio
| | - Sreenivas Karnati
- Department of Neonatology, Cleveland Clinic Children's, Cleveland, Ohio
| | - Hasan Othman
- Department of Pediatrics, Michigan State University/Sparrow Health System, Lansing, Michigan
| | - Farah Heis
- Department of Neonatology, Cleveland Clinic Children's, Cleveland, Ohio
| | - Allison Peluso
- Department of Neonatology, Cleveland Clinic Children's, Cleveland, Ohio
| | - Hany Aly
- Department of Neonatology, Cleveland Clinic Children's, Cleveland, Ohio
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Firszt O, Grabowska A, Saran A, Kluczewska E. Implementation of a standardized lung ultrasound protocol for respiratory distress in a neonatal intensive care unit: an observational study. J Perinatol 2024:10.1038/s41372-024-01900-y. [PMID: 38361003 DOI: 10.1038/s41372-024-01900-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 01/17/2024] [Accepted: 01/29/2024] [Indexed: 02/17/2024]
Abstract
OBJECTIVE To assess the feasibility of implementing a simple point-of-care lung ultrasound (LU) evaluation and reporting protocol in a neonatal intensive care unit (NICU) and its effect on patient management. STUDY DESIGN Retrospective observational study of LU examinations performed in a level III NICU. Each examination was performed according to a standardized protocol. An independent radiologist-assessed chest X-ray (CXR) was used to compare the LU diagnosis. The impact on patient management was also evaluated. RESULT A total of 206 LU studies in 158 neonates were reviewed. There was significant agreement between LU and CXR diagnoses (84.95%, 95% CI 80.07-89.83%). LU affected patient management in 87.8% of the cases (95% CI 83.33-92.28%). CONCLUSION Implementation of a simplified, sign-based protocol for LU in the NICU is feasible. LU is not inferior to CXR studies and supports patient management as an imaging modality.
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Affiliation(s)
- Oliver Firszt
- Chair and Department of Radiology in Zabrze, Medical University of Silesia, Zabrze, Poland.
| | - Agata Grabowska
- Chair and Department of Radiology in Zabrze, Medical University of Silesia, Zabrze, Poland
| | - Anna Saran
- Chair and Department of Radiology in Zabrze, Medical University of Silesia, Zabrze, Poland
| | - Ewa Kluczewska
- Chair and Department of Radiology in Zabrze, Medical University of Silesia, Zabrze, Poland
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5
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董 文, 邓 博, 悦 光, Elsayed Y, 巨 容, 王 建, 史 源. [Interpretation of the clinical guideline for point-of-care ultrasonography in the neonatal intensive care unit in the United States]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2023; 25:672-677. [PMID: 37529947 PMCID: PMC10414167 DOI: 10.7499/j.issn.1008-8830.2302004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 03/06/2023] [Indexed: 08/03/2023]
Abstract
In December 2022, the American Academy of Pediatrics released a clinical guideline for point-of-care ultrasonography (POCUS) in the neonatal intensive care unit (NICU). The guideline outlined the development and current status of POCUS in the NICU, and summarized the key elements and implementation guidelines for successful implementation of POCUS in the NICU. This article provides an overview of the key points of the clinical guideline and analyzes the current status of POCUS in China, providing a reference for the implementation of POCUS in neonatal care in China.
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Chen Q, Yao W, Xu F, Liao J, Li J, Mai M, Xie H, He X, Li N. Application of abdominal ultrasonography in surgical necrotizing enterocolitis: a retrospective study. Front Microbiol 2023; 14:1211846. [PMID: 37346747 PMCID: PMC10281645 DOI: 10.3389/fmicb.2023.1211846] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 05/16/2023] [Indexed: 06/23/2023] Open
Abstract
Background Necrotizing enterocolitis (NEC) is a severe inflammatory bowel disease that may lead to perforation, causing high morbidity and mortality in preterm infants. Abdominal ultrasound (AUS) has been shown to provide benefits in diagnosing and managing NEC in recent years. Objective This study focused on the utility of AUS in the diagnosis and evaluation of surgical NEC. Patients and methods In this retrospective study, available data of the patients diagnosed from January 2019 to June 2022 were reviewed. The sensitivity and specificity of AUS in diagnosing a perforation were analyzed. Typical cases for the application of AUS in monitoring and evaluating the progression, complications, and sequela of NEC were described. Results There were 69 neonates diagnosed with NEC and examined by AUS, of whom eight patients developed a perforation. AUS was used for diagnosing a perforation in eight patients with key features of pneumoperitoneum and/or complex ascites, allowing us to find four locations of perforation, with a sensitivity and specificity of 100%. Conclusion AUS plays an important role in diagnosing and evaluating surgical NEC in newborn infants, with good sensitivity and specificity.
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Affiliation(s)
- Qin Chen
- Department of Neonatal Intensive Care Unit, Dongguan Children's Hospital Affiliated to Guangdong Medical University, Dongguan, China
| | - Weiquan Yao
- Department of Medical Imaging, Dongguan Children's Hospital Affiliated to Guangdong Medical University, Dongguan, China
| | - Fengdan Xu
- Department of Neonatal Intensive Care Unit, Dongguan Children's Hospital Affiliated to Guangdong Medical University, Dongguan, China
| | - Jinfeng Liao
- Department of Neonatal Intensive Care Unit, Dongguan Children's Hospital Affiliated to Guangdong Medical University, Dongguan, China
| | - Jinfeng Li
- Department of Neonatal Intensive Care Unit, Dongguan Children's Hospital Affiliated to Guangdong Medical University, Dongguan, China
| | - Minling Mai
- Department of Neonatal Intensive Care Unit, Dongguan Children's Hospital Affiliated to Guangdong Medical University, Dongguan, China
| | - Haoqiang Xie
- Department of Neonatal Intensive Care Unit, Dongguan Children's Hospital Affiliated to Guangdong Medical University, Dongguan, China
| | - Xiaoguang He
- Department of Neonatal Intensive Care Unit, Dongguan Children's Hospital Affiliated to Guangdong Medical University, Dongguan, China
| | - Ning Li
- Department of Neonatal Intensive Care Unit, Dongguan Children's Hospital Affiliated to Guangdong Medical University, Dongguan, China
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7
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Ben Fadel N, Surak A, Almoli E, Jankov R. Implementing a successful targeted neonatal echocardiography service and a training program: The ten stages of change. J Neonatal Perinatal Med 2022; 15:671-676. [PMID: 35811542 DOI: 10.3233/npm-210974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Implementing any new service or program in the health care system is not always straightforward; a multi-stage implementation process is required most of the time. With the advancements in neonatal care and increased survival rates, there has been an increased need for ongoing assessment of hemodynamic stability. At the Children's Hospital of Eastern Ontario and the Ottawa Hospital Neonatal Intensive Care Units (NICUs), University of Ottawa, Canada, Targeted Neonatal Echocardiography service (TnEcho) was successfully established and has led to improvement in the hemodynamic evaluation and decision making in neonatal intensive care. In this article, we describe our experience establishing this program and the process of ensuring its success. This review article highlights the ten steps taken by multiple stakeholders to achieve this goal; this may help other centres implement a similar program.
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Affiliation(s)
| | - A Surak
- University of Alberta, Alberta, Canada
| | - E Almoli
- School of Interdisciplinary Sciences, McMaster University, Ontario, Canada
| | - R Jankov
- University of Ottawa, Ontario, Canada
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8
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Abstract
The dramatic technologic advancements seen in ultrasound have accelerated the growth of point-of-care ultrasound (POCUS) in medicine. Neonatology has lagged behind other pediatric and adult specialties in incorporating POCUS into clinical practice despite there being numerous applications in cardiac and non-cardiac arenas. Widely available training programs are aiding in improving this situation but significantly more structure and orchestration for neonatal POCUS dissemination will be needed to fully actualize the potential for POCUS to augment its widespread clinical application.
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9
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Cho HJ, Kim EJ, Son DW. Neonatologist-Performed Cranial Ultrasonography in the Neonatal Intensive Care Unit. NEONATAL MEDICINE 2022. [DOI: 10.5385/nm.2022.29.2.57] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Cranial ultrasound (CUS) is an initial screening imaging tool used to evaluate the neonatal brain. It is an accessible, inexpensive, and harmless technique that can be used at bedside as frequently as required. Timely focused CUS in the neonatal care unit can play a major role in the diagnosis, follow-up, and management of brain damage. Despite the increasing use of point-of-care ultrasonography by intensive care physicians, neonatologist-performed CUS remains unusual. This review aims to provide an overview of neonatal CUS to neonatologists, focusing on the optimal settings, standard planes of the brain, and main pathologies in preterm infants. Adding Doppler studies allows evaluation of the patency of intracranial arteries and veins, flow velocities, and indices. This may provide an opportunity for earlier targeted circulatory support to prevent brain injury and improve long-term neurodevelopmental outcomes.
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10
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Lam SHF, Berant R, Chang TP, Friedman L, Gold DL, Kornblith AE, Lin-Martore M, Pade KH, Skaugset LM, Toney AG, Wang-Flores H. The P2Network-Advancing Pediatric Emergency Care With Point-of-Care Ultrasound. Pediatr Emerg Care 2022; 38:e1014-e1018. [PMID: 34787985 DOI: 10.1097/pec.0000000000002369] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
ABSTRACT Over the last 2 decades, the use of point-of-care ultrasound (POCUS) in pediatric emergency medicine (PEM) has grown exponentially. In 2014, a group of PEM POCUS leaders met and formed the P2Network. The P2Network provides a platform to build collaborative relationships and share expertise among members from various countries and practice settings. It works with educators and researchers within and outside of the field to advance POCUS practice in PEM. As an organization, the P2Network promotes the evidence-based application of POCUS to facilitate and improve care in the PEM setting and addresses issues related to integration of the PEM POCUS practitioner in this nascent field. The P2Network is building and augmenting its infrastructure for PEM POCUS research and education and has already made some progress in the areas, with published manuscripts and ongoing clinical research studies under its sponsorship. Future goals include developing a PEM POCUS research agenda, formalizing teaching and assessment of PEM POCUS skills, and implementing multicenter research studies on potentially high impact applications.
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Affiliation(s)
- Samuel H F Lam
- From the Sutter Medical Center Sacramento, Sacramento, CA
| | | | - Todd P Chang
- Children's Hospital Los Angeles, Los Angeles, CA
| | - Lucas Friedman
- University of California Riverside School of Medicine, Riverside CA
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11
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Zheng Y, Gandhi A, Sewell K, Tumin D, Bear K. Point-of-care ultrasound educational interventions in the neonatal intensive care unit: A systematic review. J Neonatal Perinatal Med 2022; 15:511-520. [PMID: 35491808 DOI: 10.3233/npm-210925] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE The benefits of point-of-care ultrasound (POCUS) in the neonatal intensive care unit (NICU) have been widely recognized, but education on this area of practice remains variable. We reviewed published educational interventions regarding POCUS use in the NICU and whether they have led to sustainable increases in POCUS use. METHODS A systematic search of 6 databases was performed for publications from January 2000 to March 2021. Studies with quantitative data related to POCUS educational interventions in the NICU were included. Data on number of participants and roles, educational intervention, curriculum description, and project outcome measures (including sustainability) was extracted. RESULTS The search resulted in 686 articles, of which nine studies met the inclusion criteria. Educational interventions included didactic sessions, simulation practice, animal practice, and practice in real patients. The most common assessment was based on the quality and accuracy of the images. At the participant level, the average time to reach proficiency ranged from eight hours and thirty-six minutes to five months, and none of the studies evaluated sustainability of POCUS use after the intervention. CONCLUSION There is a lack of standardized training modules and assessments for POCUS use in the NICU. Given that none of the studies addressed sustainability or standardized training, we recommend that a standardized training protocol and assessment tool is developed and studied longitudinally; and that barriers to sustainable POCUS use in the NICU (such as billing issues and a lack of POCUS machines and instructors) be systematically addressed as part of this work.
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Affiliation(s)
- Y Zheng
- Department of Pediatrics, East Carolina University and Vidant Medical Center, Greenville, NC, USA
| | - A Gandhi
- Department of Pediatrics, Brody School of Medicine at East Carolina University, Greenville, NC, USA
| | - K Sewell
- Department of Pediatrics, Brody School of Medicine at East Carolina University, Greenville, NC, USA
| | - D Tumin
- Department of Pediatrics, Brody School of Medicine at East Carolina University, Greenville, NC, USA
| | - K Bear
- Department of Neonatology, Vidant Medical Center, Greenville, NC, USA
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12
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Ben Fadel N, McAleer S. Impact of a web-based module on trainees' ability to interpret neonatal cranial ultrasound. BMC MEDICAL EDUCATION 2020; 20:489. [PMID: 33272272 PMCID: PMC7713003 DOI: 10.1186/s12909-020-02400-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Accepted: 11/24/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND Accurate interpretations of neonatal cranial ultrasound (CUS) studies are essential skills for physicians in neonatal intensive care units (NICUs) in order to properly diagnose and manage brain injury. However, these skills are not formally taught to pediatric and neonatal-perinatal medicine (NPM) trainees in Canada. Therefore, our study describes the design, implementation, and evaluation of a new web-based learning (WBL) module that focuses on teaching these skills. METHODS Trainees' needs assessment survey, sent to all NPM and pediatrics trainees (n = 62), concluded that most of them feel uncomfortable with their ability to interpret CUS, highlighting the need for a new educational intervention. The needs assessment informed the development of the WBL module, which we evaluated using questionnaires and pre-and post-testing methods to measure participants' satisfaction, knowledge gain, skills development, and behaviour changes. Only trainees rotating through the NICU over 6 months (n = 23) were invited to participate in all the evaluation steps. We used the ADDIE instructional design model as a framework for this project. RESULTS Respondents were very satisfied with the module, and their baseline knowledge increased significantly after studying and engaging with the module. The post-test score was 76% (p < 0.001) compared to the pre-test mean score of 42%. Tests for CUS interpretation skills assessment showed that 49% of pre-test answers were incorrect compared to 8% in the post-test (p < 0.001). Seventy-eight percent of trainees (n = 18) responded to a survey conducted a year after implementation, and 78% of the respondents (n = 14) reported that they still used these skills and shared this knowledge with junior trainees. CONCLUSION A WBL module for teaching neonatal CUS interpretation considerably improved trainees' knowledge and enhanced their skills in interpreting neonatal CUS.
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Affiliation(s)
- Nadya Ben Fadel
- Neonatal-Perinatal Medicine program, Children's Hospital of Eastern Ontario, University of Ottawa, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada.
| | - Sean McAleer
- Centre for Medical Education, University of Dundee, Dundee, Scotland
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Bischoff AR, Giesinger RE, Rios DR, Mertens L, Ashwath R, McNamara PJ. Anatomic Concordance of Neonatologist-Performed Echocardiography as Part of Hemodynamics Consultation and Pediatric Cardiology. J Am Soc Echocardiogr 2020; 34:301-307. [PMID: 33220434 DOI: 10.1016/j.echo.2020.11.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 11/11/2020] [Accepted: 11/11/2020] [Indexed: 01/22/2023]
Abstract
BACKGROUND Targeted neonatal echocardiography (TnECHO) performed by neonatologists as part of a hemodynamics consultation is increasingly being used in neonatal intensive care units. To minimize delays in obtaining physiologic data, first echocardiograms may be obtained by the neonatal hemodynamics team and reviewed afterward by a pediatric cardiologist. This practice has not been systematically evaluated. The aim of this study was to compare concordance between anatomic findings on TnECHO and pediatric cardiology reports. METHODS This was a retrospective evaluation of 339 infants at low risk for congenital heart disease (CHD) admitted to two large referral centers with established neonatal hemodynamics programs who underwent comprehensive TnECHO as their first postnatal echocardiographic examinations. The protocol included comprehensive imaging of intracardiac anatomy, outflow tract concordance and integrity, aortic arch anatomy, pulmonary vein location and flow, and transitional shunts. The hemodynamics consultation note was compared with the cardiology report to determine anatomic concordance or major or minor discrepancies in all first studies. RESULTS Anatomic concordance occurred in 97.9% (κ = 0.862; 95% CI, 0.762-0.962; P < .001). There were seven minor discrepancies (small muscular ventricular septal defects and coronary fistulas). The index population included 23 infants (6.7%) with CHD, of whom only one (0.3%) had a ductal-dependent lesion (coarctation of the aorta) which was correctly identified by both teams. CONCLUSIONS The rate of major CHD in patients considered eligible for hemodynamics consultation was low, and there was high diagnostic concordance between trained neonatal hemodynamics specialists and pediatric cardiology. First echocardiograms obtained by subspecialty neonatologists may provide imaging of sufficient quality to evaluate a critically unwell neonate with low suspicion for critical CHD lesions. These results should not be extrapolated to infants in whom CHD is suspected. This study highlights the importance of formalized, rigorous, and standardized training for neonatologists with hemodynamics expertise who perform timely assessments using TnECHO.
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Affiliation(s)
- Adrianne Rahde Bischoff
- Department of Pediatrics, University of Iowa, Iowa City, Iowa; Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Regan E Giesinger
- Department of Pediatrics, University of Iowa, Iowa City, Iowa; Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Danielle R Rios
- Department of Pediatrics, University of Iowa, Iowa City, Iowa; Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Luc Mertens
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Ravi Ashwath
- Division of Pediatric Cardiology, University of Iowa, Iowa City, Iowa
| | - Patrick J McNamara
- Department of Pediatrics, University of Iowa, Iowa City, Iowa; Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada; Department of Internal Medicine, University of Iowa, Iowa City, Iowa.
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14
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The role of point of care ultrasound in radiology department: update and prospective. A statement of Italian college ultrasound. Radiol Med 2020; 126:636-641. [PMID: 33146845 DOI: 10.1007/s11547-020-01301-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 10/20/2020] [Indexed: 02/07/2023]
Abstract
Ultrasound, in its new point-of-care conception, has been called the stethoscope of the future. Goal-directed bedside ultrasound examination, performed by a healthcare provider to answer a specific diagnostic question or guide an invasive procedure, is currently revolutionizing medical practice. It is used by various specialties in multiple clinical contexts for procedural, diagnostic, and screening applications. Point-of-care ultrasound is also a strategic technique in clinical radiology; it brings the radiologist closer to the patient (in interaction and understanding) like interventional and angiography procedures and, as an integrative imaging modality, is a vital radiological tool for decision-making in many situations. In this commentary, we present our observations on the use of ultrasound, in a sincere appeal to refrain from omitting ultrasound as a diagnostic technique in this era of deep professional change, in which radiologists must return to being a true clinical semiologist.
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Lodha A, Bhandari V. Use of Lung Ultrasound to Improve Timeliness of Surfactant Replacement in Respiratory Distress Syndrome: Are we Ready? J Pediatr 2019; 212:8-10. [PMID: 31253411 DOI: 10.1016/j.jpeds.2019.05.057] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 05/22/2019] [Indexed: 12/12/2022]
Affiliation(s)
- Abhay Lodha
- Department of Pediatrics; Alberta Children's Hospital Research Institute; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
| | - Vineet Bhandari
- Department of Pediatrics, Drexel University College of Medicine; Department of Neonatology, St. Christopher's Hospital for Children, Philadelphia, Pennsylvania
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