Use of neonatal lung ultrasound in European neonatal units: a survey by the European Society of Paediatric Research

Abstract

ObjectiveRegarding the use of lung ultrasound (LU) in neonatal intensive care units (NICUs) across Europe, to assess how widely it is used, for what indications and how its implementation might be improved.Design and interventionInternational online survey.ResultsReplies were received from 560 NICUs in 24 countries between January and May 2023. LU uptake varied considerably (20%–98% of NICUs) between countries. In 428 units (76%), LU was used for clinical indications, while 34 units (6%) only used it for research purposes. One-third of units had <2 years of experience, and only 71 units (13%) had >5 years of experience. LU was mainly performed by neonatologists. LU was most frequently used to diagnose respiratory diseases (68%), to evaluate an infant experiencing acute clinical deterioration (53%) and to guide surfactant treatment (39%). The main pathologies diagnosed by LU were pleural effusion, pneumothorax, transient tachypnoea of the newborn and respiratory distress syndrome. The main barriers for implementation were lack of experience with technical aspects and/or image interpretation. Most units indicated that specific courses and an international guideline on neonatal LU could promote uptake of this technique.ConclusionsAlthough LU has been adopted in neonatal care in most European countries, the uptake is highly variable. The main indications are diagnosis of lung disease, evaluation of acute clinical deterioration and guidance of surfactant. Implementation may be improved by developing courses and publishing an international guideline.

Efficacy of an online lung ultrasound module on skill acquisition by clinician: a new paradigm

“…They tended to be established neonatologists/paediatricians with a particular interest in neonatology as opposed to trainees and residents (78.9% vs. 21.1%), with 69.1% having no formal training before this course. A recent European survey reveals a similar distribution with LUS performed by neonatologists as opposed to trainees and residents ( 24 ). We must understand the motivations for learners wanting to learn LUS in neonatology, as this may affect how training is provided to individuals keen to learn the skill.…”

“…This is not limited to training alone but also impacts clinical practice regarding indications, protocols, credentialing, and clinical governance. There is concern that this could affect its uptake globally ( 12 , 22 – 24 ).…”

“…In 223 (40%) units, clinicians attended a neonatal LUS course; in 62 (11%) units, clinicians attended a LUS course for paediatricians; and in 53 (9%) units, they participated in a general POCUS course. Clinicians in 119 (21%) units performing LUS received no specific training ( 24 ). There are no studies looking at the learning curve of learners in neonatal lung ultrasound from low- and middle-income countries.…”

“…We did not explore the barriers to uptake of LUS and its implementation in candidates who might have yet to take their training forward, which is a limitation of our study. The most significant barriers to implementing LUS identified by studies in developed countries are the lack of experience with the technical aspects of using the ultrasound machine, lack of experience with image interpretation, lack of qualified faculty for training, time constraints, and physician resistance to new technology ( 24 , 25 ). Training in LUS with adequate supervision may help overcome these issues.…”

“…This observation underscores the need for a comprehensive approach to LUS training with didactic and practical training covering a structured curriculum. International recommendations specify a need for but have not formalised a neonatal-specific curriculum for LUS training ( 10 – 12 , 24 , 26 ). The curriculum used in this training module is summarised in the Supplementary Material .…”