6630 Ultrasound probe – an emergency prescription pen in life-threatening neonatal emergencies

Objectives Adult physicians have pioneered the use of POCUS (point of care ultrasound) in critical care settings with the implementation of structured POCUS training.1 These efforts have been translated to paediatric and neonatal emergencies.2 Our cases demonstrate the importance of training neonatal team members to develop skills and competencies to diagnose life-threatening neonatal emergencies through SAFE-R (Sonographic Assessment of liFe-threatening Emergencies – Revised).3 Methods Case studies: 29–week baby was noted to have significant metabolic acidosis on day 4. Repeat AXR for existing concerns of abdomen reconfirmed the normal position of umbilical venous catheter(UVC), no free intraperitoneal gas and normal bowel pattern. With life threatening features, along with airway(A), breathing(B) and circulation(C) management an emergency SAFE-R approach showed cardiac tamponade and 12mls of total parenteral nutrition(TPN) fluid was drained. Unrecordable pH and other clinical parameters normalised soon. Term baby was admitted at 2hrs of age for grunting. Soon needed maximum invasive ventilation support but still remained hypoxic with increasing lactate. Urgent echocardiogram showed transposition of great arteries with intact interventricular septum and minimal shunting across foramen ovale and patent ductus arteriosus. Prostin was started. Atrial septostomy improved the clinical situation and soon clinical parameters reached normal. 28–week baby, became mottled on front of chest and abdomen with increasing respiratory support at 36 hrs of age. Along with management of A, B and C an emergency SAFE-R approach showed moderate right pleural effusion secondary to UVC extravasation of TPN. With timely diagnosis and management clinical situation quickly normalised. 29–week baby, on day 5 developed abdominal distension, tender abdomen, metabolic acidosis and respiratory decompensation. SAFE-R approach showed ascites. Baby was transferred to surgical centre and laparotomy showed TPN extravasation from UVC. In the first 2 cases cardiologist was blue lighted to local hospital. All 4 babies had good outcome. Results All 4 cases demonstrate ultrasound as an important clinical tool in the timely diagnosis and management of life-threatening neonatal conditions. Cases 1, 3 and 4 were diagnosed through simple views as recommended by SAFE – R approach and case 2 required a structured assessment for congenital heart disease. Conclusion Based on the current evidence and our own unit experience we are developing tools to train our neonatal team members to develop skills and competencies to perform ultrasound to diagnose neonatal life threatening emergencies through SAFE-R approach and we would recommend this for other units. References S Alhamid, et al. Expert round table on ultrasound in ICU. International expert statement on training standards for critical care ultrasonography. Intensive Care Med 2011;37:1077–83. Yogen Singh, et al. International evidence-based guidelines on point of care Ultrasound (POCUS) for critically ill neonates and children issued by the POCUS working group of the European society of paediatric and neonatal intensive care (ESPNIC). Critical Care 2020. Nadya Yousef, et al. 'Playing it SAFE in the NICU' SAFE-R: a targeted diagnostic ultrasound protocol for the suddenly decompensating infant in the NICU. European Journal of Pediatrics 2022;181:393–398.