• intensive care units, neonatal
• neonatology

Point-of-care lung ultrasound (LU) is gaining interest in neonatal intensive care and international recommendations now support its use in practice.1 It can provide rapid diagnostic confirmation in emergency situations, for example, tension pneumothorax,2 and enhances the diagnostic accuracy of neonatal respiratory disorders allowing targeted treatment. Increasingly, LU has been shown to accurately predict the need for surfactant and decrease time to its delivery,3 potentially reducing lung injury. For neonates, LU possesses attractive characteristics including the absence of radiation, non-invasive technique, accessibility and ease of training.

In the UK, the frequency of LU use in neonatal care is unknown. Additionally, no specific training curriculum exists. We aimed to investigate the use of LU in UK neonatal units through distribution of an anonymised web-based survey conducted over an 8-week period in 2021.

One-hundred and twenty-seven responses were returned and analysed. All questions were mandatory, therefore there were no missing answers. Sixty-one per cent of responders came from England, 26% Scotland, 10% Northern Ireland and 2% Wales. Sixty-six per cent of responders worked in level 3, 28% in level 2 and 6% in level 1 neonatal units. The majority were neonatal consultants (39%) and neonatal specialist trainees (25%). The remaining responders were paediatric consultants (12%), advanced neonatal nurse practitioners (ANNP) (11%), general paediatric trainees (9%) and specialty doctors (4%).

Only 6% of responders reported the use of LU as routine in their unit. Those who did, reported use for a median of 6 months to 1 year. The diagnoses they were using LU for included pneumothorax (6/7), pleural effusion (6/7), prediction of surfactant administration (5/7), respiratory distress syndrome (4/7) and transient tachypnoea of the newborn (4/7). Thirty-five per cent of responders reported having received any form of LU training. Eighty-five per cent of responders were interested in formal LU training and in implementing LU in their unit. Ninety-seven per cent of trainees, 83% of neonatal consultants and 79% of ANNPs were interested in gaining competency (table 1). Fifty-nine per cent of responders already had access to a linear high frequency probe in their unit.

Despite international evidence-based recommendations for the implementation LU in neonatal care, this survey indicates that LU is not routinely practised in the UK, although 85% of respondents expressed interest in learning the skill. As most neonatal units in the UK have ultrasound machines to perform cranial ultrasonography, LU does not necessitate the purchase of expensive additional equipment.

We hypothesise that the main barriers to implementation are similar to those described for neonatologist performed echocardiography, most notably being the development of a national training curriculum and protocols that ensure operator competence is safely achieved.4 The learning curve for neonatal LU is such that gaining proficiency is possible for a range of grades of staff; however, robust accredited hands-on training is not in place to facilitate this. A recent survey of LU practice in Italian neonatal units highlights similar variation in its use and the need for training, although it is generally implemented more widely in their practice.5 The development of a national neonatal training curriculum appears to be the next step for safe implementation of neonatal LU.