Article Text

Download PDFPDF
Use of neonatal lung ultrasound in European neonatal units: a survey by the European Society of Paediatric Research
  1. Almudena Alonso-Ojembarrena1,2,
  2. Harald Ehrhardt3,
  3. Merih Cetinkaya4,
  4. Anna Lavizzari5,
  5. Tomasz Szczapa6,
  6. Victor Sartorius7,
  7. Gustavo Rocha8,
  8. Richard Sindelar9,
  9. Martin Wald10,
  10. Christian Heiring11,
  11. Hanna Soukka12,
  12. Olivier Danhaive13,14,
  13. Charles C Roehr15,16,17,
  14. Manuela Cucerea18,
  15. Andrea Calkovska19,
  16. Gabriel Dimitriou20,
  17. Bernard Barzilay21,22,
  18. Claus Klingenberg23,24,
  19. Sven Schulzke25,
  20. Richard Plavka26,
  21. Rasa Tameliene27,
  22. Colm Patrick Finbarr O'Donnell28,29,
  23. Anton H van Kaam30,31
  24. on behalf of the ESPR Pulmonary Research Consortium
    1. 1 Neonatal Intensive Care Unit, Hospital Universitario Puerta del Mar, Cadiz, Spain
    2. 2 Research Unit, Puerta del Mar University Hospital, Biomedical Research and Innovation Institute of Cádiz (INiBICA), Cadiz, Spain
    3. 3 Division of Neonatology and Pediatric Intensive Care Medicine. Department of Pediatrics and Adolescent Medicine, University Medical Center Ulm, Ulm, Germany
    4. 4 Health Sciences University, Başaksehir. Cam and Sakura City Hospital, Istanbul, Turkey
    5. 5 Neonatal Intensive Care Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
    6. 6 II Department of Neonatology, Neonatal Biophysical Monitoring and Cardiopulmonary Therapies Research Unit, Poznan University of Medical Sciences, Poznan, Poland
    7. 7 Divivion of Paediatric and Neonatal Critical Care, Hôpital Antoine-Béclère, Clamart, France
    8. 8 Department of Neonatology, Centro Hospitalar Universitário de São João, Porto, Portugal
    9. 9 Department of Women's and Children's Health, Uppsala Universitet, Uppsala, Sweden
    10. 10 Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Paracelsus Medical University, University Hospital Salzburg, Salzburg, Austria
    11. 11 Department of Neonatology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
    12. 12 Department of Pediatrics and Adolescent Medicine, University Hosptial of Turky and Turku University, Turku, Finland
    13. 13 Division of Neonatology, Saint-Luc University Hospital, UCLouvain, Brussels, Belgium
    14. 14 Department of Pediatrics, University of California San Francisco, San Francisco, California, USA
    15. 15 National Perinatal Epidemiology Unit, Oxford Population Health, Medical Sciences Division, University of Oxford, Oxford, UK
    16. 16 Newborn Services, Southmead Hospital, North Bristol Trust, Bristol, UK
    17. 17 Newborn Services, Southmead Hospital. North Bristol Trust, Bristol, UK
    18. 18 Department of Neonatology, George Emil Palade University of Medicine Pharmacy Science and Technology of Targu Mures, Targu Mures, Romania
    19. 19 Department of Physiology, Jessenius Faculty of Medicine. Comenius University, Bratislava, Slovakia
    20. 20 Department of Paediatrics, University of Patras, Patras, Greece
    21. 21 Neonatology Division, Mayanei Hayeshua Medical Center, Bnei Brak, Tel Aviv, Israel
    22. 22 Tel Aviv University, Tel Aviv, Israel
    23. 23 Paediatric Research Group, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromso, Norway
    24. 24 Department of Paediatrics and Adolescence Medicine, University Hospital of North Norway, Tromso, Norway
    25. 25 Department of Neonatology, University Children’s Hospital, Basel, Switzerland
    26. 26 Division of Neonatology, Department of Obstetrics and Gynecology, General Faculty Hospital and 1st Faculty of Medicine, Charles University, Prague, Czechia
    27. 27 Department of Neonatology, Lithuanian University of Health Sciences, Kaunas, Lithuania
    28. 28 Neonatal Unit, National Maternity Hospital, Dublin, Ireland
    29. 29 School of Medicine, University College, Dublin, Ireland
    30. 30 Department of Neonatology, Emma Children’s Hospital, Amsterdam UMC, Amsterdam, The Netherlands
    31. 31 Amsterdam Reproduction & Development, Amsterdam, The Netherlands
    1. Correspondence to Dr Almudena Alonso-Ojembarrena, Neonatal Intensive Care Unit, Hospital Universitario Puerta del Mar, Cadiz, Andalucía 11009, Spain; almudena.alonso.sspa{at}


    Objective Regarding 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 intervention International online survey.

    Results Replies 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.

    Conclusions Although 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.

    • neonatology
    • intensive care units, neonatal
    • respiratory medicine

    Data availability statement

    No data are available.

    Statistics from

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


    • X @AlmudenaAlonso4, @ClausKlingenbe1

    • Collaborators ESPR Pulmonary Research Consortium: Kajsa Bohlin: Department of Neonatology, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden. Theodore Dassios: University of Patras, Greece. Daniele De Luca: Division of Pediatrics and Neonatal Critical Care, 'A.Béclère' Medical Center, Paris, Saclay University Hospitals, APHP, Paris, France Physiopathology and Therapeutic Innovation Unit-INSERM U999, Paris-Saclay University, Paris, France. Roland Hentschel: Center for Pediatrics, Department of Neonatology, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany. Rania Kaltsogianni: Department of Women and Children’s Health, King’s College London, London, UK. Gianluca Lista: Department of Neonatology, V. Buzzi Children’s Hospital, ASST-FBF-Sacco, Milan, Italy. Timo Saarela: Department of Pediatrics and Adolescent Medicine, University Hospital of Oulu and Oulu University, Oulu, Finland. Ulrich Thome: Facharzt für Kinder- und Jugendmedizin/Neonatologie/Pädiatrische Intensivmedizin, Universitätsklinik für Kinder- und Jugendmedizin, Zentrum für Frauen- und Kindermedizin, Leipzig, Germany. Tobias Werther: Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, Austria. Mirko Zibolen: Clinic of Neonatology, Jessenius Faculty of Medicine and University Hospital Martin, Slovakia.

    • Contributors AA-O conceptualised and designed the study, designed the data collection instruments, carried out the initial analysis and wrote the first draft. She is guarantor. AHvK designed data collection tools, analysed the data and drafted and revised the paper. AA-O, AHvK, HE, MC, AL, TS, VS, GR, RS, MW, CH, HS, OD, CCR, MC, AC, GD, BB, CK, SS, RP, RT, CPFO'D implemented the survey in their countries, collected data and critically reviewed the draft paper.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; internally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.