Short reports

Echocardiographic investigation of inhaled nitric oxide in newborn babies with severe hypoxaemia

There is a progressive adoption of point of care ultrasound (POCU) performed by acute care physicians in many clinical areas including the neonatal intensive care unit. There has been some resistance to POCU from consultative ultrasound specialties, much of which is due to misunderstanding the goals of POCU. Clearly there is a need for equipment, training, and accreditation structures in neonatal POCU. These structures need to be workable, relevant, and, most importantly, controlled from within the specialty of neonatology. There is a range of clinical situations in neonates where POCU can add invaluable and, at times, lifesaving diagnostic information. Understanding individual patient physiology, targeting treatment, and obtaining longitudinal feedback are important aspects of the use of neonatal POCU. Neonatal POCU is not just about the heart, but embraces the study of a range of organ systems including the brain, lungs, abdominal organs, and blood vessels for line localization.

In the absence of outcome-based evidence to guide circulatory support in the newborn, a logical approach is one that uses individual- or precision-based therapy. That is, one should try to define the individual’s hemodynamic as accurately as possible and apply treatment logically to that hemodynamic based on what we know about the effects of the pharmacologic interventions on physiology. As in the case of all approaches to circulatory support in the newborn, there is no evidence that this will improve outcomes.