A Modified Sonographic Algorithm for Image Acquisition in Life-Threatening Emergencies in the Critically Ill Newborn

Area of Science:

• Neonatal intensive care
• Point-of-care ultrasound (POCUS)
• Emergency medicine

Background:

• Point-of-care ultrasound (POCUS) use is expanding in neonatal intensive care units (NICUs).
• The Sonographic Algorithm for Life-Threatening Emergencies (SAFE) protocol was established in 2018 for neonates with sudden decompensation.
• The SAFE protocol identifies critical conditions like abnormal contractility, tamponade, pneumothorax, and pleural effusion.

Purpose of the Study:

• To present an adapted SAFE protocol for NICU and delivery room (DR) use.
• To detail a protocol for managing cardiac arrest, hemodynamic deterioration, or respiratory decompensation in neonates.
• To demonstrate the utility of POCUS in critical newborn care.

Main Methods:

• Adaptation of the SAFE protocol with core steps for at-risk newborns.
• Inclusion of views for verifying correct intubation and managing cardiac arrest.
• Detailed image acquisition protocol applicable with standard or handheld ultrasound devices.

Main Results:

• The modified SAFE protocol was used in 2.3% (25/1045) of hemodynamic/POCUS consultations between January 2019 and July 2022.
• Nineteen procedures were performed, with five life-threatening situations resolved by trained fellows on call.
• Clinical examples illustrate the protocol's importance in critical newborn care.

Conclusions:

• The adapted SAFE protocol provides timely diagnosis of life-threatening scenarios in neonates.
• This POCUS method is a valuable tool for clinicians in NICUs and DRs.
• It complements, but does not replace, comprehensive multidisciplinary analyses.