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Updated: Jun 30, 2025
A Modified Sonographic Algorithm for Image Acquisition in Life-Threatening Emergencies in the Critically Ill Newborn
Published on: April 7, 2023
Intravenous administration of ultrasound contrast to critically ill pediatric patients
Becky J Riggs1, Santiago Martinez-Correa2, Joseph Stern2
1Division of Pediatric Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA.
Insights
Intravenous ultrasound contrast is safe for critically ill pediatric patients. This study found no adverse clinical effects in neonates, infants, children, and adolescents receiving contrast-enhanced ultrasound scans.
Area of Science:
- Pediatric critical care medicine
- Diagnostic imaging
- Ultrasound technology
Background:
- Contrast-enhanced ultrasound (CEUS) is increasingly utilized off-label in pediatric populations.
- The safety and clinical impact of CEUS in critically ill children require further investigation.
Purpose of the Study:
- To evaluate clinical changes associated with intravenous (IV) ultrasound contrast administration in critically ill neonates, infants, children, and adolescents.
- To assess the safety profile of CEUS in a vulnerable pediatric intensive care unit population.
Main Methods:
- Retrospective analysis of 38 critically ill pediatric patients (2 days to 17 years) undergoing 47 CEUS scans.
- Extraction of cardiopulmonary, neurological, and hemodynamic monitoring data before, during, and after IV contrast administration.
- Statistical analysis to determine significant clinical changes (P-value < 0.05).
Main Results:
- No significant respiratory, neurological, cardiac, perfusion, or vital sign changes were observed in any patient post-contrast administration.
- The study included patients with cardiac shunts, respiratory failure, hemodynamic instability, and those on inhaled nitric oxide.
- Demographics included 50% prematurity history and 50% female patients.
Conclusions:
- Retrospective analysis revealed no adverse clinical effects from IV ultrasound contrast in critically ill pediatric patients.
- CEUS appears to be a safe imaging modality for critically ill neonates, infants, children, and adolescents.
- Further prospective studies could confirm these safety findings.
Background:
The off-label use of contrast-enhanced ultrasound has been increasingly used for pediatric patients.
Objective:
The purpose of this retrospective study is to report any observed clinical changes associated with the intravenous (IV) administration of ultrasound contrast to critically ill neonates, infants, children, and adolescents.
Materials And Methods:
All critically ill patients who had 1 or more contrast-enhanced ultrasound scans while being closely monitored in the neonatal, pediatric, or pediatric cardiac intensive care units were identified. Subjective and objective data concerning cardiopulmonary, neurological, and hemodynamic monitoring were extracted from the patient's electronic medical records. Vital signs and laboratory values before, during, and after administration of ultrasound contrast were obtained. Statistical analyses were performed using JMP Pro, version 15. Results were accepted as statistically significant for P-value<0.05.
Results:
Forty-seven contrast-enhanced ultrasound scans were performed on 38 critically ill patients, 2 days to 17 years old, 19 of which were female (50%), and 19 had history of prematurity (50%). At the time of the contrast-enhanced ultrasound scans, 15 patients had cardiac shunts or a patent ductus arteriosus, 25 had respiratory failure requiring invasive mechanical oxygenation and ventilation, 19 were hemodynamically unstable requiring continual vasoactive infusions, and 8 were receiving inhaled nitric oxide. In all cases, no significant respiratory, neurologic, cardiac, perfusion, or vital sign changes associated with IV ultrasound contrast were identified.
Conclusion:
This study did not retrospectively identify any adverse clinical effects associated with the IV administration of ultrasound contrast to critically ill neonates, infants, children, and adolescents.
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