Cranial POCUS in Neonates and Infants: Structured Evidence Synthesis and Proposal of the KORE Brain POCUS Protocol

Cranial point of care ultrasound (POCUS) is an emerging bedside tool for rapid evaluation of neurological emergencies in neonates and infants. Although widely used in neonatal intensive care, its application in emergency and critical care remains heterogeneous and lacks standardized protocols.

To synthesize the current literature on cranial POCUS in neonates and infants and propose a structured clinical protocol (KORE Brain POCUS Protocol) to support early diagnosis and management in emergency and critical care settings.

A structured search of PubMed, Scopus, Web of Science, and Cochrane Library (through August 2025) identified studies on cranial POCUS in neonatal and infant acute care. Eligible studies included original research, observational studies, case series, and narrative or systematic reviews. Two reviewers independently screened and extracted data on study characteristics, clinical context, and feasibility.

Nine studies met the inclusion criteria. Cranial POCUS was consistently reported as feasible for detecting intracranial hemorrhage (ICH), ventricular dilatation, sinovenous thrombosis, and posterior fossa lesions, and for assessing cerebral hemodynamics using transcranial Doppler. Based on converging findings, we developed the KORE Brain POCUS Protocol, a stepwise framework integrating standardized ultrasound windows and Doppler assessment for pediatric emergency and critical care.

Cranial POCUS is a promising, rapid, noninvasive tool for the bedside evaluation of acute neurological conditions in neonates and infants. The proposed KORE Brain POCUS Protocol provides a structured approach to support early diagnosis and clinical decision-making. Prospective studies are needed to validate its diagnostic performance and clinical impact.