Bubbles in the barely born-contrast-enhanced ultrasound in neonates: a single-center experience

To assess clinical value, safety, and applicability of contrast-enhanced ultrasound (CEUS) in neonates, focusing on bedside use in intensive care. This retrospective single-center study included 23 neonates undergoing intravenous CEUS between 2010 and 2024, including seven preterm infants. The liver (n = 18) was the most frequently examined organ, followed by kidneys (n = 2), brain (n = 2), and adrenals (n = 1). Findings were compared with MRI (n = 10), CT (n = 3), or biopsy (n = 8), when available. In nine cases, CEUS findings were consistent with clinical course and treatment response only, without an independent reference standard. Among the 14 cases with available reference diagnostics, CEUS established the diagnosis first in ten (71.4%); histological confirmation was available in eight cases, with concordance in five (62.5%). 13 examinations (56.5%) were performed for bedside problem-solving in the neonatal intensive care unit, and no adverse events were observed.

CEUS provided clinically relevant diagnostic information in neonates, including preterm and critically ill infants and was well tolerated. CEUS was particularly valuable in hepatic vascular tumors, where it could provide a definite diagnosis, enabled hemodynamic assessment, supported treatment decisions, and aided identification of potentially life-threatening complications. Bedside use enabled timely diagnosis without sedation, intubation, or patient transport, thereby supporting minimal handling. In selected cases, CEUS may reduce the need for cross-sectional imaging. Despite off-label use, our findings suggest a beneficial role for CEUS in neonatal imaging, predominantly for hepatic indications.

• Contrast-enhanced ultrasound (CEUS) is a radiation-free, bedside-compatible imaging technique with an established safety profile in pediatric patients. • Neonatal CEUS experience is limited to small case series, predominantly reporting cerebral applications.

• CEUS was feasible and well tolerated in neonates including preterm infants, with no adverse events in 23 examinations. • CEUS yielded clinically relevant diagnostic information across a range of indications, primarily hepatic, encompassing both focal lesions and perfusion assessment, supporting clinical decision-making in neonatal care.