Paediatric ultrasound

This post is a collection of resources collected primarily for practitioners in adult anaesthesia, critical care and emergency medicine with an interest in paeds who are looking to extend their ultrasound skillset into neonatal and paediatric practice. While that is the context, most of these will be equally relevant to anyone training primarily in paeds.

Learning ultrasound

Most diagnostic tests and POCUS guided procedures translate almost 1:1 from adult practice, although there are additional ones not relevant or practical in adults, especially in neonates and infants.

It is usually easier to achieve good imaging in neonates and children than in adults. Shorter distances equals shallower depth and thus higher frequency probes, allowing both better spatial and temporal resolution. Resources to get you started below both for procedures and diagnostics / targeted investigations.

Build a strong foundation

It’s important to understand the fundamental physics, what probes to use, how to optimise images and some of the image artifacts and pitfalls. This can be learned well from a solid online on on-site course, for instance through one of these paid options that will also teach you various versions of views to find and their use, depending on your practice.

• 123sonography
• USabcd
• medmastery
• winfocus (consider signing up as member, pretty cheap, great webinars and back log of training material)

The ibooks listed further below are also a good starting point for foundational material and broad systematic introduction.

While the theory of ultrasound physics is universal, be aware that a lot of the ‘knobology’ of optimising images is machine specific. Try to find a mentor locally to assist in developing your acquisition technique and steer clear of some of the pitfalls. Most ultrasound machine developers have good elearning material (for instance Sonosite mentioned below).

Another list with even more US course providers can be found at LITFL.

Free textbooks in iBook format

• Introduction to bedside ultrasound, by Matt and Mike from the Ultrasound Podcast. Still a great introduction to adult POCUS
  • part 1
  • part 2
• Practical guide to critical ultrasound, amazing broad scope effort by Resa Lewiss et al. (currently
  • vol 1A
  • vol 1B
  • vol 2

Regional anesthesia

These resources still hold up

• USRA
• NYSORA
• Sonosite youtube channel (includes also other procedures and diagnostics, and, unsurprisingly, a lot of info on their particular US machines)

Online FOAM outlets focused on POCUS

• Core ultrasound, took over where the now defunct, but hugely influential Ultrasound Podcast left off. Mostly adult focus, but great resource
• Sonographic tendencies
• The POCUS atlas, open access library with patient cases. Currently building out a paediatric section
• Texas Children’s Hospital: Pediatric Echocardiography. A very serious resource on everything in echochardiographic evaluation of congenital heart disease. Mostly for cardiologists
• Neonatal hemodynamics research group. Great youtube channel with free lectures including foundational introductions to TnEcho (targeted neonatal echo) and neonatal physiology. Also active on twitter/X
• Neocardiolab, an educational site on all things neonatal POCUS by Dr Gabriel Altit out of McGill. Up to date curated videos and consensus guidelines and overall great content for anyone entering the world of neonatal physiology and management
• NICUPOCUS.com, a site with introductory material on TnEcho (targeted Echo) and POCUS guided procedures in neonates. Also on twitter/X. Led by Alan Groves, M.D., Ass Prof, Dep Peds, Dell Medical Center, Austin, Texas
• MPROvE academy, an neonatal educational intiative by Dr Alok Sharma et al. Most value seems to be a rather broad coverage of neonatal topics including diagnostics, procedures and POCUS topics on their youtube channel

Apps on paediatric echo / CHD

• Echo UW – standard views in pediatric echo including loops, from University of Wisconsin.
• Tn Echo, as in: targeted neonatal echo. Lists all normal views and how to assess and grade PDA and PPHN. Currently seems to have some issues
• NeoCardioLab, seems like a wrapper for the website itself, mentioned above, which is probably the better place to go when possible as the app is not super mobile friendly
• Heartpedia, out of Cincinatti Children’s. Offers information on and visualisation of a host of congenital heart malformations including their repair. Also has a massive youtube channel, mostly for laymen, but similar illustrations of CHD for a bigger screen

Key articles

• International evidence-based guidelines on Point of Care Ultrasound (POCUS) for critically ill neonates and children issued by the POCUS Working Group of the European Society of Paediatric and Neonatal Intensive Care (ESPNIC) – a common sense document, literally, with evidence grading to support a vast array of use cases (2020)
• Guidelines and Recommendations for Targeted Neonatal Echocardiography and Cardiac Point-of-Care Ultrasound in the Neonatal Intensive Care Unit: An Update from the American Society of Echocardiography – for those in NICUs who need to support their clinical decision making. Pretty ambitious (2024)
• Recommendations for Cardiac Point-of-Care Ultrasound in Children: A Report from the American Society of Echocardiography (2023)
• Guidelines for Performing a Comprehensive Pediatric Transthoracic Echocardiogram: Recommendations From the American Society of Echocardiography (2023)
• Point-of-care ultrasound in pediatric anesthesia: perioperative considerations, Adler et al, curr opin anaes 2020
• Long-term IV access in paediatrics – why, what, where, who and how, Johansen et al, Acta 2020. Get your US guided inline approach to brachiocephalic central line game on

Know a better one?

The field of POCUS is perpetually in motion, both with regards to the science and clinical practice, but also online educational material. This is merely meant as a starting point. Let us know if stuff has gone stale or you have even better or additional suggestions below.

Mads Astvad

Website

Scandinavian paediatric anaesthetist / intensivist.
PHARM, ED, OR, ICU.
Digital MedEd
Co-founder scanFOAM.org
Co-organiser CphCC & TBS-Zermatt (aka The Big Sick)
Medical lead REPEL (resilience in pediatric emergency life support)
Web dev SSAI.info