Feasibility of RAPID Ultrasound Screening for Infants in Primary Care Settings

by Annamarie Saarinen

Coauthors: O. San Roman Orozco1, A. Saarinen2, J. Torres-Martell3, I. Gutierrez Alvarez1, B. Perez1, M. Victorova4, B. Knight-Gregson5; A. El-Bokl6 1Autonomous University of Queretaro, Queretaro City, Queretaro, MEXICO, 2Autonomous University of Queretaro, University of Minnesota Masonic Children's Hospital, Newborn Foundation, Minneapolis, MN, 3Instituto Nacional de Cardiologia (Instituto Nacional de Cardiologia Laranjeiras), Universidad Nacional Autónoma de México,, Queretaro City, Queretaro, MEXICO, 4Bloom Standard Research Lab, Hong Kong, SAR, HONG KONG, 5Swansea University Institute of Life Sciences, Bloom Standard Research Lab, Swansea, UNITED KINGDOM. 6University of Minnesota Mhealth Fairview Children's Hospital

Medical Devices & Digital Health

Background
The use of POCUS is well-established in pediatric emergency medicine and critical care, but guidelines are still lacking in consistency, and lack of training and pediatric-specific equipment remain limiting factors for pediatric ultrasound access in both high resource and low resource settings. Rapid point-of-care ultrasound screening can be a useful tool for follow-up evaluation in conjunction with newborn pulse oximetry screening for critical congenital heart disease (CCHD) and CHD. But it is an equally valuable imaging tool for confirmation and severity assessment for lung and respiratory conditions. Newborn screening for CCHD typically involves a routine pulse oximetry measurement of oxygen saturation levels in a baby's blood, in combination with routine physical examination of the newborn. If the oxygen saturation level is below a certain threshold – depending on altitude – further evaluation with an echocardiogram (ultrasound of the heart) is warranted to confirm or rule out a cardiac cause of hypoxemia. Early diagnosis of congenital heart disease is vital for the management of the newborn to effectively guide treatment, improve health outcomes and reduce mortality associated with late, missed, and misdiagnosis. Fully 20% of CHD cases are still missed by the safety net of pulse oximetry screening, and few pediatric primary care settings use pulse oximetry as a standard assessment for infants coming in clinic for routine or symptomatic care. Ultrasound is an underutilized tool in confirming or ruling out heart and lung conditions in newborns and infants, but sensitivity is variable as it is highly dependent on the operator’s training and skill, particularly in imaging the youngest patients.
Methods
A targeted RAPID scan for screening can provide triage in both the birth setting and primary care followup setting, potentially averting unnecessary medical transports or elevating timely referrals to higher levels of imaging and clinical care when needed. Rapid scans focus on recognition of specific sonographic signs that represent a narrow set of views/windows and a lean list of key cardiac and lung/pulmonary indicators, versus a full diagnostic set of information. The study profiled here provided:
Documentation of pulse oximetry values (right hand and either foot) utilizing modified AAP algorithm for newborn CCHD screening, at or near 24 hours of age, in a cohort of 60 babies in pre-discharge postnatal setting.
Comparative analysis of a “target-views” protocol for rapid ultrasound scans using both traditional pediatric ultrasound probes and a novel chip-based ultrasound probe with stationary placement/views to define feasibility, benefits and challenges of such tools for screening purposes.
Correlation of pulse oximetry values to rapid echo findings – including incidental and any known cardiac or other pathological findings.
Conclusions
The authors’ interim findings suggest opportunities for rapid target-view ultrasound screening, focusing on limited views and limited indications is potentially feasible in front line and primary care settings to provide clinical support to settings with limited access to pediatric sonographers or appropriate equipment. Following a rapid place-and-scan standardized protocol is useful in gaining meaningful ultrasound imaging data within a few minutes, and could help augment existing protocols for tele-echo and POCUS, and potentially avert unnecessary medical transports or elevate timely referrals to higher levels of imaging and clinical care when needed.