Publication:

Point-of-care ultrasound-guided hemodynamic assessment and resuscitation in neonatal shock: a prospective observational study

Background Neonatal shock is a major contributor to morbidity and mortality in neonatal intensive care units (NICUs). Clinical assessment alone often fails to accurately identify the underlying hemodynamic disturbance, which can delay appropriate management. Point-of-care ultrasound (POCUS) has emerged as a rapid bedside tool for evaluating cardiovascular status in critically ill neonates. This study aimed to assess the utility of POCUS in identifying the etiology of neonatal shock and its influence on therapeutic decision-making.

Methods This prospective observational study was conducted in the NICU of the Department of Pediatrics and Neonatology in collaboration with the Department of Cardiology at Sher-i-Kashmir Institute of Medical Sciences (SKIMS), Srinagar, over an 18-month period. Neonates presenting with clinical features of shock were enrolled. Infants with congenital heart disease, cardiomyopathy, or structural valvular abnormalities were excluded. Bedside POCUS with focused echocardiography was performed at admission and during follow-up. Hemodynamic parameters including inferior vena cava (IVC) diameter, IVC collapsibility index (IVC-CI), and IVC/aorta ratio (AO) ratio were assessed. The relationship between ultrasound findings, etiology of shock, and subsequent management decisions was analyzed.

Results A total of 110 neonates with shock were included. Septic shock was the most common etiology (41.6%), followed by cardiogenic shock (34.5%) and hypovolemic shock (23.6%). Early-onset shock (≤24 hours of life) was observed in 72.7% of cases. Significant variations in IVC parameters were observed among the different types of shock (p<0.05). Neonates with hypovolemic shock demonstrated higher IVC collapsibility, while cardiogenic shock was associated with increased IVC diameter and reduced collapsibility. POCUS findings resulted in modification of clinical management in a substantial proportion of cases, including optimization of fluid resuscitation, initiation or adjustment of inotropic therapy, and targeted supportive care. The overall mortality rate was 9.1%.

Conclusions POCUS provides rapid, bedside hemodynamic assessment in neonates with shock and aids in differentiating underlying etiologies. Its integration into routine NICU practice can facilitate timely, targeted management and may improve clinical outcomes.