Feasibility and utility of portable ultrasound during retrieval of sick preterm infants

Aim: Document the incidence of haemodynamic pathology in critically ill preterm newborns requiring transport. Method: A transport neonatologist performed cardiac and cerebral ultrasound before and after transportation of infants born 30weeks gestation. Results: Forty-four newborns were studied in 2008-2015; of them, 21 were transported by road, 19, by helicopter and four, by fixed wing: median birthweight, 1130g (680-1960g) and median gestation, 27weeks (23-30); 30 of 44 were male babies. Antenatal steroid course was complete in two babies. Ultrasound in the referring hospital was at a mean of two hours: 47 minutes (00:15-7:00) of age. Low systemic blood flow was common: 50% had right ventricular output <150mL/kg/min and 23%, a superior vena cava flow <50mL/kg/min. at stabilisation. Cranial US: 10 Grade I IVH, 2 Grade II IVH, 1 Grade IV IVH and 32 normal scans pretransport. After transport, three further Grade I IVH were reported. Mortality was higher in the babies with low systemic blood flow: 4 of 12 (33%) died vs 1 of 31 (6%) in the normal flow group (OR=7.2, 95% CI: 1.1 to 47, p=0.022). Conclusion: Point-of-care ultrasound during the retrieval of preterm infants confirms a high incidence of haemodynamic pathology. The use of ultrasound during transport may provide an opportunity for earlier targeted circulatory support.