Top 5 Questions - Neonatal & Pediatric Ultrasound

Our upcoming NEONATAL & PEDIATRIC ULTRASOUND BACHELORCLASS will include practical concepts, high-quality ultrasound images and case examples as well as clinical applications of Point of Care Ultrasound and live demonstrations on pediatric models. 


Are you wondering what's so different about performing and interpreting ultrasound exams on our youngest patients? Our international experts YOGEN SINGH, BELINDA CHAN and SASHA GORDON have prepared five frequently asked questions to give you an insight into neonatal and paediatric ultrasound.

1. How to differentiate respiratory distress syndrome (RDS) from transient tachypnea of newborn (TTN) on lung ultrasound?

rib shadow

Respiratory Distress Syndrome (RDS):

  • Confluent B lines with white out appearance
  • Thickened irregular pleural lines
  • No spared normal area
Transient tachypnea of newborn

Transient tachypnea of newborn (TTN):

  • Scattered numerous B lines 
  • Normal pleural lines
  • Spared normal area, esp. in anterior upper

2. What are some of the anatomical differences between neonatal and adult on lung ultrasound?

  • Neonates may lack rib shadow because their non-calcified ribs
  • The thymus can be easily seen before it involutes in adulthood

Non-calcified ribs – continuous pleural line

Calcified ribs
Calcified ribs
non-Calcified ribs
Non-calcified ribs

Neonates may lack rib shadow on lung ultrasound because some of their ribs may not be calcified. 

Prominent Thymus

Prominent Thymus

The thymus can be easily seen on neonatal lung ultrasound before it involutes in adolescence. It may be confused as lung consolidation or chest mass. The echogenic foci within the thymus give a “starry sky” appearance.

3. How can I use abdominal ultrasound to help managing neonates with acute abdominal distension?

  • Detect free intra-abdominal fluid
  • Characterize ascites
  • Assess bowel peristalsis
  • Detect signs of necrotizing enterocolitis
  • Detect obstructive uropathy 
  • Detect solid organ pathology
organ pathology

4. What is the easiest cranial ultrasound scanning protocol to perform for cranial emergency?

  • Quick way to identify catastrophic cranial pathology
  • Emergent cranial ultrasound can be done with the cine clip only approach
  • Use microconvex transducer
  • Select neonatal head preset
  • Place transducer on the anterior fontanel
  • Coronal sweep: place transducer with the probe marker pointing to the patient’s right, sweep from anterior to posterior. 
  • Sagittal sweep: turn the probe 90 degrees so the probe marker is pointing anteriorly, sweep from right to left
  • Detailed cranial ultrasound can be performed by radiology department afterwards
Coronal Sweep

By convention for coronal views, the patient’s right side should be on the left side of the image. 

Sagittal Sweep

By convention for sagittal views, the patient’s anterior aspect should be on the left side of the image and the posterior aspect on the right side of the screen. 

5. How can I improve a lumbar puncture procedure using ultrasound guidance?

spinal ultrasound

Spinal ultrasound can:

  • identify the best intervertebral space for needle insertion (below conus medullaris) 
  • confirm subarachnoid space has adequate cerebrospinal fluid and no hematoma
  • increase procedural success rate 
  • reduce overall procedure time

Interested in learning more about the topic of neonatal and pediatric ultrasound? Pre-register now for our upcoming Neonatal & Pediatric Ultrasound BachelorClass launching in November!

Pre-register here!