Bringing Imaging to the Bedside: The Growing Impact of Point-of-Care Ultrasound in Pediatric and Neonatal Intensive Care.

Point-of-care ultrasound (POCUS) is becoming increasingly integral to pediatric and neonatal intensive care, offering real-time, radiation-free imaging that enhances diagnostic precision and procedural safety. This narrative review synthesizes current evidence on its clinical applications, benefits, training models, and future directions in pediatric intensive care unit (PICU) and neonatal intensive care unit (NICU) practice. POCUS supports rapid hemodynamic assessment, enabling evaluation of ventricular function, preload, afterload, and shock states for timely, targeted management. Lung ultrasound reliably detects pneumothorax, pleural effusion, and consolidations with accuracy comparable to or exceeding chest radiography. Abdominal and renal applications assist in diagnosing trauma, necrotizing enterocolitis, urinary retention, and congenital anomalies, while cranial ultrasound remains essential for identifying intraventricular hemorrhage and hydrocephalus in preterm infants. Procedurally, POCUS improves success and reduces complications during vascular access, thoracentesis, and lumbar puncture. While global adoption is supported by emerging guidelines and competency-based training frameworks, challenges persist, including variability in operator expertise, inconsistent credentialing, limited faculty availability, and gaps in image archiving and quality assurance. Disparities remain between high- and low-resource settings. Advances in handheld devices, artificial intelligence, and tele-ultrasound may expand access and reduce operator dependence, though pediatric validation is limited. Future priorities include multicenter outcome studies, standardized curricula, and cost-effectiveness analyses to guide broader, safe, and equitable implementation.