Systematized Systemic Sonographic Surveillance (S4)

We are developing a systematized systemic sonographic surveillance (S4) program as a structured, sonographic technology-enabled extension of the physical examination of newborn infants.The philosophy of S4 differs from point-of-care ultrasound (POCUS), which is known for post hoc bedside confirmation/assessment/temporal monitoring of organ-system injury in at-risk/critically-ill patients.Systematized systemic sonographic surveillance utilizes radiation-free, real-time imaging for a priori assessment of risk or detection of sub-clinical lesions.We examine the brain (growth, hemorrhages), heart (preload, contractility), lungs (edema, atelectasis, consolidation, effusions, and pneumothorax), liver (size, parenchymal abnormalities, vascular complications), bowel (edema, contractility, ascites, early detection of sub-clinical necrotizing enterocolitis), urogenital tract, spine, and hips (developmental dysplasia).Visual guidance can also help in the placement of central lines and successful atraumatic performance of lumbar punctures (LPs).Systematized systemic sonographic surveillance can also reduce the duration of training and the need for sedation and transport for the evaluation of patients.Increased efficiency in clinical procedures may reduce the duration and intensity of pain and, consequently, have a positive impact on development.To summarize, sonographic surveillance could improve clinical decision-making and neonatal intensive care unit (NICU) outcomes.The costs of infrastructural enhancements in sonography still need evaluation vis--vis potential savings from reduced needs for disposables, short-and long-term morbidity, and the length of hospital stay.