{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T04:22:10Z","timestamp":1793074930019,"version":"4.5.0"},"reference-count":34,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,11,19]],"date-time":"2025-11-19T00:00:00Z","timestamp":1763510400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,11,19]],"date-time":"2025-11-19T00:00:00Z","timestamp":1763510400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Perinatol"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Accurate confirmation of endotracheal tube (ETT) placement is critical in neonatal resuscitation. This systematic review and meta-analysis assessed the diagnostic accuracy of point-of-care ultrasound (POCUS) for confirming ETT placement in neonates. We searched PubMed, Scopus, Web of Science, and Cochrane Library through May 2025. Eligible studies included neonates (&lt;28 days) and compared POCUS with gold-standard confirmation (capnography, chest radiography, or direct laryngoscopy). Diagnostic performance was pooled using a bivariate random-effects model. Thirteen studies (930 neonates) met inclusion criteria. POCUS showed pooled sensitivity of 93% and specificity of 59%, with an area under the SROC curve of 92%. tracheal placement was confirmed in 99%, and esophageal misplacement detected in 4%. Subgroup analysis indicated higher accuracy by neonatologists and with linear transducers. POCUS offers a rapid, radiation-free method for confirming neonatal ETT placement. Broader implementation requires standardized techniques and operator training.<\/jats:p>","DOI":"10.1038\/s41372-025-02461-4","type":"journal-article","created":{"date-parts":[[2025,11,19]],"date-time":"2025-11-19T14:35:54Z","timestamp":1763562954000},"page":"12-18","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Diagnostic accuracy of real\u2011time point-of-care tracheal ultrasonography for the confirmation of proper endotracheal tube placement in neonatal acute care settings: a systematic review and diagnostic test accuracy meta-analysis"],"prefix":"10.1038","volume":"46","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7278-2289","authenticated-orcid":false,"given":"Mohammed","family":"Alsabri","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eslam","family":"Abady","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammed Tarek","family":"Hasan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-4273-0827","authenticated-orcid":false,"given":"Shree","family":"Rath","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed Bostamy","family":"Elsnhory","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Khaled","family":"Abouelmagd","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdelrahman M.","family":"Tawfik","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6318-6418","authenticated-orcid":false,"given":"Ibrahim","family":"Qattea","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aysha","family":"Hasan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,11,19]]},"reference":[{"key":"2461_CR1","doi-asserted-by":"publisher","first-page":"44","DOI":"10.1136\/adc.2007.121160","volume":"93","author":"JP Wyllie","year":"2008","unstructured":"Wyllie JP. Neonatal endotracheal intubation. Arch Dis Child Educ Pr Ed. 2008;93:44\u201349. https:\/\/doi.org\/10.1136\/adc.2007.121160.","journal-title":"Arch Dis Child Educ Pr Ed"},{"key":"2461_CR2","doi-asserted-by":"publisher","first-page":"283","DOI":"10.1177\/0885066609340501","volume":"24","author":"P Rudraraju","year":"2009","unstructured":"Rudraraju P, Eisen LA. Confirmation of endotracheal tube position: a narrative review. J Intensive Care Med. 2009;24:283\u201392. https:\/\/doi.org\/10.1177\/0885066609340501.","journal-title":"J Intensive Care Med"},{"key":"2461_CR3","doi-asserted-by":"publisher","first-page":"32","DOI":"10.1067\/mem.2001.112098","volume":"37","author":"SH Katz","year":"2001","unstructured":"Katz SH, Falk JL. Misplaced endotracheal tubes by paramedics in an urban emergency medical services system. Ann Emerg Med. 2001;37:32\u201337. https:\/\/doi.org\/10.1067\/mem.2001.112098.","journal-title":"Ann Emerg Med"},{"key":"2461_CR4","doi-asserted-by":"publisher","first-page":"9","DOI":"10.1016\/j.jemermed.2016.04.007","volume":"51","author":"KA Miller","year":"2016","unstructured":"Miller KA, Kimia A, Monuteaux MC, Nagler J. Factors associated with misplaced endotracheal tubes during intubation in pediatric patients. J Emerg Med. 2016;51:9\u201318. https:\/\/doi.org\/10.1016\/j.jemermed.2016.04.007.","journal-title":"J Emerg Med"},{"key":"2461_CR5","doi-asserted-by":"publisher","first-page":"CD010221","DOI":"10.1002\/14651858.CD010221.pub2","volume":"9","author":"GM Schm\u00f6lzer","year":"2014","unstructured":"Schm\u00f6lzer GM, Roehr CC. Techniques to ascertain correct endotracheal tube placement in neonates. Cochrane Database Syst Rev. 2014;9:CD010221. https:\/\/doi.org\/10.1002\/14651858.CD010221.pub2.","journal-title":"Cochrane Database Syst Rev"},{"key":"2461_CR6","doi-asserted-by":"publisher","first-page":"731","DOI":"10.1016\/j.resuscitation.2012.11.028","volume":"84","author":"GM Schm\u00f6lzer","year":"2013","unstructured":"Schm\u00f6lzer GM, O\u2019Reilly M, Davis PG, Cheung PY, Roehr CC. Confirmation of correct tracheal tube placement in newborn infants. Resuscitation. 2013;84:731\u20137. https:\/\/doi.org\/10.1016\/j.resuscitation.2012.11.028.","journal-title":"Resuscitation"},{"key":"2461_CR7","doi-asserted-by":"publisher","first-page":"3148","DOI":"10.1002\/ppul.25605","volume":"56","author":"E Williams","year":"2021","unstructured":"Williams E, Dassios T, Greenough A. Carbon dioxide monitoring in the newborn infant. Pediatr Pulmonol. 2021;56:3148\u201356. https:\/\/doi.org\/10.1002\/ppul.25605.","journal-title":"Pediatr Pulmonol"},{"key":"2461_CR8","doi-asserted-by":"publisher","first-page":"661","DOI":"10.4300\/JGME-D-20-00216.1","volume":"12","author":"AM Maw","year":"2020","unstructured":"Maw AM, Huebschmann AG, Mould-Millman NK, Dempsey AF, Soni NJ. Point-of-care ultrasound and modernization of the bedside assessment. J Grad Med Educ. 2020;12:661\u20135. https:\/\/doi.org\/10.4300\/JGME-D-20-00216.1.","journal-title":"J Grad Med Educ"},{"key":"2461_CR9","doi-asserted-by":"publisher","first-page":"953","DOI":"10.1016\/j.ajem.2016.01.027","volume":"34","author":"S Karacabey","year":"2016","unstructured":"Karacabey S, Sanr\u0131 E, Gencer EG, Guneysel O. Tracheal ultrasonography and ultrasonographic lung sliding for confirming endotracheal tube placement: speed and reliability. Am J Emerg Med. 2016;34:953\u20136. https:\/\/doi.org\/10.1016\/j.ajem.2016.01.027.","journal-title":"Am J Emerg Med"},{"key":"2461_CR10","doi-asserted-by":"publisher","first-page":"627","DOI":"10.1016\/j.annemergmed.2018.06.024","volume":"72","author":"M Gottlieb","year":"2018","unstructured":"Gottlieb M, Holladay D, Peksa GD. Ultrasonography for the confirmation of endotracheal tube intubation: a systematic review and meta-analysis. Ann Emerg Med. 2018;72:627\u201336. https:\/\/doi.org\/10.1016\/j.annemergmed.2018.06.024.","journal-title":"Ann Emerg Med"},{"key":"2461_CR11","doi-asserted-by":"publisher","first-page":"185","DOI":"10.1159\/000338585","volume":"102","author":"D Dennington","year":"2012","unstructured":"Dennington D, Vali P, Finer NN, Kim JH. Ultrasound confirmation of endotracheal tube position in neonates. Neonatology. 2012;102:185\u20139. https:\/\/doi.org\/10.1159\/000338585.","journal-title":"Neonatology"},{"key":"2461_CR12","doi-asserted-by":"publisher","first-page":"1057","DOI":"10.1111\/apa.15097","volume":"109","author":"CS Descamps","year":"2020","unstructured":"Descamps CS, Beissel A, Vo Van P, Butin M, Stacoffe N, Giai J, et al. Role of ultrasonography in the assessment of correct endotracheal tube placement in neonates. Acta Paediatr. 2020;109:1057\u20139. https:\/\/doi.org\/10.1111\/apa.15097.","journal-title":"Acta Paediatr"},{"key":"2461_CR13","doi-asserted-by":"publisher","first-page":"n71","DOI":"10.1136\/bmj.n71","volume":"372","author":"MJ Page","year":"2021","unstructured":"Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71 https:\/\/doi.org\/10.1136\/bmj.n71.","journal-title":"BMJ"},{"key":"2461_CR14","doi-asserted-by":"publisher","first-page":"529","DOI":"10.7326\/0003-4819-155-8-201110180-00009","volume":"155","author":"PF Whiting","year":"2011","unstructured":"Whiting PF, Rutjes AW, Westwood ME, Mallett S, Deeks JJ, Reitsma JB, et al. QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies. Ann Intern Med. 2011;155:529\u201336. https:\/\/doi.org\/10.7326\/0003-4819-155-8-201110180-00009.","journal-title":"Ann Intern Med"},{"key":"2461_CR15","doi-asserted-by":"publisher","first-page":"1744","DOI":"10.1002\/ppul.25955","volume":"57","author":"S Ariff","year":"2022","unstructured":"Ariff S, Ali KQ, Tessaro MO, Ansari U, Morris S, Soofi SB, et al. Diagnostic accuracy of point-of-care ultrasound compared to standard-of-care methods for endotracheal tube placement in neonates. Pediatr Pulmonol. 2022;57:1744\u201350. https:\/\/doi.org\/10.1002\/ppul.25955.","journal-title":"Pediatr Pulmonol"},{"key":"2461_CR16","doi-asserted-by":"publisher","first-page":"481","DOI":"10.1038\/jp.2014.240","volume":"35","author":"R Chowdhry","year":"2015","unstructured":"Chowdhry R, Dangman B, Pinheiro JMB. The concordance of ultrasound technique versus X-ray to confirm endotracheal tube position in neonates. J Perinatol. 2015;35:481\u20134. https:\/\/doi.org\/10.1038\/jp.2014.240.","journal-title":"J Perinatol"},{"key":"2461_CR17","doi-asserted-by":"publisher","first-page":"3","DOI":"10.7196\/sajch.740","volume":"9","author":"SH De Kock","year":"2015","unstructured":"De Kock SH, Otto SF, Joubert G. The feasibility of determining the position of an endotracheal tube in neonates by using bedside ultrasonography compared with chest radiographs. S Afr J Child Health. 2015;9:3. https:\/\/doi.org\/10.7196\/sajch.740.","journal-title":"S Afr J Child Health"},{"key":"2461_CR18","doi-asserted-by":"publisher","first-page":"185","DOI":"10.1159\/000338585","volume":"102","author":"D Dennington","year":"2012","unstructured":"Dennington D, Vali P, Finer NN, Kim JH. Ultrasound confirmation of endotracheal tube position in neonates: prospective pilot study. Neonatology. 2012;102:185\u20139. https:\/\/doi.org\/10.1159\/000338585.","journal-title":"Neonatology"},{"key":"2461_CR19","doi-asserted-by":"publisher","first-page":"437","DOI":"10.1002\/jum.16067","volume":"42","author":"E Dincer","year":"2023","unstructured":"Dincer E, Top\u00e7uo\u011flu S, Karatekin G. Ultrasonography for determining endotracheal tube tip position in very low birth weight infants. J Ultrasound Med. 2023;42:437\u201341. https:\/\/doi.org\/10.1002\/jum.16067.","journal-title":"J Ultrasound Med"},{"key":"2461_CR20","doi-asserted-by":"publisher","first-page":"2049","DOI":"10.1017\/S1047951122003420","volume":"33","author":"BK G\u00fcrsoy","year":"2023","unstructured":"G\u00fcrsoy BK, Dilli D, Sar\u0131kaya Y, Akduman H, \u00c7itli R, \u00d6r\u00fcn UA, et al. Ultrasonographic evaluation of endotracheal tube position in newborns with CHD. Cardiol Young-. 2023;33:2049\u201353. https:\/\/doi.org\/10.1017\/S1047951122003420.","journal-title":"Cardiol Young-"},{"key":"2461_CR21","doi-asserted-by":"publisher","first-page":"886","DOI":"10.1007\/s13312-016-0953-6","volume":"53","author":"K Najib","year":"2016","unstructured":"Najib K, Pishva N, Amoozegar H, Pishdad P, Fallahzadeh E. Ultrasonographic confirmation of endotracheal tube position in neonates. Indian Pediatr. 2016;53:886\u20138. https:\/\/doi.org\/10.1007\/s13312-016-0953-6.","journal-title":"Indian Pediatr"},{"key":"2461_CR22","doi-asserted-by":"publisher","first-page":"1465","DOI":"10.7863\/ultra.15.06104","volume":"35","author":"D Saul","year":"2016","unstructured":"Saul D, Ajayi S, Schutzman DL, Horrow MM. Sonography for complete evaluation of neonatal intensive care unit central support devices: a pilot study. J Ultrasound Med. 2016;35:1465\u201373. https:\/\/doi.org\/10.7863\/ultra.15.06104.","journal-title":"J Ultrasound Med"},{"key":"2461_CR23","doi-asserted-by":"publisher","first-page":"627","DOI":"10.1055\/s-0036-1597846","volume":"34","author":"M Sheth","year":"2016","unstructured":"Sheth M, Jaeel P, Nguyen J. Ultrasonography for verification of endotracheal tube position in neonates and infants. Am J Perinatol. 2016;34:627\u201332. https:\/\/doi.org\/10.1055\/s-0036-1597846.","journal-title":"Am J Perinatol"},{"key":"2461_CR24","doi-asserted-by":"publisher","first-page":"374","DOI":"10.1007\/s13312-019-1533-3","volume":"56","author":"P Singh","year":"2019","unstructured":"Singh P, Thakur A, Garg P, Aggarwal N, Kler N. Normative data of optimally placed endotracheal tube by point-of-care ultrasound in neonates. Indian Pediatr. 2019;56:374\u201380.","journal-title":"Indian Pediatr"},{"key":"2461_CR25","doi-asserted-by":"publisher","first-page":"175","DOI":"10.1111\/ped.14069","volume":"62","author":"S Takeuchi","year":"2020","unstructured":"Takeuchi S, Arai J, Nagafuji M, Hinata A, Kamakura T, Hoshino Y, et al. Ultrasonographic confirmation of endotracheal intubation in extremely low birthweight infants \u2013 secondary publication. Pediatr Int. 2020;62:175\u20139. https:\/\/doi.org\/10.1111\/ped.14069.","journal-title":"Pediatr Int"},{"key":"2461_CR26","doi-asserted-by":"publisher","first-page":"262","DOI":"10.3390\/diagnostics15030262","volume":"15","author":"A Voulgaridou","year":"2025","unstructured":"Voulgaridou A, Deftereos S, Chloropoulou P, Bekiaridou K, Tsouvala E, Meziridou R, et al. Emergency identification of endotracheal tube tip via ultrasonography used by trained nurse in the neonatal intensive care unit. Diagnostics. 2025;15:262. https:\/\/doi.org\/10.3390\/diagnostics15030262.","journal-title":"Diagnostics"},{"key":"2461_CR27","doi-asserted-by":"publisher","first-page":"2075","DOI":"10.1080\/14767058.2018.1538350","volume":"33","author":"A Zaytseva","year":"2020","unstructured":"Zaytseva A, Kurepa D, Ahn S, Weinberger B. Determination of optimal endotracheal tube tip depth from the gum in neonates by X-ray and ultrasound. J Matern Fetal Neonatal Med. 2020;33:2075\u201380. https:\/\/doi.org\/10.1080\/14767058.2018.1538350.","journal-title":"J Matern Fetal Neonatal Med"},{"key":"2461_CR28","doi-asserted-by":"publisher","first-page":"72","DOI":"10.11152\/mu-3594","volume":"25","author":"X Li","year":"2023","unstructured":"Li X, Zhang J, Karunakaran M, Hariharan VS. Diagnostic accuracy of ultrasonography for the confirmation of endotracheal tube intubation: a systematic review and meta-analysis. Med Ultrason. 2023;25:72\u201381. https:\/\/doi.org\/10.11152\/mu-3594.","journal-title":"Med Ultrason"},{"key":"2461_CR29","doi-asserted-by":"publisher","first-page":"70","DOI":"10.5492\/wjccm.v11.i2.70","volume":"11","author":"YH Lau","year":"2022","unstructured":"Lau YH, See KC. Point-of-care ultrasound for critically ill patients: a mini-review of key diagnostic features and protocols. World J Crit Care Med. 2022;11:70\u201384. https:\/\/doi.org\/10.5492\/wjccm.v11.i2.70.","journal-title":"World J Crit Care Med"},{"key":"2461_CR30","doi-asserted-by":"publisher","DOI":"10.3389\/fped.2024.1396846","volume":"12","author":"EE Williams","year":"2024","unstructured":"Williams EE, Dassios T, Harris C, Greenough A. Capnography waveforms: basic interpretation in neonatal intensive care. Front Pediatr. 2024;12:1396846. https:\/\/doi.org\/10.3389\/fped.2024.1396846.","journal-title":"Front Pediatr"},{"key":"2461_CR31","doi-asserted-by":"publisher","first-page":"1718","DOI":"10.1038\/s41372-021-00978-y","volume":"41","author":"E Williams","year":"2021","unstructured":"Williams E, Dassios T, O\u2019Reilly N, Walsh A, Greenough A. End-tidal capnography monitoring in infants ventilated on the neonatal intensive care unit. J Perinatol. 2021;41:1718\u201324. https:\/\/doi.org\/10.1038\/s41372-021-00978-y.","journal-title":"J Perinatol"},{"key":"2461_CR32","doi-asserted-by":"publisher","first-page":"293","DOI":"10.1016\/j.case.2022.05.008","volume":"6","author":"MJ Lanspa","year":"2022","unstructured":"Lanspa MJ, Fox SW, Sohn J, Dugar S, Klick JC, Diaz-Gomez J, et al. Definitive advantages of point-of-care ultrasound: a case series. CASE. 2022;6:293\u20138. https:\/\/doi.org\/10.1016\/j.case.2022.05.008.","journal-title":"CASE"},{"key":"2461_CR33","doi-asserted-by":"publisher","first-page":"e1594","DOI":"10.1097\/PEC.0000000000002767","volume":"38","author":"N Parri","year":"2022","unstructured":"Parri N, Berant R, Giacalone M, Jones SD, Friedman N, REPEM POCUS collaboration. Dissemination and use of point-of-care ultrasound by pediatricians in Europe: a research in European pediatric emergency medicine network collaborative survey. Pediatr Emerg Care. 2022;38:e1594\u2013e600. https:\/\/doi.org\/10.1097\/PEC.0000000000002767.","journal-title":"Pediatr Emerg Care"},{"key":"2461_CR34","doi-asserted-by":"publisher","first-page":"12","DOI":"10.1186\/s13089-023-00350-5","volume":"16","author":"DT Al-Absi","year":"2024","unstructured":"Al-Absi DT, Simsekler MCE, Omar MA, Soliman-Aboumarie H, Abou Khater N, Mehmood T, et al. Evaluation of point-of-care ultrasound training among healthcare providers: a pilot study. Ultrasound J. 2024;16:12. https:\/\/doi.org\/10.1186\/s13089-023-00350-5.","journal-title":"Ultrasound J"}],"container-title":["Journal of Perinatology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41372-025-02461-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41372-025-02461-4","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41372-025-02461-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,19]],"date-time":"2026-01-19T08:20:02Z","timestamp":1768810802000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41372-025-02461-4"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,19]]},"references-count":34,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2026,1]]}},"alternative-id":["2461"],"URL":"https:\/\/doi.org\/10.1038\/s41372-025-02461-4","relation":{},"ISSN":["0743-8346","1476-5543"],"issn-type":[{"value":"0743-8346","type":"print"},{"value":"1476-5543","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,19]]},"assertion":[{"value":"3 July 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"20 August 2025","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"17 October 2025","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"19 November 2025","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors declare no competing interests.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}},{"value":"All authors have approved the manuscript and agree with its submission to BMC Emergency Medicine Journal.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}}]}}