{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T09:06:48Z","timestamp":1790068008515,"version":"4.0.1"},"reference-count":30,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T00:00:00Z","timestamp":1790035200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pediatr."],"abstract":"<jats:p>Point-of-care ultrasound (POCUS) is increasingly used in neonatal intensive care units (NICUs) for hemodynamic assessment, but standardized protocols for central venous pressure (CVP) estimation remain lacking. This narrative review synthesizes current evidence on POCUS parameters\u2014primarily the inferior vena cava collapsibility index (IVC-CI), maximum IVC diameter, the inferior vena cava-to-aortic ratio (IVC\/Ao), and internal jugular vein (IJV) indices\u2014for non-invasive CVP assessment in critically ill neonates. Key advances include demonstrating that ultrasound-measured IVC diameter correlates with invasively measured CVP in low birth weight infants and the emergence of multi-parameter models. However, major barriers persist: inconsistent neonatal-specific thresholds, operator dependence, limited training infrastructure, and insufficient validation in extremely low birth weight populations. We propose a practical clinical decision algorithm integrating IVC and IJV parameters with adjunctive lung and cardiac POCUS assessment, structured reassessment after every fluid bolus, and objective triggers for transitioning to invasive monitoring. Recent guidelines from the European Society of Paediatric and Neonatal Intensive Care (ESPNIC) and the American Society of Echocardiography (ASE) provide foundational frameworks, but dedicated neonatal training and credentialing standards remain essential. Future directions include artificial intelligence-assisted measurement, multi-parameter scoring systems (e.g., Venous Excess Ultrasound score), and multicenter prospective validation. POCUS serves as a complementary tool to\u2014not a replacement for\u2014invasive monitoring in complex hemodynamic instability. Standardized thresholds, structured training, and quality assurance programs are critical for safe clinical translation, especially in resource-limited settings.<\/jats:p>","DOI":"10.3389\/fped.2026.1871758","type":"journal-article","created":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T08:46:00Z","timestamp":1790066760000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["From invasive to non-invasive: point-of-care ultrasound parameters and a clinical decision algorithm for central venous pressure assessment in critically Ill neonates"],"prefix":"10.3389","volume":"14","author":[{"given":"Runshu","family":"Zhang","sequence":"first","affiliation":[{"name":"Department of Pediatrics, The Affiliated Hospital of Southwest Medical University","place":["Luzhou, Sichuan, China"]},{"name":"Department of Pediatrics, Chengdu Wenjiang District Maternal and Child Health Hospital","place":["Chengdu, Sichuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rong","family":"Ju","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, The Affiliated Hospital of Southwest Medical University","place":["Luzhou, Sichuan, China"]},{"name":"Department of Neonatology, Chengdu Women\u2019s and Children\u2019s Central Hospital, School of Medicine, University of Electronic Science and Technology of China","place":["Chengdu, Sichuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yiyong","family":"Fu","sequence":"additional","affiliation":[{"name":"Department of Neonatology, Chengdu Women\u2019s and Children\u2019s Central Hospital, School of Medicine, University of Electronic Science and Technology of China","place":["Chengdu, Sichuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xinyu","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Neonatology, Chengdu Women\u2019s and Children\u2019s Central Hospital, School of Medicine, University of Electronic Science and Technology of China","place":["Chengdu, Sichuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xin","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Chengdu Wenjiang District Maternal and Child Health Hospital","place":["Chengdu, Sichuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qun","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Chengdu Wenjiang District Maternal and Child Health Hospital","place":["Chengdu, Sichuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yajun","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, 363 Hospital","place":["Chengdu, Sichuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,22]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"1611740","DOI":"10.3389\/fped.2025.1611740","article-title":"Central venous pressure dynamics in neonates with hypoxic-ischemic encephalopathy: insights into high mean airway pressure, PPHN, and ECMO management","volume":"13","author":"Kurimoto","year":"2025","journal-title":"Front Pediatr"},{"key":"B2","doi-asserted-by":"publisher","first-page":"e404","DOI":"10.1542\/hpeds.2024-008248","article-title":"Implementation frameworks, strategies, and outcomes in optimizing central venous access device practice in neonates: a scoping review","volume":"15","author":"Comber","year":"2025","journal-title":"Hosp Pediatr"},{"key":"B3","doi-asserted-by":"publisher","first-page":"46","DOI":"10.1002\/ajum.12322","article-title":"Neonatal and paediatric point-of-care ultrasound review","volume":"26","author":"Pan","year":"2023","journal-title":"Australas J Ultrasound Med"},{"key":"B4","doi-asserted-by":"publisher","first-page":"53","DOI":"10.1007\/s00431-022-04636-z","article-title":"Point-of-care ultrasound (POCUS) protocol for systematic assessment of the crashing neonate-expert consensus statement of the international crashing neonate working group","volume":"182","author":"Elsayed","year":"2023","journal-title":"Eur J Pediatr"},{"key":"B5","doi-asserted-by":"publisher","first-page":"123","DOI":"10.2147\/mder.s454849","article-title":"Usefulness of non-invasive parameters (Inferior vena Cava diameter, Inferior vena Cava collapsibility, Inferior vena Cava-aortic ratio) for hemodynamic monitoring in critically ill children: a systematic review","volume":"17","author":"Hakim","year":"2024","journal-title":"Med Devices (Auckl)"},{"key":"B6","doi-asserted-by":"publisher","first-page":"473","DOI":"10.1016\/j.ultrasmedbio.2025.04.008","article-title":"Evaluating the role of point-of-care ultrasound in central venous pressure monitoring for critically ill patients. A Comprehensive Systematic Review and Meta-analysis","volume":"52","author":"Shaban","year":"2026","journal-title":"Ultrasound Med Biol"},{"key":"B7","doi-asserted-by":"publisher","first-page":"751","DOI":"10.1007\/s12098-017-2382-5","article-title":"Echocardiographic Inferior vena Cava measurement as an alternative to central venous pressure measurement in neonates","volume":"84","author":"Mugloo","year":"2017","journal-title":"Indian J Pediatr"},{"key":"B8","doi-asserted-by":"publisher","first-page":"171","DOI":"10.1016\/j.echo.2023.11.016","article-title":"Guidelines and recommendations for targeted neonatal echocardiography and cardiac point-of-care ultrasound in the neonatal intensive care unit: an update from the American society of echocardiography","volume":"37","author":"McNamara","year":"2024","journal-title":"J Am Soc Echocardiogr"},{"key":"B9","doi-asserted-by":"publisher","first-page":"478","DOI":"10.1038\/sj.jp.7210782","article-title":"Handheld, portable ultrasound in the neonatal intensive care nursery: a new, inexpensive tool for the rapid diagnosis of common neonatal problems","volume":"22","author":"Burdjalov","year":"2002","journal-title":"J Perinatol"},{"key":"B10","doi-asserted-by":"publisher","first-page":"e1","DOI":"10.1097\/pcc.0000000000002526","article-title":"Central venous pressure estimation by ultrasound measurement of Inferior vena Cava and aorta diameters in pediatric critical patients: an observational study","volume":"22","author":"Mercolini","year":"2021","journal-title":"Pediatr Crit Care Med"},{"key":"B11","doi-asserted-by":"publisher","first-page":"65","DOI":"10.1186\/s13054-020-2787-9","article-title":"International evidence-based guidelines on point of care ultrasound (POCUS) for critically ill neonates and children issued by the POCUS working group of the European society of paediatric and neonatal intensive care (ESPNIC)","volume":"24","author":"Singh","year":"2020","journal-title":"Crit Care"},{"key":"B12","doi-asserted-by":"publisher","first-page":"1586","DOI":"10.1038\/s41372-025-02458-z","article-title":"Neonatal SONography assisted resuscitation (NeoSONAR): scoping review of the current literature and future directions","volume":"45","author":"Singh","year":"2025","journal-title":"J Perinatol"},{"key":"B13","doi-asserted-by":"publisher","first-page":"113","DOI":"10.1038\/s41372-025-02367-1","article-title":"Neonatal point-of-care ultrasound\u2014guidelines for training, credentialing and quality assurance","volume":"46","author":"Fraga","year":"2026","journal-title":"J Perinatol"},{"key":"B14","doi-asserted-by":"publisher","first-page":"108","DOI":"10.1038\/s41372-025-02359-1","article-title":"Neonatal point-of-care ultrasound\u2014steps for program development","volume":"46","author":"Bhombal","year":"2026","journal-title":"J Perinatol"},{"key":"B15","doi-asserted-by":"publisher","first-page":"170","DOI":"10.1007\/s12098-024-05180-4","article-title":"Advances in point-of-care ultrasound in pediatric acute care medicine","volume":"92","author":"Becker","year":"2025","journal-title":"Indian J Pediatr"},{"key":"B16","doi-asserted-by":"publisher","first-page":"e241","DOI":"10.1111\/apa.12247","article-title":"The diameter of the inferior vena cava provides a noninvasive way of calculating central venous pressure in neonates","volume":"102","author":"Sato","year":"2013","journal-title":"Acta Paediatr"},{"key":"B17","doi-asserted-by":"publisher","first-page":"2266","DOI":"10.62347\/bmdj4584","article-title":"Correlation between ultrasound-measured inferior vena cava diameter and peripherally inserted central catheter measured central venous pressure in low birth weight infants","volume":"17","author":"Li","year":"2025","journal-title":"Am J Transl Res"},{"key":"B18","doi-asserted-by":"publisher","first-page":"914","DOI":"10.1038\/s41372-025-02271-8","article-title":"Integration of inferior vena cava measurements into routine functional echocardiography in preterm neonates. Are We There Yet?","volume":"45","author":"Unal","year":"2025","journal-title":"J Perinatol"},{"key":"B19","doi-asserted-by":"publisher","first-page":"97","DOI":"10.4103\/abr.abr_213_17","article-title":"A comparison between the bedside sonographic measurements of the Inferior vena Cava indices and the central venous pressure while assessing the decreased intravascular volume in children","volume":"7","author":"Babaie","year":"2018","journal-title":"Adv Biomed Res"},{"key":"B20","doi-asserted-by":"publisher","first-page":"607","DOI":"10.1186\/cc3877","article-title":"Clinical review: positive end-expiratory pressure and cardiac output","volume":"9","author":"Luecke","year":"2005","journal-title":"Crit Care"},{"key":"B21","doi-asserted-by":"publisher","first-page":"73","DOI":"10.4330\/wjc.v16.i2.73","article-title":"Seeing beneath the surface: harnessing point-of-care ultrasound for internal jugular vein evaluation","volume":"16","author":"Chayapinun","year":"2024","journal-title":"World J Cardiol"},{"key":"B22","doi-asserted-by":"publisher","first-page":"1500","DOI":"10.1038\/s41598-022-22867-w","article-title":"Central venous pressure estimation with force-coupled ultrasound of the internal jugular vein","volume":"13","author":"Jaffe","year":"2023","journal-title":"Sci Rep"},{"key":"B23","doi-asserted-by":"publisher","first-page":"109","DOI":"10.24908\/pocusj.v10i02.18249","article-title":"Use of internal jugular vein POCUS to assess intravascular volume Status: a study in critically ill pediatric post-operative cardiac patients","volume":"10","author":"Jayasimha","year":"2025","journal-title":"POCUS J"},{"key":"B24","doi-asserted-by":"publisher","first-page":"5139","DOI":"10.1007\/s00431-024-05792-0","article-title":"Hepatic vein Doppler ultrasound to estimate central venous pressure in mechanically ventilated children","volume":"183","author":"Franzon","year":"2024","journal-title":"Eur J Pediatr"},{"key":"B25","doi-asserted-by":"publisher","first-page":"101366","DOI":"10.1016\/j.siny.2022.101366","article-title":"The role of bedside functional echocardiography in the assessment and management of pulmonary hypertension","volume":"27","author":"More","year":"2022","journal-title":"Semin Fetal Neonatal Med"},{"key":"B26","doi-asserted-by":"publisher","first-page":"370","DOI":"10.34197\/ats-scholar.2024-0076ht","article-title":"How I teach the estimation of right ventricular systolic pressure using point-of-care ultrasound","volume":"6","author":"Jackson","year":"2025","journal-title":"ATS Sch"},{"key":"B27","doi-asserted-by":"publisher","first-page":"1255","DOI":"10.1007\/s00431-023-05371-9","article-title":"Lung ultrasound-guided fluid resuscitation in neonatal septic shock: a randomized controlled trial","volume":"183","author":"Huang","year":"2024","journal-title":"Eur J Pediatr"},{"key":"B28","doi-asserted-by":"publisher","first-page":"513","DOI":"10.1097\/pcc.0000000000001534","article-title":"Cardiac Index changes with fluid bolus therapy in children with sepsis-an observational study","volume":"19","author":"Long","year":"2018","journal-title":"Pediatr Crit Care Med"},{"key":"B29","doi-asserted-by":"publisher","first-page":"21","DOI":"10.1186\/s13052-024-01829-0","article-title":"Abnormal characteristics of inferior vena cava and abdominal aorta among neonates with early onset septic shock","volume":"51","author":"Mi","year":"2025","journal-title":"Ital J Pediatr"},{"key":"B30","doi-asserted-by":"publisher","first-page":"2610","DOI":"10.1002\/ppul.26563","article-title":"The future of neonatal lung ultrasound: validation of an artificial intelligence model for interpreting lung scans. A multicentre prospective diagnostic study","volume":"58","author":"Perri","year":"2023","journal-title":"Pediatr Pulmonol"}],"container-title":["Frontiers in Pediatrics"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2026.1871758\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T08:46:01Z","timestamp":1790066761000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2026.1871758\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,22]]},"references-count":30,"alternative-id":["10.3389\/fped.2026.1871758"],"URL":"https:\/\/doi.org\/10.3389\/fped.2026.1871758","relation":{},"ISSN":["2296-2360"],"issn-type":[{"value":"2296-2360","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,22]]},"article-number":"1871758"}}