Case Report: A structured point-of-care ultrasound pathway for the crashing neonate in the NICU: a case series and algorithm proposal.

Point-of-care ultrasound (POCUS) is increasingly recognized as an essential diagnostic tool in the neonatal intensive care unit (NICU), often described as the "stethoscope of the modern era". It provides real-time, bedside imaging that enhances clinical assessment and guides urgent intervention. Sudden clinical deterioration in neonates-commonly due to tension pneumothorax, pericardial tamponade, massive pleural effusion, or severe intracranial hemorrhage-requires prompt diagnosis and management. This retrospective case series illustrates the utility of POCUS in three critically ill neonates: one with postoperative tension pneumothorax, another with umbilical venous catheter-associated pericardial tamponade, and a third with severe intraventricular hemorrhage in an extremely preterm infant. In each case, POCUS enabled rapid diagnosis, guided immediate intervention, and influenced outcomes. We also review the literature supporting POCUS integration into NICU practice and propose a structured screening protocol for neonates with acute cardiopulmonary decompensation. This series underscores the role of POCUS as a first-line imaging tool in neonatal emergencies and underscores the imperative for standardized training to ensure its effective and responsible use (diagnostic stewardship) within the NICU.