Functional Assessment of the Neonatal Diaphragm Using Point-of-Care Ultrasound: A Review of Techniques, Clinical Applications, and Challenges.

The diaphragm is the primary muscle of respiration; its dysfunction can result in serious respiratory complications and prolonged mechanical ventilation, particularly in critically ill neonates. However, detecting diaphragmatic dysfunction in this population remains challenging due to anatomical constraints and the absence of standardized assessment tools. Point-of-care ultrasound (POCUS) offers a noninvasive, bedside, and real-time method to evaluate diaphragmatic function during both spontaneous and assisted breathing. Consequently, its role in guiding therapeutic decision-making in neonates is attracting growing interest. POCUS is currently being explored for applications such as assessing extubation readiness, monitoring diaphragmatic performance, and evaluating respiratory function in neonates receiving invasive or noninvasive support. Despite these promising applications, several barriers limit the routine adoption of diaphragmatic POCUS. Highly skilled operators are required for accurate imaging as well as interpretation, and currently, only a limited number of neonatologists are adequately trained. In addition, the lack of standardized protocols, normative reference values, and validated clinical decision algorithms specific to neonates limits widespread application. This review provides a comprehensive overview of POCUS-based functional assessment of the neonatal diaphragm, outlining techniques, clinical applications, and existing challenges. It also emphasizes the need for further research to establish normative data, standardize imaging approaches, and expand clinician training to support implementation into neonatal care.