Point-of-care ultrasound in neonatal necrotizing enterocolitis: integrating clinician-performed evidence and nurse-led implementation

Neonatal necrotizing enterocolitis (NEC) is one of the most severe gastrointestinal emergencies in the neonatal intensive care unit (NICU), for which early identification, accurate assessment, and dynamic monitoring are critical for improving outcomes. Point-of-care ultrasound (POCUS) has emerged as a non-invasive, reproducible, and portable imaging modality with unique advantages for NEC assessment. However, direct evidence on nurse-led POCUS specifically in NEC remains scarce; most published ultrasound studies have been conducted by radiologists, sonographers, or neonatologists. This review synthesizes evidence from two sources: (1) clinician-performed POCUS technical evidence in NEC, including the detection of pneumatosis intestinalis, portal venous gas, and hemodynamic alterations; and (2) nurse-led implementation evidence derived from POCUS programs in other neonatal or critical care settings, including screening workflows, documentation standards, and training requirements. We discuss the current evidence base, highlight the gap between clinician-performed technical evidence and nurse-led implementation, and propose a framework for integrating POCUS into NICU nursing practice. By critically synthesizing the available evidence, this review aims to provide practical guidance for future nurse-led POCUS programs in NEC and to outline priority areas for prospective research.