# Diagnostic accuracy of real‑time 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

## TL;DR

This study evaluates how well ultrasound can confirm correct placement of breathing tubes in newborns during emergencies.

## Contribution

The study provides a meta-analysis of real-time tracheal ultrasonography accuracy in neonates for endotracheal tube placement confirmation.

## Key findings

- POCUS showed a pooled sensitivity of 93% and specificity of 59% for ETT placement.
- Tracheal placement was confirmed in 99% of cases, and esophageal misplacement detected in 4%.
- Higher accuracy was observed with neonatologists and linear transducers.

## Abstract

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 (<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.