Dr. Nusra Begum Mohamed Ansar Marikkar
Plymouth University Hospitals NHS Trust, United Kingdom
Abstract Title:
The Invisible Barrier to Neonatal POCUS by the Neonatologist: Rethinking Roles, Governance, and Credentialing in the UK
Biography:
Dr. Nusra Begum Mohamed Ansar Marikkar is a Senior Clinical Fellow at Plymouth University Hospitals NHS Trust, United Kingdom. She obtained her medical degree from Zaporozhe State Medical University, Ukraine, and completed a Diploma in Child Health at the Postgraduate Institute of Medicine, Colombo, Sri Lanka. She is a Member of the Royal College of Paediatrics and Child Health (MRCPCH) and became a Member of the Sri Lanka College of Paediatricians in 2024. Since 2011, Dr. Marikkar has worked in Level III Neonatal Intensive Care Units (NICUs) across Sri Lanka, Oman, and the United Kingdom. Her professional interests include guideline development, quality improvement, clinical audits, neonatal research, and point-of-care ultrasound (POCUS).
Research Interests:
Background: Point-of-care ultrasound (POCUS) is increasingly integrated into neonatal practice worldwide, providing rapid bedside diagnostic and procedural support. However, its adoption in the United Kingdom remains inconsistent. While barriers such as limited access to equipment and training are frequently cited, a more significant challenge is the lack of national governance frameworks, standardized credentialing pathways, and clearly defined interprofessional roles and responsibilities between neonatologists and radiologists.
Aim: To identify the systemic, cultural, and organizational barriers limiting neonatologist-performed POCUS in the UK, compare UK practices with established international models, and propose a collaborative, scalable framework for national credentialing.
Methods: This work synthesized evidence from recent UK and European surveys, international consensus statements, and local implementation experiences. Thematic analysis focused on professional role allocation, medico-legal and governance requirements, patient safety considerations, and workforce implications related to training, supervision, and service delivery.
Results: A radiology-centered scanning paradigm, historical reliance on chest radiography, and the absence of a national credentialing framework collectively restrict neonatologist-led POCUS in the UK. Neonatologists report uncertainty regarding their scope of practice, considerable variation in local governance approval processes, and limited opportunities for structured, supervised training. In contrast, many European centers have successfully implemented neonatologist-led POCUS programs supported by strong collaboration between radiology and neonatology, standardized competency assessments, and clearly defined escalation pathways. A feasible UK framework would include: (1) a tiered competency structure (basic, intermediate, and advanced); (2) standardized assessment and logbook requirements; (3) joint governance committees involving radiology and neonatology at the institutional level; and (4) national accreditation aligned with existing adult intensive care POCUS frameworks.
Conclusion: Governance not technology remains the primary barrier to expanding neonatal POCUS in the UK. Establishing a nationally coordinated, collaboratively designed credentialing and governance framework would promote safe clinical practice, clarify professional responsibilities, and support equitable access to POCUS, ultimately improving diagnostic accuracy and reducing unnecessary imaging in newborns.
Keywords: Neonatal POCUS; Credentialing; Governance; Interprofessional Collaboration; Training Frameworks.
