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 MRCPCH qualified and became a Member of the Sri Lanka College of Pediatricians in 2024. Since 2011, Dr Marikkar has worked in Level 3 NICUs in Sri Lanka, Oman, and the UK. Her interests include guideline development, quality improvement, audits, research, and point-of-care ultrasound (POCUS).
Research Interest: Background: Point-of-care ultrasound (POCUS) is increasingly embedded in neonatal practice globally, offering rapid bedside diagnostic and procedural support. However, adoption in the United Kingdom remains inconsistent. Beyond commonly cited limitations such as equipment and training access, a more fundamental barrier lies in the absence of national governance structures, credentialing pathways, and clear inter-professional role delineation between neonatologists and radiologists. Aim: To identify the systemic, cultural, and organizational obstacles 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 centered on professional role allocation, medico-legal and governance requirements, safety considerations, and workforce implications related to training, supervision, and service delivery. Results: A radiology-cent red scanning paradigm, historical reliance on chest radiography, and lack of national credentialing collectively restrict neonatologist-led POCUS in the UK. Neonatologists report uncertainty about scope of practice, substantial variation in local governance approval, and limited structured opportunities for supervised training. Conversely, many European centers have successfully implemented neonatologist-led POCUS programmers supported by strong radiology–neonatology collaboration, standardized competency assessments, and clear escalation pathways. A feasible UK model would include: (1) a tiered competency structure (basic, intermediate, advanced), (2) standardized assessment and logbook requirements, (3) joint governance groups between radiology and neonatology at institutional level, and (4) national accreditation aligned with adult intensive care POCUS frameworks. Conclusion: Governance - not technology - remains the primary barrier to neonatal POCUS expansion in the UK. Establishing a national, co-designed credentialing and governance framework would promote safe practice, clarify professional boundaries, and support equitable access, ultimately enhancing diagnostic precision and reducing unnecessary imaging for newborns. Keywords: Neonatal POCUS; Credentialing; Governance; Inter-professional Collaboration; Training Frameworks.