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Point-of-care lung ultrasound in infants with bronchiolitis in the pediatric emergency department: a prospective study

  • Maria Chiara SupinoEmail author
  • Danilo Buonsenso
  • Simona Scateni
  • Barbara Scialanga
  • Maria Alessia Mesturino
  • Caterina Bock
  • Antonio Chiaretti
  • Emanuele Giglioni
  • Antonino Reale
  • Anna Maria Musolino
Original Article

Abstract

Bronchiolitis is the most common cause of hospitalization of children in the first year of life. The lung ultrasound is a new diagnostic tool which is inexpensive, non-invasive, rapid, and easily repeatable. Our prospective study was conducted in the emergency department and all patients underwent a routine clinical evaluation and lung ultrasound by the pediatricians who defined the clinical and the ultrasound score. We enrolled 76 infants (median age 90 days [IQR 62–183], 53.9% males). In nasopharyngeal aspirates, the respiratory syncytial virus was isolated in 33 patients. Considering the clinical score, children with higher score had a higher probability of requiring respiratory support (p 0.001). At the ultrasound evaluation, there was a significant difference on ultrasound score between those who will need respiratory support or not (p 0.003). Infants who needed ventilation with helmet continuous positive airway pressure had a more severe ultrasound score (p 0.028) and clinical score (p 0.004), if compared with those who did not need it.

Conclusion: Our study shows that lung ultrasound in the bronchiolitis may be a useful method to be integrated with the clinical evaluation to better define the prognosis of the individual patient. Multicenter studies on larger populations are necessary to confirm our data.

What is Known:

Bronchiolitis is the main cause of lower respiratory tract infection in children younger than 24 months.

Ultrasound can evaluate the lung parenchyma without ionizing radiations.

What is New:

Lung ultrasound may be a useful diagnostic tool to define the prognosis of the infants affected by bronchiolitis if performed at the first assessment in the emergency department.

• The score obtained at the ultrasound evaluation is higher in those who will need oxygen therapy during admission for more time and in those who will need respiratory support with helmet continuous positive airway pressure.

Keywords

Ultrasound Bronchiolitis Children Pocus Lung Precision medicine 

Abbreviations

ANOVA

Analysis of variance

AAP

American Academy of Pediatrics

ED

Emergency department

HCPAP

Helmet continuous positive airway pressure

HFNC

High-flow nasal cannula

IQR

Interquartile range

LUS

Lung ultrasound

NICE

National Institute for Health and Care Excellence

PICU

Pediatric intensive care unit

POCUS

Point-of-care ultrasound

RSV

Respiratory syncytial virus

SaO2

Hemoglobin oxygen saturation

SD

Standard deviation

SPSS

Statistical Package for the Social Science

Notes

Acknowledgments

The authors are grateful to all the children and their parents, nurses, and physicians who helped to perform this study. We also thank Dr. Umberto Raucci (Bambino Gesù Children Hospital of Rome, Italy) for his excellent assistance.

Authors’ contribution

Conception and research design: M.C. Supino, D. Buonsenso, A.M. Musolino

Data collection: S. Scateni, M.A. Mesturino, C. Bock, A. Chiaretti

Data analysis and interpretation and drafting the article: A. Reale, B. Scialanga, E. Giglioni, M.C. Supino

Final approval of the article: all the authors.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study described has been carried out in accordance with the abovementioned standards and has been approved by the institutional ethic committee.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Maria Chiara Supino
    • 1
    Email author
  • Danilo Buonsenso
    • 2
  • Simona Scateni
    • 1
  • Barbara Scialanga
    • 1
  • Maria Alessia Mesturino
    • 1
  • Caterina Bock
    • 3
  • Antonio Chiaretti
    • 2
  • Emanuele Giglioni
    • 1
  • Antonino Reale
    • 1
  • Anna Maria Musolino
    • 1
  1. 1.Emergency Pediatric Department, Institute for Research and Health Care (IRCCS)Bambino Gesù Children’s HospitalRomeItaly
  2. 2.Department of Pediatrics, Institute for Research and Health Care (IRCCS)Fondazione Policlinico Universitario GemelliRomeItaly
  3. 3.Department of Imaging, Institute for Research and Health Care (IRCCS)Bambino Gesù Children’s HospitalRomeItaly

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