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

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European Journal of Pediatrics Aims and scope Submit manuscript

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.

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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

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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.

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Authors and Affiliations

  1. Emergency Pediatric Department, Institute for Research and Health Care (IRCCS), Bambino Gesù Children’s Hospital, Piazza Sant’Onofrio 4, 00165, Rome, Italy

    Maria Chiara Supino, Simona Scateni, Barbara Scialanga, Maria Alessia Mesturino, Emanuele Giglioni, Antonino Reale & Anna Maria Musolino

  2. Department of Pediatrics, Institute for Research and Health Care (IRCCS), Fondazione Policlinico Universitario Gemelli, Largo Agostino Gemelli 8, 00168, Rome, Italy

    Danilo Buonsenso & Antonio Chiaretti

  3. Department of Imaging, Institute for Research and Health Care (IRCCS), Bambino Gesù Children’s Hospital, Piazza Sant’Onofrio 4, 00165, Rome, Italy

    Caterina Bock

Authors
  1. Maria Chiara Supino
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  2. Danilo Buonsenso
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  3. Simona Scateni
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  4. Barbara Scialanga
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  5. Maria Alessia Mesturino
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  7. Antonio Chiaretti
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  8. Emanuele Giglioni
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  9. Antonino Reale
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  10. Anna Maria Musolino
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Contributions

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.

Corresponding author

Correspondence to Maria Chiara Supino.

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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.

Additional information

Communicated by Mario Bianchetti

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Supino, M.C., Buonsenso, D., Scateni, S. et al. Point-of-care lung ultrasound in infants with bronchiolitis in the pediatric emergency department: a prospective study. Eur J Pediatr 178, 623–632 (2019). https://doi.org/10.1007/s00431-019-03335-6

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  • DOI: https://doi.org/10.1007/s00431-019-03335-6

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