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The lung ultrasound in children with SARS-COV-2 infection: a national multicenter prospective study

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Abstract

Coronavirus disease-19 (COVID-19) caused hospitalizations, severe disease, and deaths in any age, including in the youngest children. The aim of this multicenter national study is to characterize the clinical and the prognostic role of lung ultrasound (LU) in children with COVID-19. We enrolled children between 1 month and 18 years of age with severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) infection who underwent a LU within 6 h from the first medical evaluation. A total of 213 children were enrolled, 51.6% were male, median age was 2 years and 5 months (interquartile range (IQR) 4 months –11 years and 4 months). One hundred and forty-eight (69.4%) children were admitted in hospital, 9 (6.1%) in pediatric intensive care unit. We found an inverse correlation between the lung ultrasound score (LUS) and the oxygen saturation at the first clinical evaluation (r = −0.16; p = 0.019). Moreover, LUS was significantly higher in patients requiring oxygen supplementation (8 (IQR 3–19) vs 2 (IQR 0–4); p = 0.001). Among LU pathological findings, irregular pleural lines, subpleural consolidations, and pleural effusions were significantly more frequent in patients needing oxygen supplementation (p = 0.007, p = 0.006, and p = 0.001, respectively).

  Conclusion: This multicenter study showed that LU in children with COVID-19 can highlight pleural line irregularities, vertical artifacts, and subpleural consolidation. Notably, children with higher LUS have a higher risk of hospitalization and need for oxygen supplementation, supporting LU as a valid and safe point-of-care first level tool for the clinical evaluation of children with COVID-19.

What is Known:

• Few children infected with SARS-CoV-2 develop a severe disease and need oxygen therapy.

• Lung ultrasound can easily detect low respiratory tract infection during SARS-CoV-2.

What is New:

• Children with higher lung ultrasound score have a higher risk of need for oxygen supplementation.

• Irregular pleural line, sub-pleural consolidations and pleural effusions were significantly more frequent in patients needing oxygen supplementation.

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Data availability

No datasets were generated or analyzed during the current study.

Abbreviations

COVID-19:

Coronavirus disease-19

ED:

Emergency department

IQR:

Interquartile range

LRTI:

Low respiratory tract infection

LU:

Lung ultrasound

LUS:

Lung ultrasound score

Mm:

Months

PED:

Pediatric emergency department

RedCap:

Research Electronic Data Capture

SARS-CoV-2:

Severe acute respiratory syndrome coronavirus 2

SD:

Standard deviation

Yy:

Years

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Acknowledgements

PLUSCOVID-19 Study group: Pediatric Lung UltraSoundCOrona Virus Disease 19. Simona Scateni1, MD, Valentina Ferro1, MD, Barbara Scialanga1, MD, Maria Alessia Mesturino1, MD, Elena Boccuzzi1, MD, Roberta Puxeddu4, MD, Carolina D’Anna6, MD, Vittorio Romagnoli10, MD, Gaia Martinelli10, MD, Silvia Marino11, MD. 1Pediatric Emergency Unit, Pediatric Emergency Department and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy. 4Department of Pediatrics, San Jacopo Hospital, Pistoia, Italy. 6Pediatric Emergency and Short Stay Unit, Santobono-PausiliponChildren's Hospital, Naples, Italy. 10Pediatric Unit, Department of Mother and Child Health, Salesi Children's Hospital, Ancona, Italy. 11Pediatric and Pediatric Emergency Department, AOUP “Rodolico San Marco”, PO “San Marco”, University of Catania, Catania.

Funding

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

Author information

Authors and Affiliations

  1. Pediatric Emergency Unit, Pediatric Emergency Department and General Pediatrics, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy

    Maria Chiara Supino, Alberto Villani & Anna Maria Musolino

  2. Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy

    Danilo Buonsenso & Rosa Morello

  3. Centro di Salute Globale, Università Cattolica del Sacro Cuore, Rome, Italy

    Danilo Buonsenso

  4. Department of Pediatrics, San Jacopo Hospital, Pistoia, Italy

    Rino Agostiniani

  5. Department of Maternal and Child Health, Division of Pediatric Unit, S. Chiara Hospital, Pisa, Italy

    Laura Gori

  6. Pediatric Emergency and Short Stay Unit, Santobono-Pausilipon Children’s Hospital, Naples, Italy

    Vincenzo Tipo

  7. Pediatric Emergency Unit, City of Health and Science of Turin, Turin, Italy

    Giovanni Del Monaco

  8. Neonatal Intensive Care Unit [NICU], AOU “Rodolico-San Marco”, PO “San Marco”, University of Catania, Catania, Italy

    Raffaele Falsaperla

  9. Pediatric Emergency Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy

    Carlotta Biagi

  10. Pediatric Unit, Department of Mother and Child Health, Salesi Children’s Hospital, Ancona, Italy

    Salvatore Cazzato

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  1. Maria Chiara Supino
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Consortia

PLUSCOVID-19 Study Group

  • Simona Scateni
  • , Valentina Ferro
  • , Barbara Scialanga
  • , Maria Alessia Mesturino
  • , Elena Boccuzzi
  • , Roberta Puxeddu
  • , Carolina D’Anna
  • , Vittorio Romagnoli
  • , Gaia Martinelli
  •  & Silvia Marino

Contributions

MCS and AM conceptualized and designed the study. AM, AV, RA, VT, and DB cured the data. MCS and AM carried out the formal analysis. DB drafted the initial manuscript. LG, GDM, RM, RF, CB, SC, and RA coordinated and supervised data collection. All authors were involved in writing the paper and had final approval of the submitted and published versions.

Corresponding author

Correspondence to Maria Chiara Supino.

Ethics declarations

Ethics approval

This study was conducted in accordance with the Declaration of Helsinki and approved by the ethics committee of the Bambino Gesù Children Hospital (2293_OPBG_2020).

Consent to participate

Written informed consent was obtained from all participants and, if under aged, also by their legal guardians.

Consent for publication

All obtained data were pseudonymized. Consent to publish pseudonymized data has been received from all participants as part of the consent to participate. No individual person’s data are included in this manuscript.

Competing interests

The authors declare no competing interests.

Additional information

Communicated by Daniele De Luca

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Supino, M.C., Buonsenso, D., Agostiniani, R. et al. The lung ultrasound in children with SARS-COV-2 infection: a national multicenter prospective study. Eur J Pediatr (2024). https://doi.org/10.1007/s00431-024-05609-0

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