Lung Ultrasound Characteristics in Neonates With Positive Real Time Polymerase Chain Reaction for SARS-CoV-2 on a Tertiary Level Referral Hospital in Mexico City

Abstract

IntroductionAcute respiratory syndrome secondary to SARS-CoV-2 virus infection has been declared a pandemic since December 2019. On neonates, severe presentations are infrequent but possible. Lung ultrasound (LUS) has been shown to be useful in diagnosing lung involvement and following up patients, giving more information, and reducing exposure compared to traditional examination.MethodsLUS was performed after the diagnosis of SARS-CoV-2 infection with respiratory Real Time Polymerase Chain Reaction RT-PCR with portable equipment protected with a silicone sleeve. If hemodynamic or cardiology consultation was necessary, a prepared complete ultrasound machine was used. Ten regions were explored (anterior superior and inferior, lateral, and posterior superior and inferior, right and left), and a semiquantitative score (LUSS) was calculated. Disease severity was determined with a pediatric modified score.ResultsThirty-eight patients with positive RT-PCR were admitted, 32 (81%) of which underwent LUS. Included patients had heterogenous diagnosis and gestational ages as expected on a referral neonatal intensive care unit (NICU) (median, ICR: 36, 30–38). LUS abnormalities found were B-line interstitial pattern 90%, irregular/interrupted/thick pleural line 88%, compact B-lines 65%, small consolidations (≤5 mm) 34%, and extensive consolidations (≥5 mm) 37%. Consolidations showed posterior predominance (70%). LUSS showed a median difference between levels of disease severity and ventilatory support (Kruskal–Wallis, p = 0.001) and decreased with patient improvement (Wilcoxon signed-rank test p = 0.005). There was a positive correlation between LUSS and FiO2 needed (Spearman r = 0.72, p = 0.01). The most common recommendation to the attending team was pronation (41%) and increase in positive end expiratory pressure (34%). Five patients with comorbidities died. A significant rank difference of LUSS and FiO2 needed between survivors and non-survivors was found (Mann–Whitney U-test, p = 0.005).ConclusionLUS patterns found were like the ones described in other series (neonatal and pediatrics). Eighty-eight percent of the studies were performed with handheld affordable equipment. While there is no specific pattern, it varies according to gestational age and baseline diagnosis LUS, which were shown to be useful in assessing lung involvement that correlated with the degree of disease severity and respiratory support.

The Assessment of COVID-19 Pneumonia in Neonates: Observed by Lung Ultrasound Technique and Correlated with Biomarkers and Symptoms

“…Most of the frequent transmission types were postnatal ones, according to the idea that vertical transmission was at low risk [ 5 ]. Moreover, the rate of postnatal transmission reported by Ibarra-Ríos et al was 91%, pretty much similar to the 84.21% found in our report [ 25 ].…”

“…The present study’s mean of LUSS was 12.21 ± 3.56 (S.D) which is higher than Li et al’s study (8.40 ± 1.70) and was included in the range of Ibarra-Ríos et al study (11.2–16) which is scored using a 10-area score [ 18 , 25 ]. The most common signs found in the newborns included in study were represented by B-lines changes, a fact confirmed also by Musolino et al [ 24 , 29 ].…”

“…In accordance with Musolino et al and Smargiassi et al, the importance of LUS is demonstrated in differentiating mild and moderate forms of COVID-19 pneumonia in children, due to the fact that children with mild forms mostly have a normal LUS pattern with no pathological findings [ 23 , 24 ]. The severity of the admitted cases has been reduced when compared to other similar studies that describe the need for intubation and even death among newborns with COVID-19 pneumonia [ 25 ]. This fact is also confirmed by our study results: a higher mean birth weight (2936.84 g vs. 2394 g), the percentage of preterm births was lower (10.52% vs. 41%), the mean of APGAR score was higher (8.71 vs. 8), and there was only one preterm (5.26%) who needed respiratory support at birth, compared to a 25% rate of intubation at birth in the other study [ 25 ].…”

“…The severity of the admitted cases has been reduced when compared to other similar studies that describe the need for intubation and even death among newborns with COVID-19 pneumonia [ 25 ]. This fact is also confirmed by our study results: a higher mean birth weight (2936.84 g vs. 2394 g), the percentage of preterm births was lower (10.52% vs. 41%), the mean of APGAR score was higher (8.71 vs. 8), and there was only one preterm (5.26%) who needed respiratory support at birth, compared to a 25% rate of intubation at birth in the other study [ 25 ].…”

“…The inflammatory status was well defined by the leukocytes, lymphocytes, and the level of the following biomarkers CK, CRP, LDH, AST, ferritin, and IL-6. For example, the mean of leukocytes (14,807.77/µL) was higher than the others reported (11,900/µL), but with differences in the mean of lymphocytes (6207.77/µL vs. 4032/µL) and neutrophils (6748.88/µL vs. 5936/µL) [ 25 ]. This difference can be explained by the changes in the immune system during the SARS-CoV2 infection, with the possibility of associated bacterial infection (and increase of the neutrophil level).…”