Prognostic Role of Lung Ultrasound in Children with Bronchiolitis: Multicentric Prospective Study

Abstract

There is increasing recognition of the role of lung ultrasound (LUS) to assess bronchiolitis severity in children. However, available studies are limited to small, single-center cohorts. We aimed to assess a qualitative and quantitative LUS protocol to evaluate the course of bronchiolitis at diagnosis and during follow-up. This is a prospective, multicenter study. Children with bronchiolitis were stratified according to clinical severity and underwent four LUS evaluations at set intervals. LUS was classified according to four models: (1) positive/negative; (2) main LUS pattern (normal/interstitial/consolidative/mixed) (3) LUS score; (4) LUS score with cutoff. Two hundred and thirty-three children were enrolled. The baseline LUS was significantly associated with bronchiolitis severity, using both the qualitative (positive/negative LUS p < 0.001; consolidated/normal LUS pattern or mixed/normal LUS p < 0.001) and quantitative models (cutoff score > 9 p < 0.001; LUS mean score p < 0.001). During follow-up, all LUS results according to all LUS models improved (p < 0.001). Better cut off value was declared at a value of >9 points. Conclusions: Our study supports the role of a comprehensive qualitative and quantitative LUS protocol for the identification of severe cases of bronchiolitis and provides data on the evolution of lung aeration during follow-up.

Role of Lung Ultrasound in the Follow-Up of Children with Previous SARS-CoV-2 Infection: A Case-Control Assessment of Children with Long COVID or Fully Recovered

“…Given the large number of adults with COVID-19 followed up with LUS, we implemented our protocol based on the rational that LUS may help recognize recovery or persisting peripheral lung pathology. The rational was also based on a small study we previously published on COVID-19 children [11] and also on our local practice (we use LUS routinely to follow up patients with pneumonia and bronchiolitis) [31]. In contrast to adult data, which are characterized by a more severe lung involvement during acute infection, more reassuring data are available for children, although fewer studies have assessed this issue.…”

A combined rapid clinical and lung ultrasound score for predicting bronchiolitis severity

“…In paediatrics, a large number of studies have focused on bronchiolitis [2][3][4][5][6][7][8][9][10][11][12][13][14][15]. It is now well established that LUS can detect different patterns of lung involvement in children with bronchiolitis, including vertical artifacts and different-size subpleural consolidations, which, according to a recent study with a standardized follow-up, seem to be mostly peripheral areas of disventilation/atelectasis given their rapid resolution [15].…”

“…In paediatrics, a large number of studies have focused on bronchiolitis [2][3][4][5][6][7][8][9][10][11][12][13][14][15]. It is now well established that LUS can detect different patterns of lung involvement in children with bronchiolitis, including vertical artifacts and different-size subpleural consolidations, which, according to a recent study with a standardized follow-up, seem to be mostly peripheral areas of disventilation/atelectasis given their rapid resolution [15]. Moreover, previous studies using different ultrasound approaches showed that children with bronchiolitis have frequent posterior paravertebral small consolidations or that patients requiring oxygen or ventilation usually have higher LUS scores, however with large overlaps of LUS scores between the different groups and mostly including small or no patients needing PICU admission [2][3][4][5][6][7][8][9][10][11][12][13][14][15].…”

“…More recently, the rst national multicentric study has been performed in Italy, providing an extensive LUS assessment of all thoracic areas in more than 200 children, showing a good concordance of a score of the Italian Academy of Thoracic Ecography (ADET) with clinical severity scores, however despite large numbers the study failed to include enough children needing PICU admission or a higher level of respiratory support such as continuous positive airway pressure, (CPAP) [ 1 5]. 15 . Also, an extensive approach that require a time-consuming LUS protocol may be di cult to be adapted in real-life contexts, and more speci cally in busy emergency departments or with more severe children.…”

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

“…Similar evidence is already available from other pediatric respiratory conditions like acute bronchiolitis, where several studies have documented that children with higher LUS score have a higher risk of hospitalization, respiratory support and intensive care unit admission. 28 In our study, we performed subanalyses according to age groups. In general, we found that lung involvement was more significant in children older than 1 year of age, which is in line with a well-established although not yet fully understood gradient of more severe disease according to increasing age.…”