Buonsenso Danilo, Soldati Gino, Curatola Antonietta, Morello Rosa, De Rose Cristina, Vacca Maria Eugenia, Lazzareschi Ilaria, Musolino Anna Maria, Valentini Piero
Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
Istituto di Microbiologia, Università Cattolica del Sacro Cuore, Roma, Italia.
J Ultrasound Med. 2020 Dec;39(12):2379-2388. doi: 10.1002/jum.15347. Epub 2020 May 29.
Lung ultrasound (LUS) has gained a primary role in the diagnosis and management of pleuropulmonary disorders in pediatric practice. However, normal and pathologic patterns are translated from adult studies and have never been specifically studied in children, particularly in infants. This was a prospective observational pilot study aiming to define the normal LUS pattern in healthy infants during the first 6 months of life.
We recruited healthy neonates at 7 to 10 days of life, and these were followed until the sixth month of life (times: 7-10 days, 1 month, 3 months, and 6 months). We excluded neonates with a gestational age before 33 weeks and neonates with cardiac or lung abnormalities or diseases, immune deficiencies, metabolic or genetic conditions, and acute or chronic respiratory diseases. A LUS evaluation was performed by a single certified pediatrician. The chest wall was examined in 18 areas, addressing A-lines, short and long B-lines, pleural abnormalities, and subpleural consolidations.
Thirty-seven neonates were enrolled and followed until the sixth month of life, 27 (73%) of whom were born at term (≥37 weeks) and 10 (27%) of whom were born preterm (33-36 weeks). Most of the patients at 7 to 10 days showed multiple B-lines (long and short) with a progressive normalization toward a normal A pattern at 6 months (P < .00001; 95% confidence interval, 13.75-23.24). No infants showed subpleural consolidations or pleural abnormalities.
This study has implications for the interpretation of LUS during the first 6 months of life. Most healthy infants show a diffuse pattern of vertical artifacts (B-lines), and the LUS pattern tends to be similar to the physiologic pattern (A-lines) after the sixth month of life. The only pathologic LUS findings were pleural irregularities and effusion and subpleural consolidations, which have never been described in healthy infants.
肺部超声（LUS）在儿科临床实践中对胸膜肺部疾病的诊断和管理中发挥着重要作用。然而，正常和病理模式是从成人研究中转化而来的，从未在儿童中进行过专门研究，尤其是在婴儿中。这是一项前瞻性观察性试点研究，旨在确定健康婴儿出生后前6个月的正常LUS模式。
我们招募了出生7至10天的健康新生儿，并对其进行随访直至6个月大（时间点：7至10天、1个月、3个月和6个月）。我们排除了胎龄小于33周的新生儿以及患有心脏或肺部异常或疾病、免疫缺陷、代谢或遗传疾病以及急慢性呼吸道疾病的新生儿。由一名经过认证的儿科医生进行LUS评估。在18个区域检查胸壁，观察A线、长短B线、胸膜异常和胸膜下实变。
37名新生儿被纳入研究并随访至6个月大，其中27名（73%）为足月儿（≥37周），10名（27%）为早产儿（33至36周）。大多数7至10天的患儿显示多条B线（长B线和短B线），在6个月时逐渐恢复正常，呈现正常A模式（P <.00001；95%置信区间，13.75至23.24）。没有婴儿出现胸膜下实变或胸膜异常。
本研究对出生后前6个月LUS的解读具有重要意义。大多数健康婴儿表现出弥漫性的垂直伪像（B线）模式，6个月后LUS模式趋于与生理模式（A线）相似。仅有的病理性LUS表现为胸膜不规则和积液以及胸膜下实变，这些在健康婴儿中从未被描述过。
