Pediatric Emergency Unit, Pediatric Emergency Department and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
Eur J Pediatr. 2024 Aug;183(8):3397-3405. doi: 10.1007/s00431-024-05609-0. Epub 2024 May 20.
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.
新型冠状病毒病-19（COVID-19）可导致任何年龄段的住院、重症和死亡，包括年龄最小的儿童。本多中心国家研究的目的是描述儿童 COVID-19 患者肺部超声（LU）的临床特征和预后作用。我们招募了年龄在 1 个月至 18 岁之间的、有严重急性呼吸综合征冠状病毒 2（SARS-CoV2）感染且在首次医疗评估后 6 小时内进行 LU 的儿童。共纳入 213 例儿童，其中 51.6%为男性，中位年龄为 2 岁零 5 个月（四分位距 4 个月-11 岁零 4 个月）。148 例（69.4%）儿童住院，9 例（6.1%）入住儿科重症监护病房。我们发现 LU 评分（LUS）与首次临床评估时的血氧饱和度呈负相关（r=-0.16；p=0.019）。此外，需要氧疗的患者的 LUS 显著较高（8（IQR 3-19）vs 2（IQR 0-4）；p=0.001）。在 LU 病理发现中，需要氧疗的患者胸膜线不规则、胸膜下实变和胸腔积液更为常见（p=0.007、p=0.006 和 p=0.001）。结论：本多中心研究表明，COVID-19 患儿的 LU 可突出胸膜线不规则、垂直伪影和胸膜下实变。值得注意的是，LUS 较高的患儿住院和需要氧疗的风险更高，支持 LU 作为 COVID-19 患儿临床评估的有效、安全的床边一线工具。已知情况：• 少数感染 SARS-CoV-2 的儿童会发展为严重疾病并需要氧疗。• 肺部超声可在 SARS-CoV-2 感染期间轻松检测下呼吸道感染。新发现：• LUS 较高的患儿需要氧疗的风险更高。• 需要氧疗的患者中，胸膜线不规则、胸膜下实变和胸腔积液更为常见。
