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To B or not to B. The rationale for quantifying B-lines in paediatric lung diseases.
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  • Niccolò Parri,
  • Marco Allinovi,
  • Martina Giacalone,
  • Iuri Corsini
Niccolò Parri
Azienda Ospedaliero Universitaria Ospedale Pediatrico Meyer
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Marco Allinovi
Azienda Ospedaliero Universitaria Careggi
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Martina Giacalone
Azienda Ospedaliero Universitaria Meyer
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Iuri Corsini
Azienda Ospedaliero Universitaria Careggi
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Abstract

The evaluation of the lung by ultrasound is an adjunct tool to the clinical assessment. Among different hallmarks at lung ultrasound, B-lines are well known artifacts which are not correlated to identifiable structures but can be used as an instrument for pathological classification. Multiple B-lines are the sonographic sign of lung interstitial syndrome with a direct correlation between the number of B-lines and the severity of the interstitial involvement of lung disease. In neonatology and paediatrics, the quantitative assessment of B-lines is questionable as opposed to in adult medical care. Counting B-lines is an attempt to enrich the clinical assessment and clinical information, and not simply arrive at a dichotomous answer. A semiquantitative or quantitative B-lines assessment was shown to correlate with fluid overload and demonstrated prognostic implications in specific neonatal and paediatric conditions. In neonatology, the count of B-lines is used to predict the need for admission in neonatal intensive care unit and the need for exogenous surfactant treatment. In paediatrics, the B-lines count has the role of quantifying hypervolemia in infants and children receiving dialysis. B-lines as predictors of length of stay in the paediatric intensive care unit after cardiac surgery, as a marker of disease severity in bronchiolitis, or as an indicator of lung involvement from SARS-CoV-2 infection are speculative and not yet supported by solid evidence. Lung ultrasound with the quantitative B-lines assessment is promising. The current evidence allows to use the quantification of B-lines in a limited number of neonatal and paediatric diseases.

Peer review status:IN REVISION

11 Nov 2021Submitted to Pediatric Pulmonology
12 Nov 2021Assigned to Editor
12 Nov 2021Submission Checks Completed
14 Nov 2021Reviewer(s) Assigned
13 Dec 2021Review(s) Completed, Editorial Evaluation Pending
05 Jan 2022Editorial Decision: Revise Major