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The lung ultrasound in children with SARS-COV 2 infection: a national multicenter prospective study
Maria Chiara Supino1*, MD, Danilo Buonsenso2,3, MD, PhD, Rino Agostiniani4, MD, Laura Gori5, MD, Vincenzo Tipo6, MD, Rosa Morello2, MD, Giovanni Del Monaco7, MD, Raffaele Falsaperla8, MD, Carlotta Biagi9, MD, Salvatore Cazzato10, MD, Alberto Villani1, MD, PhD, Anna Maria Musolino1, MD and the PLUSCOVID-19 Study Group
PLUSCOVID-19 Study group: Pediatric Lung UltraSoundCOrona Virus Disease 19
Simona Scateni1, MD, Valentina Ferro1, MD, Barbara Scialanga1, MD, Maria Alessia Mesturino1, MD, Elena Boccuzzi1, MD, Carolina D’Anna6, MD, Vittorio Romagnoli10, MD, Silvia Marino11, MD, Roberta Puxeddu4, MD, Gaia Martelli10, MD, Thaililja Gagliardo6 , MD, Manuel Murciano1, MD, Federica Pellizzoni12, MD
Affiliations:
1 Pediatric Emergency Unit, Department of Emergency and General Pediatrics, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy.
2 Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome Italy.
3 Centro di Salute Globale, Università Cattolica del Sacro Cuore, Roma, Italy.
4 Department of Pediatrics, San Jacopo Hospital, Pistoia, Italy.
5 Department of Maternal and Child Health, Division of Pediatric Unit, S. Chiara Hospital, Pisa, Italy.
6 Pediatric Emergency and Short Stay Unit, Santobono-Pausilipon Children’s Hospital, Naples, Italy.
7 Pediatric Emergency Unit, City of Health and Science of Turin, Turin, Italy.
8 Neonatal Intensive Care Unit [NICU], AOU ”Rodolico-San Marco”, PO ”San Marco”, University of Catania, Catania, Italy.
9 Pediatric Unit, Department of Mother and Child Health, Salesi Children’s Hospital, Ancona, Italy.
10 Pediatric Emergency Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
11 Pediatric and Pediatric Emergency Department, AOUP “Rodolico San Marco”, PO “San Marco”, University of Catania, Catania
12 Pediatric and Neonatal Unit, San Raffaele Hospital, Università Vita-Salute San Raffaele, Milano
Keywords: pediatric, thorax, infection disease, emergency,pulmonary ultrasound
Conflict of interests : the authors declare that there are no conflicts of interests.
Funding : This work was supported also by the Italian Ministry of Health with ”Current Research funds”
Data availability statement: the data that support the findings of this study are available from the corresponding author upon reasonable request.
* Correspondence: Maria Chiara Supino, MD
ORCID: https://orcid.org/0000-0003-2507-8886
Pediatric Emergency Unit
Department of Emergency and General Pediatrics
Bambino Gesù Children’s Hospital, IRCCS
Piazza Sant’Onofrio 4, Rome, Italy.
Tel: +39 0668592909
E-mail:mariachiarasupino@gmail.com
Running title:The lung ultrasound in children with SARS-COV 2 ABSTRACT
Covid-19 causedhospitalizations, 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 (LUS) in children with Covid-19.
We enrolled children between 1 month and 18 years of age diagnosed with SARS-CoV2 infection and whounderwenta lung ultrasound within 6 hours from firstmedical evaluation.
A total of 213 children were enrolled, 51.6%were male, median age was2 years and 5 months (IQR 4mm- 11 yearsand4 months).One hundred and fortyeight (69.4%) children were admitted in hospital, 9 (6.1%) in pediatric intensive care unit.We found an inverse correlation between the LUS score and the oxygen saturationatthe clinical evaluation (r = −0.16; p = 0.019). Moreover, LUS scores were significantly higher in patients requiring oxygen supplementation (8 (IQR 3 - 19) vs 2 (IQR 0 - 4); p= 0.001).
Among LUS pathological findings, irregular pleural line, sub-pleural consolidations and pleural effusions were significantly more frequentin patients whoneeded oxygen supplementation (p = 0.007; p = 0.006 andp = 0.001, respectively).
This multicentric study confirmed that LUS is able to detect Covid-19 low respiratory tract involvement, which is characterized by pleural line irregularities, vertical artifacts and subpleural consolidations. Notably, children with higher LUS score have an higher risk of hospitalization or need for oxygen supplementation, supporting LUS as a valid and safe point-of-care first level tool for the clinical evaluation of children with Covid-19.