Purpose: Children with bronchiolitis admiteed to the pediatric intensive care unit (PICU) for acute respiratory failure may require respiratory support with non-invasive ventilation (NIV). Enteral nutrition (EN) is associated with a reduction in hospital stay. Even so, guidelines do not specify on how to initiate, increase and maintain EN in these patients. Methods This was a prospective interventional study. Inclusion criteria were patients with bronchiolitis under NIV. A multidisciplinary team created an algorithm to improve EN for critically ill patients with bronchiolitis in need of NIV. In order to assess the protocol implementation, two periods of time were compared: Group 1: without nutrition implementation protocol vs Group 2, once the protocol was implemented. The project aim was to decrease the mean time to EN initation by 50% after the start of NIV. Secondary endpoints were time to reach target calories ( 100 kcal/kg/day), NIV duration, and % of patients with adverse effects. Results Hundred two patients were included in this study. In group 1, Forty eight and 54 in group 2. Statistically significant differences were detected in the main outcome. The mean time until the start of EN decreased from 18.5 hours to 6 hours (p<0.05) Median time to reach calorie goal decreased from 103.5 hours to 48.5 hours (p<0.05). No differences were dettected in other outcomes. Conclusions The implementation of a standardized route for EN in patients with NIV allow a decrease in the time of the start feeds and the time to the goal of caloric enteral nutrition.

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.