Point-of-care lung ultrasound in infants with bronchiolitis in the pediatric emergency department: a prospective study
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Bronchiolitis is the most common cause of hospitalization of children in the first year of life. The lung ultrasound is a new diagnostic tool which is inexpensive, non-invasive, rapid, and easily repeatable. Our prospective study was conducted in the emergency department and all patients underwent a routine clinical evaluation and lung ultrasound by the pediatricians who defined the clinical and the ultrasound score. We enrolled 76 infants (median age 90 days [IQR 62–183], 53.9% males). In nasopharyngeal aspirates, the respiratory syncytial virus was isolated in 33 patients. Considering the clinical score, children with higher score had a higher probability of requiring respiratory support (p 0.001). At the ultrasound evaluation, there was a significant difference on ultrasound score between those who will need respiratory support or not (p 0.003). Infants who needed ventilation with helmet continuous positive airway pressure had a more severe ultrasound score (p 0.028) and clinical score (p 0.004), if compared with those who did not need it.
What is Known:
• Bronchiolitis is the main cause of lower respiratory tract infection in children younger than 24 months.
• Ultrasound can evaluate the lung parenchyma without ionizing radiations.
What is New:
• Lung ultrasound may be a useful diagnostic tool to define the prognosis of the infants affected by bronchiolitis if performed at the first assessment in the emergency department.
• The score obtained at the ultrasound evaluation is higher in those who will need oxygen therapy during admission for more time and in those who will need respiratory support with helmet continuous positive airway pressure.
KeywordsUltrasound Bronchiolitis Children Pocus Lung Precision medicine
Analysis of variance
American Academy of Pediatrics
Helmet continuous positive airway pressure
High-flow nasal cannula
National Institute for Health and Care Excellence
Pediatric intensive care unit
Respiratory syncytial virus
Hemoglobin oxygen saturation
Statistical Package for the Social Science
The authors are grateful to all the children and their parents, nurses, and physicians who helped to perform this study. We also thank Dr. Umberto Raucci (Bambino Gesù Children Hospital of Rome, Italy) for his excellent assistance.
Conception and research design: M.C. Supino, D. Buonsenso, A.M. Musolino
Data collection: S. Scateni, M.A. Mesturino, C. Bock, A. Chiaretti
Data analysis and interpretation and drafting the article: A. Reale, B. Scialanga, E. Giglioni, M.C. Supino
Final approval of the article: all the authors.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study described has been carried out in accordance with the abovementioned standards and has been approved by the institutional ethic committee.
Informed consent was obtained from all individual participants included in the study.
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