Lung ultrasound in bronchiolitis.
bronchiolitis
infant
lung
ultrasound
Journal
Pediatric pulmonology
ISSN: 1099-0496
Titre abrégé: Pediatr Pulmonol
Pays: United States
ID NLM: 8510590
Informations de publication
Date de publication:
01 2021
01 2021
Historique:
received:
04
07
2020
revised:
25
09
2020
accepted:
26
10
2020
pubmed:
6
11
2020
medline:
16
6
2021
entrez:
5
11
2020
Statut:
ppublish
Résumé
Bronchiolitis is the most common acute viral infection of the lower respiratory tract in infants. Clinical severity is associated with different risk factors; however, no clinical, laboratory, or radiological findings are able to predict the course of the disease in full-term infants. Lung ultrasound (LUS) is a valid technique for the diagnosis and evaluation of pediatric respiratory diseases. The aim of our study was to correlate an LUS score with a clinical score, to describe lung ultrasound findings in cases and controls, and to compare LUS findings with chest X-ray (CXR) in infants hospitalized with bronchiolitis. We conducted a single-center, longitudinal, prospective study on 92 infants. Sixty-three out of 92 infants were hospitalized for acute bronchiolitis (cases) and twenty-nine out of 92 for diseases not involving the respiratory system (controls). All patients with bronchiolitis underwent a clinical evaluation with the assignment of a clinical severity score and performed lung ultrasound with the assignment of an LUS score. Twenty-three out of 63 infants with bronchiolitis underwent also a CXR for clinical indications. Control infants performed only LUS. In infants with bronchiolitis LUS score showed a positive correlation with the clinical score (r = .62, p < .001) and the length of hospitalization (r = .42; p < .001). The need of oxygen therapy was more frequent in the patients with higher LUS score (p < .001). LUS findings observed in the cases were the presence of B-lines, subpleural consolidations, and abnormalities of the pleural line. No LUS alterations were observed in the controls. In patients who performed LUS and CXR, we found a correlation between the presence of abnormalities of the pleural line with LUS and the presence of air trapping with CXR (r = .55; p = .007).
Sections du résumé
BACKGROUND
Bronchiolitis is the most common acute viral infection of the lower respiratory tract in infants. Clinical severity is associated with different risk factors; however, no clinical, laboratory, or radiological findings are able to predict the course of the disease in full-term infants. Lung ultrasound (LUS) is a valid technique for the diagnosis and evaluation of pediatric respiratory diseases.
AIMS
The aim of our study was to correlate an LUS score with a clinical score, to describe lung ultrasound findings in cases and controls, and to compare LUS findings with chest X-ray (CXR) in infants hospitalized with bronchiolitis.
METHODS
We conducted a single-center, longitudinal, prospective study on 92 infants. Sixty-three out of 92 infants were hospitalized for acute bronchiolitis (cases) and twenty-nine out of 92 for diseases not involving the respiratory system (controls). All patients with bronchiolitis underwent a clinical evaluation with the assignment of a clinical severity score and performed lung ultrasound with the assignment of an LUS score. Twenty-three out of 63 infants with bronchiolitis underwent also a CXR for clinical indications. Control infants performed only LUS.
RESULTS
In infants with bronchiolitis LUS score showed a positive correlation with the clinical score (r = .62, p < .001) and the length of hospitalization (r = .42; p < .001). The need of oxygen therapy was more frequent in the patients with higher LUS score (p < .001). LUS findings observed in the cases were the presence of B-lines, subpleural consolidations, and abnormalities of the pleural line. No LUS alterations were observed in the controls. In patients who performed LUS and CXR, we found a correlation between the presence of abnormalities of the pleural line with LUS and the presence of air trapping with CXR (r = .55; p = .007).
Types de publication
Comparative Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
234-239Informations de copyright
© 2020 Wiley Periodicals LLC.
Références
Meissner HC. Viral bronchiolitis in children. NEng J Med. 2016;374:62-72.
Midulla F, Eber E. ERS handbook: pediatric respiratory medicine. In: Midulla F, Nicolai A, Moretti C, eds. Acute Viral Bronchiolitis. 9, 1st Edn. Hermes; 2013:305-309.
Ralston SL, Lieberthal AS, Meissner HC, et al. American Academy of Pediatrics. Clinical practice guideline: the diagnosis, management, and prevention of bronchiolitis. Pediatrics. 2014;134:5-e1502.
Midulla F, Eber E. ERS handbook: pediatric respiratory medicine. In: Casini C, Basile V, Manzionna M, eds. Ultrasonography. Vol 5, 1st Edn. Hermes; 2013:182-189.
Supino MC, Buonsenso D, Scateni S, et al. Point-of-care lung ultrasound in infants with bronchiolitis in the pediatric emergency department: a prospective study. Eur J Pediatr. 2019;178(5):623-632.
Bueno-Campaña M, Sainz T, Alba M, et al. Lung ultrasound for prediction of respiratory support in infants with acute bronchiolitis: a cohort study. Pediatr Pulmonol. 2019;54(6):873-880.
Baraldi E, Lanari M, Manzoni P, et al. Inter-society consensus document on treatment and prevention of bronchiolitis in newborns and infants. Ital J Pediatr. 2014;40:65.
Petrarca L, Nenna R, Frassanito A, et al. Bronchiolitis under 6 months of age: time for changing definition? Eur Respir J. 2018:52 PA4641.
Midulla F, Scagnolari C, Bonci E, et al. Respiratory syncytial virus, human bocavirus and rhinovirus bronchiolitis in infants. Arch Dis Child. 2010;95(1):35-41.
Midulla F, Di Mattia G, Nenna R, et al. Novel variants of respiratory syncytial virus A ON1 associated with increased clinical severity of bronchiolitis. J Infect Dis. 2020;222(1):102-110.
Copetti R, Cattarossi L, Macagno F, Violino M, Furlan R. Lung ultrasound in respiratory distress syndrome: a useful tool for early diagnosis. Neonatology. 2008;94(1):52-59.
Lichtenstein D, Mézière G, Biderman P, Gepner A, Barré O. The comet-tail artifact. An ultrasound sign of alveolar-interstitial syndrome. Am J Respir Crit Care Med. 1997;156(5):1640-1646.
Basile V, Di Mauro A, Scalini E, et al. Lung ultrasound: a useful tool in diagnosis and management of bronchiolitis. BMC Pediatr. 2015;15:63.
Caiulo VA, Gargani L, Caiulo S, et al. Lung ultrasound in bronchiolitis: comparison with chest X-ray. Eur J Pediatr. 2011;170(11):1427-1433.
Bloise S, La Regina DP, Pepino D, et al. Lung ultrasound (LUS) for the diagnosis of community-acquired pneumonia (CAP) in children: a comparison study with chest X-ray (CXR). In peer.
Biagi C, Pierantoni L, Baldazzi M, et al. Lung ultrasound for the diagnosis of pneumonia in children with acute bronchiolitis. BMC Pulm Med. 2018;18:191.