TITLE PAGE
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.