COVID-19 and lung ultrasound: reasons why paediatricians can support adult COVID-19 units during critical epidemiologic periods

Abstract

Since the beginning of the SARS-CoV-2 spread outside China, several hospitals have changed their organisation to increase critical care capacity and isolation areas to COVID19 patients as well as to generate new flows to guarantee safety and care to non-COVID-19 patients. In addition, the paediatric practice has changed completely. SARS-CoV-2 rarely involves children, and most of the time, the paediatric COVID-19 disease is mild [1]. Moreover, parents have stopped routinely bringing their children to the hospital either because of the fear that their children might contract the infection or because of a lockdownrelated drop of seasonal infectious diseases [2]. As a result, the workload of paediatricians has significantly reduced in the past few months [3], and therefore, their inclusion in COVID units should be considered by institutions. Although not directly involved in adult care, paediatricians may play a significant role in managing COVID19 patients for several reasons. From a clinical point of view, several common clinical scenarios can be included in COVID-19 adults that overlap with common paediatric conditions to which paediatricians, especially some categories of them, are already accustomed to their diagnosis and management (Table 1) [4, 5]. In the last few years, in several paediatric settings, lung ultrasound (LUS) has become the first-line imaging method in children evaluated for respiratory disease, allowing the real-time diagnosis and monitoring of lung involvement [6–13]. In recent years, several studies have shown that LUS is a useful and accurate tool for detecting pneumonia in children and it may be better than chest radiography in the diagnosis of community-acquired pneumonia [6–9, 13]. Other studies have shown that LUS can be used to predict more severe pneumonia and monitor antibiotic response, and recently, different LUS patterns have been used to differentiate viral from bacterial pneumonia by defining their etiology [6, 9, 13]. Many studies have described and validated LUS scores (based mainly on vertical artefacts and sub-pleural consolidations) in neonatal respiratory disorders [10] and bronchiolitis. [11, 12]. Over the years, the development of LUS studies on the paediatric population and the use of LUS in paediatric clinical practice have become fundamental in references to studies performed on adults [14, 15], hence the translation of knowledge acquired from these studies in the clinical paediatric practice. However, true collaboration between paediatric and adult specialists is also fundamental, especially in the interpretation of some ultrasound findings, such as in the cases of vertical artefacts and ultrasound interstitial syndrome [7, 14, 15]. Since the outbreak of the pandemic, this sharing/collaboration of experiences and studies has assumed a greater force that takes shape every day in the fight against COVID19. In particular, it is not a coincidence that of all medical professionals, a paediatrician not only suggested that the medical community use ultrasound more frequently in suspected COVID-19 patients but also described the first case of COVID-19 (an adult patient), diagnosed and managed with thoracic ultrasound [16–18]. Since then, LUS has played a key role in the management of patients with COVID-19 pneumonia. More importantly, the ultrasound patterns of viral pneumonia and bronchiolitis in children are similar to those seen in COVID-19 pneumonia patients (e.g. pleural line irregularities and vertical artefacts (B-lines) with patchy distribution, sub-pleural * Danilo Buonsenso [email protected]