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The lung ultrasound in children with SARS-COV 2 infection: a national multicenter prospective study

Maria Chiara Supino^1*, MD, Danilo Buonsenso^2,3, 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.