BackgroundThere are few prospective evaluations of point-of-care ultrasonography (US) for the diagnosis of pediatric community-acquired pneumonia (CAP). In particular, there are very few data concerning the efficiency of US in comparison with that of chest radiography (CR) in defining different kinds of lung alterations in the various pulmonary sections. The aim of this study was to bridge this gap in order to increase our knowledge of the performance of US in diagnosing CAP in childhood.MethodsA total of 103 children (56 males, 54.4%; mean age ± standard deviation 5.6 ± 4.6 years) admitted to hospital with a clinical diagnosis of suspected CAP were prospectively enrolled and underwent CR (evaluated by an independent expert radiologist) and lung US (performed by a resident in paediatrics with limited experience in US). The performance of US in diagnosing CAP (i.e. its sensitivity, specificity, and positive and negative predictive values) was compared with that of CR.ResultsA total of 48 patients had radiographically confirmed CAP. The sensitivity, specificity, and positive and negative predictive values of US in comparison with CR were respectively 97.9%, 94.5%, 94.0% and 98.1%. US identified a significantly higher number of cases of pleural effusion, but the concordance of the two methods in identifying the type of CAP was poor.ConclusionUS can be considered a useful means of diagnosing CAP in children admitted to an Emergency Department with a lower respiratory tract infection, although its usefulness in identifying the type of lung involvement requires further evaluation.

There are few and partially discordant data regarding nasopharyngeal rhinovirus (RV) load and viremia, and none of the published studies evaluated the two variables together. The aim of this study was to provide new information concerning the clinical relevance of determining nasopharyngeal viral load and viremia when characterising RV infection. Nasopharyngeal swabs were obtained from 251 children upon their admission to hospital because of fever and signs and symptoms of acute respiratory infection in order to identify the virus and determine its nasopharyngeal load, and a venous blood sample was taken in order to evaluate viremia. Fifty children (19.9 %) had RV-positive nasopharyngeal swabs, six (12 %) of whom also had RV viremia: RV-C in four cases (66.6 %), and RV-A and RV-B in one case each. The RV nasopharyngeal load was significantly higher in the children with RV viremia (p < 0.001), who also had a higher respiratory rate (p = 0.02), white blood cell counts (p = 0.008) and C-reactive protein levels (p = 0.006), lower blood O2 saturation levels (P = 0.005), and more often required O2 therapy (p = 0.009). The presence of RV viremia is associated with a significantly higher nasopharyngeal viral load and more severe disease, which suggests that a high nasopharyngeal viral load is a prerequisite for viremia, and that viremia is associated with considerable clinical involvement.

Objectives-Point-of-care lung sonography has theoretical usefulness in numerous diseases; however clinical indications and the impact of this technique have not been fully investigated. We aimed to describe the current use of point-of-care lung sonography.Methods-A 2-year prospective observational study was performed by pulmonologists in an Italian university hospital. Techniques, indications, consequences of lung sonography, and barriers to the examination were analyzed. Conclusions-Point-of-care lung sonography performed by pulmonologists is quick and feasible and could be widely used for different clinical indications with a potentially high clinical impact. The widespread use of this technique may have a relevant clinical impact in several indications.

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Urinary tract dilatation is identified sonographically in 1-2% of fetuses and reflects a spectrum of possible nephro-uropathies. There is significant variability in the clinical management of individuals with prenatal urinary tract dilatation to postnatal urinary pathologies, because of a lack of consensus and uniformity in defining and classifying urinary tract dilation. Ultrasonography is the first step to screen and diagnose kidneys and the urinary tract diseases of the children. The need for a correct ultrasound approach led to the realization of algorithms aimed at standardizing the procedures, the parameters and the classifications. Our objective was to highlight the strengths of the Classification of Urinary Tract Dilation (UTD) suggested by the Consensus Conference which took place in 2014 with the participation of eight Scientific Societies and was subsequently published on the Journal of Pediatric Urology. Before its spread out, the definition of UTD was not uniform and the ultrasonographic measurements were not clearly defined, leading to misunderstandings between physicians. The Classification by the Consensus Conference of 2014 represents a revolutionary tool for the diagnosis and management of UTD. Furthermore, the parameters suggested by the classification proposed are applicable for both prenatal and postnatal classification, ensuring a correct follow-up in children with UTD whose diagnosis had been already made during pregnancy. Keywords Urinary tract dilatation • Ultrasound • Contrast-enhanced ultrasound • Kidney Sommario Dilatazioni a carico delle vie urinarie vengono identificate nell' 1-2% dei feti e riflettono uno spettro molto variabile di possibilinefro-uropatie. A causa dell'assenza di un chiaro consenso ed uniformità nella definizione e classificazione di dilatazione a carico delle vie urinarie esiste una notevole variabilità nella gestione clinica di soggetti con questa diagnosi prenatale. L'ecografia rappresenta certamente la metodica di primo livello per l'iniziale individuazione e diagnosi di malattie dei reni e delle vie urinarie. L'esigenza di un corretto approccio ecografico ha portato ad una standardizzazione delle procedure, dei parametri e delle classificazioni. L'obiettivo di questo lavoro è quello di evidenziare i punti di forza della Classificazione della dilatazione delle vie urinarie (Urinary Tract Dilation-UTD) suggerita dalla Consensus Conference tenutasi nel 2014 con la partecipazione di 8 società scientifiche e pubblicata successivamente sul Journal of Pediatric Urology. Prima della sua diffusione, infatti, la definizione di UTD non era uniforme e le misurazioni ecografiche non erano chiaramente definite, dando luogo a incomprensioni o diverse interpretazioni tra i medici coinvolti. La classificazione della Consensus Conference del 2014 rappresenta uno strumento rivoluzionario per la diagnosi e la gestione dell' UTD. I parametri suggeriti da tale classificazione, inoltre, sono applicabili sia al periodo prenatale che a quello postnatale, assicurando una corretta classi...

BackgroundThere is limited information available on fast and safe bedside tools that could help clinicians establish whether the pathological process underlying cases of wheezing is due to asthmatic exacerbation, asthmatic bronchitis, or pneumonia. The study's aim was to characterize Lung Ultrasound (LUS) in school-aged children with wheezing and evaluate its use for their follow-up treatment.Materials and methodsWe carried out a cross-sectional study involving 68 consecutive outpatients (mean age 9.9 years) with wheezing and suggestive signs of an acute respiratory infection. An expert sonographer, blinded to all subject characteristics, clinical course, and the study pediatrician's diagnosis, performed an LUS after spirometry and before BDT. The severity of acute respiratory symptoms was determined using the Pediatric Respiratory Assessment Measure (PRAM) score.ResultsThe LUS was positive in 38.2% (26/68) of patients [12 (46.1%) with multiple B-lines, 24 (92.3%) with consolidation, and 22 (84.6%) with pleural abnormalities]. In patients with pneumonia, asthmatic bronchitis, and asthma, the percentages of those patients with a positive LUS were 100%, 57.7%, and 0%, respectively. Of note, patients with a positive LUS were associated with an increased need for hospital admission (30.8% vs. 2.4%, p = 0.001), administration of oxygen therapy (14.6% vs. 0%, p = 0.009), oral corticosteroids (84.6% vs. 19.0%, p &lt; 0.001), and antibiotics (88.5% vs. 11.9%, p &lt; 0.001); and a higher median value of PRAM score (4.0 (2.0–7.0) vs. 2.0 (1.0–5.0); p &lt; 0.001).ConclusionsOur findings would suggest the use of LUS as a safe and cheap tool used by clinicians to define the diagnosis of school-aged children with wheezing of unknown causes.

Clinical EvaluationA 17-year-old male subject with allergic asthma since childhood was transferred from a local hospital to our Department of Pediatrics with reports of chest pain preceded by 3 days of a dry cough and worsening dyspnea. In the last year, he had been controlling his asthma symptoms exclusively with salbutamol, several times a month. The patient had smoked marijuana and tobacco on the previous morning of admission. He denied neurologic complaint, air travel, trauma, or vomiting. On physical examination, the patient was nontoxic appearing but was short of breath and unable to speak in full sentences. He was afebrile with an initial heart rate of 134 beats/min, a respiratory rate of 35 breaths/min, and room air pulse oximetry of 90%. Blood analysis revealed no significant changes, except for a neutrophil count of 14.62 Â 10