Optic Nerve Ultrasound Evaluation in Children: A Review

Abstract

Managing patients with neurocritical illness requires monitoring and treating elevated intracranial pressure (ICP), especially in cases in children. In terms of precise and real-time measurements, invasive ICP measurements are presently the gold standard for the initial diagnosis and follow-up ICP assessments. As a rapid and non-invasive way to detect elevated ICP, point-of-care ultrasonography (POCUS) of optic nerve sheath diameter (ONSD) has been proposed. The utility of bedside POCUS of ONSD to detect elevated ICP with excellent diagnostic test accuracy in adults has already been demonstrated. Nonetheless, data on the relationship between POCUS of ONSD and ICP in children are scarce. Therefore, the purpose of this review is to point out the most recent findings from the pediatric published literature and briefly discuss what was assessed with ONSD ultrasound examination, and also to describe and discuss the diagnostic procedures available for optic nerve ultrasound appraisal. A search of the medical databases PubMed and Scopus was carried out. The terms such as “ocular ultrasonography”, “ICP assessment”, “children”, “point-of-care ultrasound”, and “POCUS” were searched. In conclusion, the use of the standardized A-scan technique coupled with the B-scan technique should be suggested to provide data that are as accurate, precise, repeatable, and objective as possible.

Lung function assessment in children with Long‐Covid syndrome

“…However,, the authors observed increased CaNO levels in the severe/critical disease group compared to the mild disease one. Contrarily, Lindahl et al 42 found normal FeNO and CaNO levels in adult patients previously hospitalized for severe COVID‐19 at 3‐6 months from the recovery 36 . Nitric oxide has an antimicrobial action versus bacteria, fungi, parasites and selected viral species, and its production increases during viral infections 43 .…”

“…Similarly, Rinaldo et al 35 studied a cohort of 91 adult COVID‐19 survivors by cardiopulmonary exercise testing, with the most frequently observed abnormality consisting in early anaerobic threshold likely induced by muscle deconditioning. In the absence of permanent functional abnormalities, symptoms such as fatigue and exercise intolerance might be explained by muscle deconditioning, and behavioral changes induced by lockdown and social isolation 36 . In a prospective cohort study, including 518 Russian children aged 10 years with previous SARS‐CoV‐2 infection, 5% of the parents reported emotional and behavioral changes of their children, such as changes in eating habits, emotional wellbeing and physical activities 37 .…”

Optic nerve sheath diameter and its association with brain swelling in pediatric cerebral malaria: a retrospective study

“…The persistence of ONSD expansion beyond resolution of increased ICP has been demonstrated in traumatic brain injury in the adult population, limiting ONSD's use in the acute phase ( 23 ). In addition, only one method of measuring ONSD was employed in this study that has limitations in its imaging ability of small structures, an example of which is the optic nerve ( 24 ). It is possible that with the introduction of a second, possibly more accurate technique, such as A-scan ultrasonography, the prevalence of increased ONSD would be lower in our patient population.…”