Role of Lung Ultrasound in the Follow-Up of Children with Previous SARS-CoV-2 Infection: A Case-Control Assessment of Children with Long COVID or Fully Recovered

Buonsenso, Danilo; Morello, Rosa; Mariani, Francesco; Cortese, Riccardo; Vetrugno, Luigi; Valentini, Piero

doi:10.3390/jcm12093342

Cited by 5 publications

(4 citation statements)

References 34 publications

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“…According to our findings, in a prospective study including 647 children aged 8 years, Buonsenso et al 45 observed persistent symptoms in about 40% of patients 2 months after acute infection.…”

Section: Resultssupporting

confidence: 70%

“…The usefulness of LUS in detecting lower respiratory tract involvement in children with SARS-CoV-2 acute infection is well known. 45 In an observational study including eight children during acute COVID-19, Denina et al 46 firstly demonstrated a concordance of LUS findings with radiologic findings in seven out of eight patients, suggesting that LUS may be a reliable method to detect lung abnormalities in children with COVID-19. However, the role of LUS in follow-up assessment is still unclear.…”

Section: Resultsmentioning

confidence: 96%

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Lung function assessment in children with Long‐Covid syndrome

Sansone,

Di Filippo,

Russo

et al. 2023

Pediatric Pulmonology

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IntroductionA significant percentage of patients who survived the Coronavirus Infection Disease 2019 (COVID‐19) showed persistent general and respiratory symptoms even months after recovery. This condition, called Post‐Acute Sequelae of COVID‐19 or Long‐Covid syndrome (LCS), has been described also in children with positive history for severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection. Little is known about the pathophysiologic mechanisms underlying this syndrome. The aim of this study was to investigate any difference between children with LCS and asymptomatic peers with previous COVID‐19 in terms of lung function and lung ultrasound (LUS) patterns. Secondly, we tested associations between lung function abnormalities and LUS findings with Long‐Covid.MethodsWe carried out a prospective, descriptive, observational study including 58 children aged 5–17 years: 28 with LCS compared to 30 asymptomatic children with previous COVID‐19. We collected demographic data, history of asthma, allergy or smoke exposure, and acute COVID‐19 symptoms. After a median period of 4.5 months (1%–95% range 2–21) since the infection, lung function was assessed by spirometry, body plethysmography, diffusion lung capacity for carbon monoxide (DLCO). Airways inflammation was investigated by fractional exhaled nitric oxide (FeNO). LUS was performed independently by two experienced clinicians.ResultsWe found that children with LCS were older than controls (mean (SD) 12 (4.1) vs. 9.7 (2.6); p = .04). Children with LCS complained more frequently fatigue (46.4%), cough (17.9%), exercise intolerance (14.3%) and dyspnea (14.3%). Lung function was normal and similar between the two groups. The frequency of LUS abnormalities was similar between the two groups (43.3% children with LCS vs. 56.7% controls; p = .436). Children with LCS showed lower FeNO values (log difference −0.30 (CI 95% −0.50, −0.10)), but no association of LCS with a lower lung function and abnormal LUS findings was found.ConclusionsLCS seems to be more frequent in older age children. Lung functional and structural abnormalities were not different between children with LCS and asymptomatic subjects with previous COVID‐19. In addition, children with LCS showed lower FeNO values than controls, suggesting its potential role as a marker in LCS. However, further and larger studies are needed to confirm our findings.

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Section: Resultssupporting

confidence: 70%

Section: Resultsmentioning

confidence: 96%

Lung function assessment in children with Long‐Covid syndrome

Sansone,

Di Filippo,

Russo

et al. 2023

Pediatric Pulmonology

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“…Almost all children displayed either a normal LUS pattern or minimal artifacts, signifying complete lung recovery post initial infection. Importantly, the LUS findings were similar in both the recovered children and those who developed long COVID [61].…”

Section: Discussionmentioning

confidence: 63%

“…Nonspecific abnormalities, such as the presence of multiple bilateral B-lines, indicating a reduction in air content, thickening of the pleural line with associated abnormalities, and peripheral consolidation, may be observed on the LUS scans of children with COVID-19 pneumonia [56]. Since the early stages of the pandemic, LUS has demonstrated to be a helpful tool to assess lung conditions, monitor any changes over time, and guide therapeutic decisions in both adults and children [57][58][59][60][61]. The LUS in this study was conducted using a linear probe.…”

Section: Cmentioning

confidence: 99%

COVID-19 Pediatric Follow-Up: Respiratory Long COVID-Associated Comorbidities and Lung Ultrasound Alterations in a Cohort of Italian Children

Indolfi,

Klain,

Dinardo

et al. 2024

Children

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In children, the factors that influence COVID-19 disease and its medium- and long-term effects are little known. Our investigation sought to evaluate the presence of comorbidity factors associated with respiratory long COVID manifestations in children and to study ultrasound abnormalities following SARS-CoV-2 infection. Children, who arrived at the ‘Respiratory Diseases of Pediatric Interest Unit’ at the Department of Woman, Child, and General and Specialized Surgery of the University of Campania ‘Luigi Vanvitelli’, were selected during the timeframe from September 2021 to October 2022. The children were diagnosed with a SARS-CoV-2 infection that occurred at least one month before the visit. All patients followed a COVID-19 follow-up protocol, developed by the Italian Society of Pediatric Respiratory Diseases (SIMRI), which included: collection of data regarding SARS-CoV-2 illness and history of known respiratory and allergic diseases; physical examination; BMI assessment; baseline spirometry and after bronchodilation test; six-minute walking test; and lung ultrasound (LUS). In a cohort of 104 participants with respiratory long COVID symptoms (64.7% male, average age 8.92 years), 46.1% had fever with other symptoms, and 1% required hospitalization. BMI analysis showed 58.4% of the cohort was overweight. The LUS was positive in 27.0% of cases. A significant BMI association was observed with COVID-19 symptoms and LUS score (p-value < 0.05). No associations were found with asthma or atopy.

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Lung ultrasound among Expert operator’S: ScOring and iNter-rater reliability analysis (LESSON study) a secondary COWS study analysis from ITALUS group

Boero,

Gargani,

Schreiber

et al. 2024

J Anesth Analg Crit Care

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Background Lung ultrasonography (LUS) is a non-invasive imaging method used to diagnose and monitor conditions such as pulmonary edema, pneumonia, and pneumothorax. It is precious where other imaging techniques like CT scan or chest X-rays are of limited access, especially in low- and middle-income countries with reduced resources. Furthermore, LUS reduces radiation exposure and its related blood cancer adverse events, which is particularly relevant in children and young subjects. The score obtained with LUS allows semi-quantification of regional loss of aeration, and it can provide a valuable and reliable assessment of the severity of most respiratory diseases. However, inter-observer reliability of the score has never been systematically assessed. This study aims to assess experienced LUS operators’ agreement on a sample of video clips showing predefined findings. Methods Twenty-five anonymized video clips comprehensively depicting the different values of LUS score were shown to renowned LUS experts blinded to patients’ clinical data and the study’s aims using an online form. Clips were acquired from five different ultrasound machines. Fleiss-Cohen weighted kappa was used to evaluate experts’ agreement. Results Over a period of 3 months, 20 experienced operators completed the assessment. Most worked in the ICU (10), ED (6), HDU (2), cardiology ward (1), or obstetric/gynecology department (1). The proportional LUS score mean was 15.3 (SD 1.6). Inter-rater agreement varied: 6 clips had full agreement, 3 had 19 out of 20 raters agreeing, and 3 had 18 agreeing, while the remaining 13 had 17 or fewer people agreeing on the assigned score. Scores 0 and score 3 were more reproducible than scores 1 and 2. Fleiss’ Kappa for overall answers was 0.87 (95% CI 0.815–0.931, p < 0.001). Conclusions The inter-rater agreement between experienced LUS operators is very high, although not perfect. The strong agreement and the small variance enable us to say that a 20% tolerance around a measured value of a LUS score is a reliable estimate of the patient's true LUS score, resulting in reduced variability in score interpretation and greater confidence in its clinical use.

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Role of Lung Ultrasound in the Follow-Up of Children with Previous SARS-CoV-2 Infection: A Case-Control Assessment of Children with Long COVID or Fully Recovered

Cited by 5 publications

References 34 publications

Lung function assessment in children with Long‐Covid syndrome

Lung function assessment in children with Long‐Covid syndrome

COVID-19 Pediatric Follow-Up: Respiratory Long COVID-Associated Comorbidities and Lung Ultrasound Alterations in a Cohort of Italian Children

Lung ultrasound among Expert operator’S: ScOring and iNter-rater reliability analysis (LESSON study) a secondary COWS study analysis from ITALUS group

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