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Updated: Dec 20, 2025
Protocol and Guidelines for Point-of-Care Lung Ultrasound in Diagnosing Neonatal Pulmonary Diseases Based on International Expert Consensus
Published on: March 6, 2019
Lung Ultrasound Pattern in Healthy Infants During the First 6 Months of Life
Danilo Buonsenso1,2, Gino Soldati3,4, Antonietta Curatola2
1Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
Insights
This study defines normal lung ultrasound (LUS) patterns in healthy infants. Initially, infants show B-lines, transitioning to a normal A-line pattern by six months, crucial for pediatric LUS interpretation.
Area of Science:
- Pediatric Pulmonology
- Medical Imaging
- Neonatology
Background:
- Lung ultrasound (LUS) is vital for diagnosing pediatric pleuropulmonary disorders.
- Current LUS patterns are extrapolated from adult studies and lack specific pediatric validation, especially in infants.
- Defining normal LUS patterns in infants is essential for accurate diagnosis.
Purpose of the Study:
- To prospectively define the normal lung ultrasound (LUS) pattern in healthy infants during the first six months of life.
- To establish age-specific LUS findings in neonates and young infants.
- To differentiate normal LUS variations from pathological findings in early infancy.
Main Methods:
- Prospective observational pilot study following healthy neonates from 7-10 days to six months of age.
- Exclusion criteria included prematurity before 33 weeks and congenital cardiac/lung abnormalities.
- LUS evaluations were performed by a single pediatrician, assessing 18 chest wall areas for A-lines, B-lines, and pleural abnormalities.
Main Results:
- Thirty-seven healthy infants were followed; 27 were term and 10 preterm.
- Most neonates initially exhibited multiple B-lines, progressively normalizing to an A-line pattern by six months (P < .00001).
- No subpleural consolidations or pleural abnormalities were observed in healthy infants throughout the study.
Conclusions:
- This study provides crucial insights into interpreting LUS in infants up to six months.
- Healthy infants typically present with diffuse B-lines, evolving to a physiologic A-line pattern by six months.
- Pleural irregularities, effusion, and subpleural consolidations were absent in healthy infants, highlighting their pathological significance.
Objectives:
Lung ultrasound (LUS) has gained a primary role in the diagnosis and management of pleuropulmonary disorders in pediatric practice. However, normal and pathologic patterns are translated from adult studies and have never been specifically studied in children, particularly in infants. This was a prospective observational pilot study aiming to define the normal LUS pattern in healthy infants during the first 6 months of life.
Methods:
We recruited healthy neonates at 7 to 10 days of life, and these were followed until the sixth month of life (times: 7-10 days, 1 month, 3 months, and 6 months). We excluded neonates with a gestational age before 33 weeks and neonates with cardiac or lung abnormalities or diseases, immune deficiencies, metabolic or genetic conditions, and acute or chronic respiratory diseases. A LUS evaluation was performed by a single certified pediatrician. The chest wall was examined in 18 areas, addressing A-lines, short and long B-lines, pleural abnormalities, and subpleural consolidations.
Results:
Thirty-seven neonates were enrolled and followed until the sixth month of life, 27 (73%) of whom were born at term (≥37 weeks) and 10 (27%) of whom were born preterm (33-36 weeks). Most of the patients at 7 to 10 days showed multiple B-lines (long and short) with a progressive normalization toward a normal A pattern at 6 months (P < .00001; 95% confidence interval, 13.75-23.24). No infants showed subpleural consolidations or pleural abnormalities.
Conclusions:
This study has implications for the interpretation of LUS during the first 6 months of life. Most healthy infants show a diffuse pattern of vertical artifacts (B-lines), and the LUS pattern tends to be similar to the physiologic pattern (A-lines) after the sixth month of life. The only pathologic LUS findings were pleural irregularities and effusion and subpleural consolidations, which have never been described in healthy infants.
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