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COVID-19 in Infants and Children under 2 Years-Could Lung Ultrasound Score Be Correlated with Biomarkers and
Emil Robert Stoicescu1,2,3, Jovan Lovrenski4,5, Roxana Iacob1,3
1Department of Radiology and Medical Imaging, 'Victor Babes' University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square No. 2, 300041 Timisoara, Romania.
Insights
Lung ultrasonography (LUS) is valuable for managing COVID-19 in infants and children. This non-irradiating technique helps assess respiratory symptoms and correlates with inflammatory markers in young patients.
Area of Science:
- Pediatric Pulmonology
- Infectious Diseases
- Medical Imaging
Background:
- Infants and children with COVID-19 typically present with mild symptoms like fever and congestion.
- Respiratory symptoms can occur, necessitating non-irradiating imaging techniques for lung assessment.
- Lung ultrasonography (LUS) offers a safe alternative to radiation-based imaging in pediatric patients.
Purpose of the Study:
- To evaluate the utility of lung ultrasonography (LUS) in the clinical management of COVID-19 in infants and children.
- To correlate LUS findings with clinical presentation and inflammatory biomarkers in pediatric SARS-CoV-2 infections.
Main Methods:
- Lung ultrasonography (LUS) was performed on infants and children under two years old diagnosed with SARS-CoV-2.
- Patients with co-existing respiratory pathologies were excluded.
- The Lung Ultrasound Score (LUSS) was correlated with biomarkers and clinical data using statistical analysis (Mann-Whitney U test, Spearman's rank correlation).
Main Results:
- The mean LUSS was 4.47 ± 2.36, with all patients showing sparse B-lines (100%) and 36.84% exhibiting alveolar syndrome.
- A strong positive correlation was observed between LUSS and inflammatory markers, including LDH, D-dimers, and IL-6 (rho = 0.55-0.60, p < 0.05).
- In symptomatic infants with respiratory involvement, LUSS correlated significantly with D-dimer levels and oxygen saturation.
Conclusions:
- COVID-19 in infants and children under two years often presents with a mild B-line pattern on LUS, despite elevated inflammatory markers.
- LUS is a valuable tool for assessing lung involvement in pediatric COVID-19 cases.
- D-dimer levels and oxygen saturation show correlation with LUSS in pediatric patients experiencing respiratory symptoms.
Introduction:
It is already well known that infants and children infected with COVID-19 develop mild to moderate forms of the disease, with fever and oropharyngeal congestion being the most common symptoms. However, there are instances when patients claim to be experiencing respiratory symptoms. Because of the repeated lung examinations required in these situations, non-irradiating imaging techniques are preferred. This study's objective is to ascertain the value of lung ultrasonography (LUS) in the medical management of these specific cases.
Methods:
Infants and children under two years old with SARS-CoV-2 infection were evaluated using LUS. Patients with other respiratory pathologies were excluded by using specific tests. The LUS score (LUSS) was correlated with biomarkers and clinical findings using the Mann-Whitney U test and Spearman's rank correlation rho.
Results:
The LUSS for each patient varied from 1 to 8 points out of a maximum of 36 points. The arithmetic mean was 4.47 ± 2.36 (S.D), while the 95% CI for the arithmetic mean was 3.33 to 5.61. Sparse B-lines were present in all enrolled infants and children (100%), while only 36.84% developed alveolar syndrome (confluent B-lines). The lung changes were correlated with their biomarkers, specifically inflammatory markers. The correlation between LUSS and LDH, D-dimers, and IL-6 was a strongly positive one with rho = 0.55 (p = 0.001, 95% CI 0.13 to 0.80) between the LUSS and D-dimer levels and rho = 0.60 (p = 0.03, 95% CI 0.04 to 0.87) between LUSS and D-dimer levels at symptomatic infants and children (with respiratory involvement).
Conclusions:
Infants and children under the age of two are prone to develop mild forms of COVID-19 disease with a B-line pattern on LUS, although inflammatory markers have elevated blood levels. Despite the small sample, D-dimer levels and O2 saturation were correlated with LUSS in patients with respiratory involvement, while similar results were also found in the entire lot.
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