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Updated: Jul 6, 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 biopsies in infants and children in critical care situation
Yaël Levy1, Lauren Bitton2, Chiara Sileo3
1Pediatric and neonatal intensive care unit, Armand Trousseau Hospital, APHP, Sorbonne University, Paris, France.
Insights
Lung biopsy is a reliable diagnostic tool for critically ill neonates with suspected lung developmental disorders. Complications were mainly associated with extracorporeal membrane oxygenation (ECMO).
Area of Science:
- Pediatric critical care medicine
- Pulmonology
- Diagnostic procedures
Background:
- Lung biopsy is an invasive diagnostic tool for lung diseases.
- Its use in critically ill pediatric patients requires careful consideration of risks and benefits.
Purpose of the Study:
- To evaluate the diagnostic yield of lung biopsy in critically ill pediatric patients.
- To assess diagnostic reliability across different age groups.
- To identify complications associated with lung biopsy in this population.
Main Methods:
- Retrospective review of pediatric patients undergoing lung biopsy in the ICU between 1995 and 2022.
- Exclusion of biopsies performed in the operating room and post-mortem.
- Analysis of diagnostic yield, reliability by age, and complication rates.
Main Results:
- 31 patients included; 67.7% were newborns. 81% of biopsies yielded a diagnosis.
- Diagnostic reliability was highest in newborns (95%) and decreased with age.
- Diffuse developmental lung disorders (49%) were the most common diagnosis. Complications occurred in 29% of patients, primarily hemorrhages in those on ECMO.
Conclusions:
- Lung biopsy is a reliable diagnostic procedure for critically ill neonates with suspected diffuse developmental lung disorders.
- Complications are significantly associated with extracorporeal membrane oxygenation (ECMO).
- Further prospective evaluation of complications in specific subgroups (e.g., prolonged ECMO, older children) is warranted.
Introduction:
Lung biopsy is considered as the last step investigation for diagnosing lung diseases; however, its indication must be carefully balanced with its invasiveness. The present study aims to evaluate the diagnostic yield of lung biopsy in critically ill patients hospitalized in the pediatric intensive care unit (ICU).
Material And Methods:
Children who underwent a lung biopsy in the ICU between 1995 and 2022 were included. Biopsies performed in the operating room and post-mortem biopsies were excluded.
Results:
Thirty-one patients were included, with a median age of 18 days (2 days to 10.8 years); 21 (67.7%) were newborns. All patients required invasive mechanical ventilation, 26 (89.7%) had a pulmonary hypertension, and 22 (70.9%) were placed under extracorporeal membrane oxygenation (ECMO). The lung biopsy led to a diagnosis in 81% of the patients. The diagnostic reliability seemed to decrease with age (95% in newborns, 71% in 1 month to 2 years and 0/3 patients aged over 2 years old). Diffuse developmental disorders of the lung accounted for 15 (49%) patients, primarily alveolar capillary dysplasia, followed by surfactant disorders in 5 (16%) patients. Complications occurred in 9/31 (29%) patients including eight under ECMO, with massive hemorrhages in seven cases.
Discussion And Conclusion:
In critical situations, lung biopsy should be performed. Lung biopsy is a reliable diagnostic procedure for neonates in critical situation when a diffuse developmental disorder of the lung is suspected. The majority of lung biopsy complication was associated with the use of ECMO. The prospective evaluation of the complications of such procedure under ECMO, and particularly over 10 days of ECMO and in children over 2-year-old remains to be ascertained.
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