The Role of Lung Ultrasound in Diagnosis and Follow-Up of Children With Coronavirus Disease 2019.

To the Editor:

Since December 2019, starting from Wuhan, in the province of Hubei in China, a new pathogen called severe acute respiratory syndrome coronavirus 2 has spread all over the world. To date, have been reported 2,074,529 confirmed cases and 139,378 deaths attributable to coronavirus disease 2019 (COVID-19) (1).

In their recent article published in Pediatric Critical Care Medicine, Ong et al (2) confirm that children have milder forms than adults of COVID-19 and the use of CT scan should be limited and nonroutine.

During a pandemic, it is necessary to guarantee the highest standards of care for the patients and the maximum safety for healthcare workers, using the least number of healthcare workers and medical devices (3). Undoubtedly, this work is very important for the diagnosis and the clinical management of COVID-19 in childhood. Soldati et al (4) highlighted how lung ultrasound (LUS) patterns of subjects with COVID-19 pneumonia are quite characteristic.

In our opinion, LUS is helpful in diagnosis and in follow-up management of the COVID-19 children.

LUS is useful to complement the clinical evaluation and to monitor the evolution of lung disease until its resolution. In fact, the same operator can perform clinical examination and lung imaging bedside to the patient, thus reducing the risk of virus diffusion due to patient displacement from visit room in x-ray room when is in hospital or moving the patient from home to hospital after the discharge. The LUS is performed with an ultrasound pocket device and a probe put in a transparent, single-use plastic cover (5). The pediatrician selects a convex or a linear probe according to the patient’s body size. Ultrasound transmission gel in single use package is chosen to eliminate cross-contaminations. A single operator is required in order to reduce all possible contaminations. The pediatrician carries out the complete clinical check and performs the LUS in only 10 minutes.

For the analysis of the whole thorax, we suggest an ideal subdivision in 12 parts: anterior right and left (apical and basal), posterior right and left (apical and basal), and axillary right and left (apical and basal).

At the end of the procedure, in a dedicated area, the used cover will be easily removed, ultrasound pocket device will be disinfected and subsequently covered with a new plastic bag.

In conclusion, we believe that LUS can improve COVID-19 outcomes, allowing an adequate and safer management of the disease in emergency department and during follow-up.