Lung ultrasound compared with bedside chest radiography in a paediatric cardiac intensive care unit.

AIM: Postoperative recovery of children with heart disease is encumbered by pulmonary complications like pneumothorax (PNX), pleural effusion (PLE), interstitial oedema and pulmonary consolidation (PC). Recently, lung ultrasound (LUS) has become an important diagnostic tool for evaluation of pulmonary diseases in the paediatric context. LUS is accurate in diagnosing pleural and parenchymal diseases. The aim of this study was to evaluate the accuracy of LUS in the identification of PNX, PLE and PC in a paediatric population of patients with congenital heart disease after heart surgery. METHODS: Fifty-three patients aged 0-17 years who underwent cardiac surgery were evaluated in the postoperative period by chest X-ray (CXR) and LUS at the same time. The methods where compared for recognition of PNX, PLE and PC. RESULTS: LUS showed a good agreement for PNX and a moderate agreement for both PLE and PC. LUS also showed a significantly superior relative sensitivity than CXR for PC and PLE and a significantly inferior relative sensitivity for PNX. CONCLUSION: This study confirms that LUS has a sufficient agreement rate with the current clinical standard (CXR). Non-inferiority in diagnosis together with the easiness of bedside performance makes LUS a very attractive tool for the paediatric cardiac intensive care unit.

[Management of children with headache in a Pediatric Emergency Department before and after the introduction of the Second International Classification of Headache Disorders (ICHD-II)]. / Il percorso dei pazienti con cefalea in Pronto Soccorso pediatrico prima e dopo la seconda classificazione internazionale delle cefalee.

The aim of this study was to evaluate how the management of children admitted with headache to a Pediatric Emergency Department, was modified by the introduction of the Second International Classification of Headache Disorders ( ICHD-II) published in 2004. The complexity and average costs of the services provided to patients in 2002 and 2011 were compared. The results revealed a decrease in the number of tests performed and in-hospital admissions. However, tests were more complex, and an increase in requests of specialist advice was observed. We hypothesized that this change may be related to the introduction of ICHD-II, which suggests a more rational approach to the child with headache and a better use of hospital resources.

Lung ultrasound: A useful additional tool in clinician's hands to identify pulmonary atelectasis in children with neuromuscular disease.

INTRODUCTION AND OBJECTIVES: Patients with neuromuscular disease (NMD) are often exposed to ionizing radiations which could be reduced if a noninvasive and reliable diagnostic method is identified. The major aim of this study was to compare the use of chest X-ray (CXR) with lung ultrasound (LUS) in pediatric patients with NMD, to identify pulmonary atelectasis (PA). MATERIALS AND METHODS: A prospective study was conducted on children affected by NMD. In all patients who underwent CXR, a LUS was also performed and results compared for the assessment of PA. RESULTS: Forty children affected by NMD were enrolled. Spinal muscular atrophy type 1 was the most common NMD, followed by spinal muscular atrophy type 2 and congenital myopathies. More than half of the subjects presented PA, more prevalent in the lung left lower lobes. LUS agreed with CXR results (negative or positive for atelectasis) in 31 patients (77.5%). In two patients, an agreement evaluation was not possible due to non-conclusive LUS. Conversely, LUS disagreed with CXR in seven patients, four of which were positive for atelectasis. If only complete agreement was considered, the statistical analysis between CXR and LUS showed: LUS sensitivity of 57%, LUS specificity of 82%, positive predictive value 80%, negative predictive value 61%. CONCLUSIONS: This study suggests that the use of LUS should be recommended to early identify PA and reduce frequent ionizing exposition of these fragile patients. Finally, our study also suggests that LUS can provide relevant information for clinicians and respiratory physiotherapists.