Patients
We recruited acutely ill children , aged 1 month to 18 years, and
elevated pro-BNP levels (over 300pg/mL)18,19 with
final diagnosis of A) isolated cardiac disease (with and without heart
failure) or B) systemic inflammatory disease / sepsis without heart
involvement or C) systemic inflammatory disease and heart involvement as
in the case of the acute rheumatic carditis, the Kawasaki disease or the
syndrome of pediatric multisystem inflammation temporally related to
SARS-CoV-2 (PIMS-TS).
Specifically, at the time of first evaluation, all children with an
acute or previous history of heart disease (with and without signs and
symptoms of respiratory distress) or with signs and symptoms of
suspected systemic inflammatory disease or sepsis (with and without
signs and symptoms of respiratory distress) underwent pro-BNP level
assay and lung ultrasound evaluation. Furthermore, all children,
belonging to these categories, were subjected to anamnesis, clinical and
vital parameters evaluation, evaluation of inflammation indices, always
at the first evaluation. In particular, blood tests including C-reactive
protein (CRP) and white blood cell count (WCC) and in some cases also
procalcitonin (PCT) were performed for all patients. In addition, all
were subjected to microbiological tests (molecular and cultural) of the
airways to exclude acute upper or lower respiratory tract infections.
Further investigations were performed only when deemed necessary by the
evaluating pediatricians (troponin dosage, echocardiogram, chest x-ray
and other microbiological tests as appropriate).
Finally, keeping in mind the objective of the study - to define whetheracutely ill children with cardio-pulmonary interactions had a
specific and different lung ultrasound pattern from other categories of
patients with primary infectious lung disease and / or completely
healthy patients - we enrolled patients belonging to these other two
categories. In particular we analyzed the epidemiological and clinical
data - as well as the LUS findings - of 1) patients with acute
lower respiratory tract infections (in particular bronchiolitisascertained by culture and molecular examinations of the upper airways)
aged between 1 month and 2 years and 2) completely healthy
infants, then comparing these data with those of the study population
of acutely ill children .