Serial lung ultrasounds in pediatric pneumonia in Mozambique and Pakistan

Ginsburg, Amy Sarah; Nisar, Imran; Madrid, Lola; Lenahan, Jennifer L.; Balouch, Benazir; Vitorino, Pio; Hwang, Jun; Lamorte, Alessandro; Kanth, Neel; Bila, Rubao; Valente, Marta; Varo, Rosauro; May, Susanne; Bassat, Quique; Jehan, Fyezah; Volpicelli, Giovanni

Lung ultrasound (LUS) is a promising point-of-care imaging technology for diagnosing and managing pneumonia. We sought to explore serial LUS examinations in children with chest-indrawing pneumonia in resource-constrained settings and compare their clinical and LUS imaging courses longitudinally. We conducted a prospective, observational study among children aged 2 through 23 months with World Health Organization Integrated Management of Childhood Illness chest-indrawing pneumonia and among children without fast breathing, chest indrawing or fever (no pneumonia cohort) at 2 district hospitals in Mozambique and Pakistan. We assessed serial LUS at enrollment, 2, 6, and 14 days, and performed a secondary analysis of enrolled children’s longitudinal clinical and imaging courses. By Day 14, the majority of children with chest-indrawing pneumonia and consolidation on enrollment LUS showed improvement on follow-up LUS (100% in Mozambique, 85.4% in Pakistan) and were clinically cured (100% in Mozambique, 78.0% in Pakistan). In our cohort of children with chest-indrawing pneumonia, LUS imaging often reflected the clinical course; however, it is unclear how serial LUS would inform the routine management of non-severe chest-indrawing pneumonia.