Lung ultrasound for the diagnosis and monitoring of Community-Acquired Pneumonia in children: a prospective observational study

Mariantonietta Francavilla¹Lucia Scarlato^1*Anna Camporesi²Azzurra Orlandi¹Claudio Cafagno¹Celeste Lidia Raguseo¹Valentina Santoiemma¹Roberto Russo¹Antonello Sacco¹Anna Maria Musolino³Maria Chiara Supino³Anna Clemente³Luca Tagliaferri⁴Rosa Morello⁴Vittorio Greco Miani¹Cristian Bisceglia¹Giandomenico Stellacci¹Desiree Caselli¹Danilo Buonsenso⁴

• ¹Giovanni XXIII Children's Hospital, Bari, Italy
• ²Ospedale dei Bambini Vittore Buzzi, Milan, Italy
• ³Ospedale Pediatrico Bambino Gesu IRCCS, Rome, Italy
• ⁴Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy

ABSTRACT Introduction Community-acquired pneumonia remains a noteworthy concern in pediatrics due to the difficulty in identifying the underlying etiology and the risk of complications associated with high morbidity and mortality. Methods This is a multicenter, prospective study that enrolled 315 children admitted to three different hospitals in Italy between March 2023 and June 2024. The ultrasound scans were performed according to the approach proposed by Soldati et al. in 2020 at admission (T0) and during hospitalization (T1). Results Lung ultrasound proved to be a valuable tool for differentiating etiologies, with significantly higher scores observed in bacterial and viral pneumonias compared to atypical cases (respectively p < 0.001 and p = 0.018). Furthermore, elevated ultrasound scores were predictive of adverse outcomes, such as the need for respiratory support or admission to the intensive care unit (p<0.05). Finally, our findings highlight the importance of timing in follow-up assessments: a 72-hour interval was sufficient to detect improvements in lung ultrasound findings in severe cases (p < 0.01), while it appeared unnecessary in mild ones (p = 0.139). Discussion This study confirms the usefulness of lung ultrasound in monitoring children with community-acquired pneumonia and in the early identification of those at risk of clinical deterioration. Moreover, our findings offer useful guidance for optimizing follow-up timing, supporting personalized ultrasound approaches tailored to disease severity while reducing unnecessary examinations.