Paediatric necrotizing pneumonia: single tertiary center experience

Abstract

Objectives: Necrotizing pneumonia (NP) is an increasingly recognized complication of community-acquired pneumonia in paediatrics. We describe the epidemiology, management and outcomes of children presented with NP over 2 years at the Children’s Hospital-Ain Shams University, Cairo, Egypt. Results: A total of 29 cases of NP were identified. The age ranged from 2 months to 15 years. All patients gave history of fever before admission; with median duration of 10 days. 8 (27%) patients needed PICU admission due to severe respiratory distress. A total of 26 patients received antibiotics prior to presentation (90%). Initial imaging showed pyopneumothorax in 22 patients (75%). 27 (93%) patients had a chest drainage inserted, with variable duration ranging from 2 to 37 days. 3 (10%) patients had a bronchopleural fistula. Initial lab revealed leucocytosis in 93% of the patients (mean 21.05 103/uL); with neutrophil predominance. A total of 25 (86%) patients had thrombocytosis during the course of illness. Pleural fluid was grossly purulent in 62% of the patients, analysis showed an elevated LDH (median 9593 U/L) with low glucose (median 5.15 mg/dL) and elevated proteins (median 4 g/dL). The causative organism was identified in 11 cases (37%); And polymicrobial infections were reported in 4 cases (13%). All patients were treated with prolonged courses of parenteral antibiotics during admission. The median duration of hospitalization was 21 days; and 5 patients needed surgery (17%) . The outcome was complete resolution at the 1 year follow-up. Conclusion: despite the severe initial clinical presentation of NP in children,with prolonged duration of hospital stay; But the final outcome was favourable with complete resolution.