Necrotizing Pneumonia In Children Research Articles

Risk Prediction Model for Necrotizing Pneumonia in Children with Mycoplasma pneumoniae Pneumonia.

To analyze the predictive factors for necrotizing pneumonia (NP) in children with Mycoplasma pneumoniae pneumonia (MPP) and construct a prediction model. The clinical data with MPP at the Children's Hospital of Kunming Medical University from January 2014 to November 2022 were retrospectively analyzed. Eighty-four children with MPP who developed NP were divided into the necrotizing group, and 168 children who did not develop NP were divided into the non-necrotizing group by propensity-score matching. LASSO regression was used to select the optimal factors, and multivariate logistic regression analysis was used to establish a clinical prediction model. The receiver operating characteristic (ROC) curve and calibration curve were used to evaluate the discrimination and calibration of the nomogram. Clinical decision curve analysis was used to evaluate the clinical predictive value. LASSO regression analysis showed that bacterial co-infection, chest pain, LDH, CRP, duration of fever, and D-dimer were the influencing factors for NP in children with MPP (P < 0.05). The results of ROC analysis showed that the AUC of the prediction model established in this study for predicting necrotizing MPP was 0.870 (95% CI: 0.813-0.927, P < 0.001) in the training set and 0.843 (95% CI: 0.757-0.930, P < 0.001) in the validation set. The Bootstrap repeated sampling for 1000 times was used for internal validation, and the calibration curve showed that the model had good consistency. The Hosmer-Lemeshow test showed that the predicted probability of the model had a good fit with the actual probability in the training set and the validation set (P values of 0.366 and 0.667, respectively). The clinical decision curve showed that the model had good clinical application value. The prediction model based on bacterial co-infection, chest pain, LDH, CRP, fever duration, and D-dimer has a good predictive value for necrotizing MPP.

Necrotizing Pneumonia in Children: Early Recognition and Management

Necrotizing pneumonia (NP) is an uncommon complicated pneumonia with an increasing incidence. Early recognition and timely management can bring excellent outcomes. The diagnosis of NP depends on chest computed tomography, which has radiation damage and may miss the optimal treatment time. The present review aimed to elaborate on the reported predictors for NP. The possible pathogenesis of Streptococcus pneumoniae, Staphylococcus aureus, Mycoplasma pneumoniae and coinfection, clinical manifestations and management were also discussed. Although there is still a long way for these predictors to be used in clinical, it is necessary to investigate early predictors for NP in children.

Necrotizing pneumonia among Italian children in the pneumococcal conjugate vaccine era.

Necrotizing pneumonia (NP) is a severe complication of community-acquired pneumonia. The impact of 13-valent pneumococcal conjugate vaccine (PCV13) on the epidemiology of NP in children has not been assessed. Medical records of children less than 18 years admitted with NP to two pediatric hospitals in Italy between 2005 and 2019 were reviewed. The following four periods were defined: 2005-2010 (pre-PCV13), 2011-2013 (early post-PCV13), 2014-2016 (intermediate post-PCV13), and 2017-2019 (late post-PCV13). Forty-three children (median age, 44 months) were included. Most of them (93%) were previously healthy. No differences in age, sex, season of admission, comorbidity, clinical presentation, or hospital course were identified between pre-PCV13 and post-PCV13 periods. A significant decrease in the rate of NP-associated hospitalizations was found between the early (1.5/1000 admissions/year) and the intermediate (0.35/1000 admissions/year) post-PCV13 period (p = .001). An increased trend in admissions was found thereafter. Streptococcus pneumoniae was the most common agent detected in both periods (pre-PCV13: 11/18, 61%; post-PCV13: 13/25, 52%). Serotype 3 was the most common strain in both periods (pre-PCV13: 3/11, 27%; post-PCV13; 4/13, 31%). There were no changes in the etiology over time, but most patients with Streptococcus pyogenes or Staphylococcus aureus infection were admitted during the post-PCV13 period. The hospitalization rate for NP in children decreased a few years after the implementation of PCV13 immunization in Italy. However, an increased trend in admissions was found thereafter. S. pneumoniae was the most frequent causal agent in both pre- and post-PCV13 periods. Pneumococcal serotypes were mainly represented by Strain 3.

D-dimer: The Risk Factor and Predictive Indicator of Necrotizing Pneumonia in Children.

Necrotizing pneumonia (NP) is a severe complication of community-acquired pneumonia in children. This article assesses the risk factors and the diagnostic value of D-dimer for NP in children. The selected patients with lobar pneumonia were divided into two groups, namely: the NP group and the pneumonia only group. This article conducted a comparative study in the differences between the two groups. The authors identified the independent factors of NP with the assistance of multivariate logistic regression analysis upon the completion of the univariate analysis. The authors applied the receiver operating characteristic (ROC) curve for the purpose of discovering the indicators with the most predictive abilities of NP. Three risk factors were observed to be independently associated with the development of NP: Total duration of fever (OR 1.406, 95% CI 1.264 - 1.834), WBC counts (OR 2.662, 95% CI 1.592 - 3.981), and D-dimer (OR 2.878, 95% CI 1.671 - 4.902). D-dimer levels present with higher accuracy in terms of predicting the development of NP than the other two, with a value that is under the ROC of 0.886 (95% CI, 0.815 - 0.958). Significantly higher D-dimer levels are observed in children with NP. D-dimer could be considered as one of the most important risk factors and predictive indicators of NP.

A retrospective study of etiology, clinical features, management, and outcomes in children with necrotizing pneumonia

Introduction: Necrotizing pneumonia (NP) is a severe and emerging complication in children with community-acquired pneumonia (CAP). The study was conducted to analyze the etiology, clinical features, treatment strategies, and outcome of NP in children admitted in a single pediatric tertiary referral care center. Materials and Methods: The study is a retrospective chart review which included children above 1 month and below 18 years who were admitted at Indira Gandhi Institute of Child Health, from January 2015 to December 2018, with community-acquired NP. Results: During the study period, 1393 cases of CAP were admitted in our institute. Three hundred and fifty-two cases (25.2%) of complicated pneumonia were admitted which include cases of NP, lung abscess, and empyema. Children who were diagnosed with NP were 3.3% (n = 46) of all CAP cases. All the cases with NP were immunocompetent, with the most common organism isolated being Staphylococcus aureus followed by Streptococcus pneumoniae. NP is associated with complications such as empyema, pneumothorax, and bronchopleural fistula. All the children in the study group survived except for mortality in one case. Conclusion: NP can be well managed with conservative approaches such as prolonged antibiotic therapy and pleural drainage. Although there are commonly associated with local complications, in general the clinical outcome is good.

Clinical analysis of 49 cases of necrotizing pneumonia in children

Objective To explore the clinical characteristics, pathogens, inflammatory biomarkers, therapeutic methods and prognosis of necrotizing pneumonia (NP) in children. Methods The clinical data of children with NP who were admitted to the Department of Pediatrics of Shengjing Hospital of China Medical University from October 2010 to October 2015 were collected.The data included demographic data, laboratory test results, intrapulmonary complications, therapeutic methods and so on were analyzed, retrospectively. Results Forty-nine pediatric patients with NP were enrolled, 31 cases were boys, 18 cases were girls; the average age of the patients were 2.5 years (4 months -13 years). The average febrile time were (15.08±5.92) d, and the hospital stay was(21.19±10.83) d, respectively.The median value of peripheral blood leukocyte count was 17.7×109/L, the average of neutrophils ratio was (67.62±18.52)%, and the median value of C-reactive protein(CRP) and procalcitonin(PCT) was 97.9 mg/L and 0.54 μg/L, respectively.Nineteen cases had Mycoplasma pneumoniae(MP) infection, 16 cases with pneumonia chlamydia infection, 9 cases complicated with MP and chlamydia pneumoniae infection, and 8 cases with positive bacterial culture, and 10 cases suffered from the intrapulmonary complications.Forty-seven cases got better prognosis with the treatment of antibiotics, glucocorticoids, intravenous immunoglobulin and other comprehensive therapeutic methods such as bronchoalveolar lavage with fiber bronchoscope and closed thoracic drainage. Conclusions NP is a severe complication of community-acquired pneumonia in children, and the occurrence of NP should be alerted in the children who have persistent high fever, higher inflammatory index and pleural effusion, but the great majority of patients do recover fully after comprehensive treatment. Key words: Necrotizing pneumonia; Clinical characteristics; Child

Clinical features of necrotizing pneumonia in children

Purpose: Necrotizing pneumonia (NP) is a complication of invasive pneumonia. Few studies have reported on the clinical features of NP in children. Methods: Nineteen patients with NP who were admitted to Pusan National University Hospital and Pusan National University Children's Hospital between December 2008 and March 2013, were studied in terms of sex, age at diagnosis, clinical characteristics, detected organisms, radiologic findings, treatments and clinical outcomes. Results: Twelve patients (63.2%) were males and seven patients (36.8%) were female. Eight patients (44.4%) were younger than 5 years of age, seven patients (38.9%) were at 6–10 years of age and four patients (21.1%) were older than 11 years of age. Most patients had fever and cough at the time of diagnosis. Minorganism were identified in 9 cases (47.4%): Mycoplasma pneumonia in 4 (21.1%), Streptococcus pneumonia in 1 (5.3%), Staphylococcus aureus in 1 (5.3%), G+cocci in 1 (5.3%), and M. pneumonia + S. pneumoniae coinfection in 2 (10.5%). The diagnosis of NP was established by computerized tomography. Cavitary necrosis was shown in all patients, and pleural effusion was shown in 15 patients (78.9%). Six patients (31.6%) presented local atelectasis and 2 patients (10.5%) presented pneumothorax. Five patients (26.3%) treated with only antibiotics were cured completely. Invasive treatment was needed by 14 patients (73.7%): 10 patients (52.6%) needed chest tubing, and 5 patients (26.3%) needed surgery. Only one patient (5.3%) expired. Conclusion: NP is a rare complication of pneumonia in children and has a good prognosis, typically resolving completely with medical treatment alone. However, patients who present with the worsening of clinical status or pleural complications despite the use of appropriate antibiotics should be evaluated for surgical indications. (Allergy Asthma Respir Dis 2014;2:208-212)

Pneumonia necrosante em crianças submetidas à toracoscopia por empiema pleural: incidência, tratamento e evolução clínica

To assess the incidence of necrotizing pneumonia (NP) in children submitted to thoracoscopy, comparing patients with and without NP in terms of the presentation and clinical evolution. A retrospective study of children with pleural empyema submitted to thoracoscopy. Thoracoscopy was performed in patients not previously submitted to thoracic drainage and in whom there was evidence of loculated effusion or pneumothorax, as well as in those previously submitted to thoracic drainage and in whom there was persistent pneumothorax or fever with purulent discharge. On the basis of the thoracoscopy findings, patients were distributed into two groups: those with NP (NP group) and those without (no-NP group). The study sample comprised 52 patients. Of the 24 patients with NP, 19 (79%) had undergone thoracic drainage prior to thoracoscopy, 11 (46%) presented with pneumothorax, and 16 (67%) developed bronchopleural fistula. In the NP group, the median drainage time and the median length of hospital stay were 18 and 19 days, respectively. Of the 28 patients without NP, 10 (36%) had undergone thoracic drainage prior to thoracoscopy, 9 (32%) presented pneumothorax, and 5 (18%) developed bronchopleural fistula. In the no-NP group, the median drainage time and the median length of hospital stay were 6 and 10 days, respectively. Pneumothorax should raise the suspicion of NP. Early thoracoscopy can be a valuable treatment option for NP in children because it hastens recovery in comparison with the medical treatment alone and avoids extensive late thoracotomy lung resections.