Pleural Effusion In Children Research Articles

Efficacy of dexamethasone as adjunctive therapy in the treatment of parapneumonic pleural effusion in children

Background Parapneumonic effusion (PPE) occurs as a complication in around 13% of instances of community-acquired pneumonia. Aim To assess the effect of dexamethasone as an adjunctive therapy in the treatment of PPEs in children. Patients and methods This is a double-blinded, parallel-group, placebo-controlled, randomized clinical trial carried out on 60 children aged from 1 to 13 years with pneumonia complicated by PPEs. Patients were randomly divided into two equal groups (with the usual treatment in the form of double antibiotics given to all) and either intravenous dexamethasone at a dose of 0.25 mg/kg every 12 h for 3 days (group A) or intravenous saline every 12 h for 3 days as placebo (group B). Results Duration of hospitalization, chest tube insertion, and number of patients referred to the pediatric intensive care unit were significantly lower in group A than in group B (P=0.007, P<0.001 and P=0.025, respectively). Normal PPE was significantly higher in group A than in group B (P=0.025) after 2 weeks, and small PPEs were significantly higher in group A than group B (P=0.008) on the 7th day. Fluid thickness by chest ultrasound on the 7th day was significantly lower in group A than in group B (P=0.016). Conclusion Dexamethasone was an effective adjunctive therapy for PPEs in children.

Aetiology of pleural effusions in children living in a high TB endemic setting.

<sec id="st1"><title>BACKGROUND</title>Confirming the aetiology of pleural effusion in children may be difficult in TB-endemic settings. We investigated the role of polymerase chain reaction (PCR) and routine biochemical tests in discriminating pleural effusion caused by bacteria from other aetiologies.</sec><sec id="st2"><title>METHODS</title>This is a cross-sectional post-hoc analysis among children with pleural effusion in a tertiary hospital in South Africa, incorporating new data from PCR testing of stored pleural fluid. Aetiological classification was defined by microbiological confirmation.</sec><sec id="st3"><title>RESULTS</title>Ninety-one children were enrolled; the median age 31 months (IQR 12-102). The aetiology of pleural effusion was 40% (36/91) bacteria, 11% (10/91) TB, 3% (3/91) viruses, 11% (10/91) polymicrobial and 35% (32/91) had no pathogen identified. The most common pathogen was Staphylococcus aureus (27/91, 30%) with similar yields on culture and PCR, followed by Streptococcus pneumoniae (12/91, 13%), detected more commonly by PCR. PCR reduced the number of children with unconfirmed aetiologies from 48 to 32. Characteristics of children with no pathogen most resembled those with TB. Pleural fluid lactate dehydrogenase ≥1,716 U/L best discriminated bacterial pleural effusion from other aetiologies (sensitivity of 86%; specificity 95%).</sec><sec id="st4"><title>CONCLUSION</title>PCR improved detection of pathogens and reduced number of children with unconfirmed aetiologies in presumed exudative pleural effusion.</sec>.

Etiology and outcomes of pleural effusion in children admitted in national institute of child health.

Etiology and outcomes of pleural effusion in children admitted in national institute of child health.

Role of octreotide in the management of chylous pleural effusion in children: Experience with two cases

Role of octreotide in the management of chylous pleural effusion in children: Experience with two cases

Predictive value of BALF IL-6, Serum IL-6, CRP and SSA on pleural effusion in children with MPP

Objective: This study aimed to analyze the clinical characteristics of children with Mycoplasma Pneumoniae Pneumonia (MPP) and assess the predictive value of Balf IL-6, serum IL-6, CRP and SSA for pleural effusion in pediatric MPP cases. Methods: Between May 17, 2020, and February 24, 2024, 77 patients admitted to The First Clinical College of Xinxiang Medical University who underwent Bronchoalveolar Lavage (BAL) treatment were categorized into groups based on the presence or absence of pleural effusion. Clinical data was collected and analyzed using Pearson correlation to investigate the relationship between inflammatory factors and clinical manifestations. Additionally, ROC curve analysis was performed to determine the predictive capability of inflammatory factors for pleural effusion

Pattern and outcome of paediatric pleural effusion seen at Usmanu Dafodiyo University Teaching Hospital, Sokoto: A 5-year retrospective study

Background: Pleural effusion is an abnormal accumulation of fluid in the pleural cavity which present with spectrum of clinico-aetiological manifestations often requiring multidisciplinary approach.&#x0D; Objectives: This study set out to determine the prevalence, aetiology, clinical presentation, treatment modalities and outcome of pleural effusion in children.&#x0D; Materials and Methods: This was a retrospective study where records of children with diagnosis of pleural effusion admitted at UDUTH, Sokoto were obtained between January 2017 and December 2022 and reviewed. Diagnosis was based on clinical presentation and radiological confirmation of pleural effusion. Data was analyzed with SPSS version 20.0.&#x0D; Results: A total of 49 cases were retrieved. The prevalence of pleural effusion was 0.54% (9,056). It was more prevalent in males with ratio of 2.5:1 (χ² = 9.833, P = 0.007). The median age was 9 years (IQR 7). The most common cause of pleural effusion was pneumonia 26 (53.1%) followed by tuberculosis 16 (32.6%), malignancy 3 (6.1%), cardiac and renal causes accounted for 2 (4.1%) each. Cough (100.0%), difficulty in breathing (100.0%), tachypnea (100.0%), respiratory distress (100.0%), and desaturation (98.0%) were the common presentations. Most (77.5%) of them presented with right sided pleural effusion. The majority (93.9%) had closed thoracostomy tube drainage. The outcome showed majority (83.7%) of the cases been discharged, with a median duration of hospital stay of 22days (IQR 17). However, mortality rate for the malignant causes was 100.0%.&#x0D; Conclusion: Infections were the major cause of paediatric pleural effusion with relatively good outcome. Surgical intervention and multidisciplinary team approach are needed to reduce the morbidity and mortality in patients with pleural effusion especially for the malignant causes.

Management of pneumonia and pleural effusion in children.

Management of pneumonia and pleural effusion in children.

Cough-induced chylothorax in a two-year-old boy – case report and review of the literature

BackgroundChylothorax is a very rare form of pleural effusion in children, especially after the neonatal period, and predominantly occurs secondary to cardiothoracic surgery. It can lead to significant respiratory distress, immunodeficiency, and malnutrition. Effective treatment strategies are therefore required to reduce morbidity.Case presentationA previously healthy two-year old boy was admitted with history of heavy coughing followed by progressive dyspnea. The chest X-ray showed an extensive opacification of the right lung. Ultrasound studies revealed a large pleural effusion of the right hemithorax. Pleural fluid analysis delivered the unusual diagnosis of chylothorax, most likely induced by preceded excessive coughing. After an unsuccessful treatment attempt with a fat-free diet and continuous pleural drainage for two weeks, therapy with octreotide was initiated. This led to complete and permanent resolution of his pleural effusion within 15 days, without any side effects.ConclusionsSevere cough may be a rare cause of chylothorax in young children. Octreotide seems to be an effective and safe treatment of spontaneous or traumatic chylothorax in children.There is, however, a lack of comprehensive studies for chylothorax in children and many issues concerning diagnostic strategies and treatment algorithms remain.

The thoracoscopic approach in the management of parapneumonic pleural effusion in children

Background: Parapneumonic pleural effusion is a relatively common entity and continues to be a major cause of morbidity in children. However, managing this disease is still a matter of controversy between surgical and non-surgical options. With the advancement of mini-invasive surgery, video-assisted thoracoscopic surgery (VATS) has become a mainstay in the treatment of parapneumonic effusion in children. This study aimed to evaluate the clinical characteristics and pathological features of parapneumonic pleural effusion in children and to explore the feasibility and safety of the thoracoscopic approach in the pediatric population. Methods: The clinical data of all patients who underwent VATS for parapneumonic effusion between 2007 and 2021 were analyzed retrospectively. Factors that were documented included demographic criteria, clinical manifestations, preoperative examinations, therapeutic procedures, intraoperative findings, postoperative complications, and outcomes. Results: Totally, 35 patients with a mean age of 5.14 ± 3.9 years were operated on thoracoscopically. The mean duration of evolution before VATS was 9 days ± 4. All children were hospitalized in a Pediatric Continuing Care Unit. Antibiotic therapy was administrated in combination in all cases. Corticosteroid therapy was used in 2 patients. Thoracentesis was performed in 6 patients. Thoracostomy tube drainage was placed before surgery in 11 patients. The average duration of drainage before VATS was 6 days ± 4. VATS decortication and/or debridement was indicated as second-line in 23 patients. The average duration of the surgery was 51 minutes (20 min - 115 min). There is no conversion to open surgery and no intraoperative procedure-dependent complication. 4 children have early complications after the VATS and one patient had a late postoperative complication. There were no deaths during the hospital stay or follow-up. Conclusion: In skilled hands, VATS is safe, feasible, and effective in the management of parapneumonic pleural effusion in children with excellent outcomes.

Treatment and outcomes of chylothorax in children: 20-year experience of a single institute.

Chylothorax is an uncommon cause of pleural effusion in children. This study aimed to determine the characteristics, treatment strategies, and outcomes of chylothorax in children from a single institute. The 65 episodes of chylothorax in patients aged 0-15 years who were diagnosed and received treatment in Songklanagarind Hospital between January 2001 and December 2020 were retrospectively review and analyzed. Of the 65 episodes, 80% were postoperative chylothorax, and were mostly related to cardiac surgery. The most common treatment strategy employed was dietary modification (64.6%). Octreotide was used as adjunctive therapy in 33.8%. Most cases of chylothorax were successfully treated by conservative treatment, while 10.7% required surgical therapy. The median time to resolution of chylothorax was 21 days [interquartile range (IQR): 8-33 days]. Young children aged <1 year were more likely to require mechanical ventilation and develop ventilator-associated pneumonia and catheter-related complications. The factors associated with death or prolonged hospitalization (>28 days) were non-postoperative chylothorax, use of total parental nutrition (TPN) >14 days, hypoalbuminemia, and ventilator-associated pneumonia. Most (89.2%) cases of chylothorax were successfully treated conservatively using dietary modification and octreotide therapy. The modifiable risk factors for death or prolonged hospitalization were use of TPN >14 days and hypoalbuminemia.

Etiological factors and treatment of chylothorax in paediatric patients - a systematic review

Chylothorax is an accumulation of chyle in the pleural cavity. It is a relatively rare cause of pleural effusion in children and its annual incidence is 14 cases per 100 000 children in Europe. &#x0D; The pleural fluid triglyceride level greater than 110 mg/dl with a cholesterol level lower than 200 mg/dl confirms the diagnosis of chylothorax. Medical imaging are also necessary such as a non-invasive and easily accessible lung ultrasound. Symptoms of this disease are tachypnea, dyspnea, and in some cases dry cough.&#x0D; This review aims to summarize the current literature regarding chylothorax in children, analyze its possible etiologies and treatments.&#x0D; The causes of chylothorax are varied. It may appear after surgical interventions, traumas, infections and also be congenital. Iatrogenic factors are the most common cause of chylothorax in children with cardiothoracic surgeries. Management of chylothorax can be quite complex and highly variable, depending on patient’s condition and their response to the introduced treatment. Conservative treatment consisting of nutrition therapy, chest drain, and pharmacotherapy is typically a first-line of treatment. Diet modification consist in dietary supplements enriched with medium chain triglycerides (MCT) or starting the patient on a total parenteral nutrition (TPN). In most of the analyzed cases the conservative treatment alone proved sufficient in the management of chylothorax. In case of its failure, surgical treatment was a secondary therapy choice. One of the most common surgical procedures for pleural effusion is a thoracic duct ligation (TDL) or pleurodesis and both of these methods are highly effective therapy for chylothorax.&#x0D; This review of the literature reveals a wide variety of causes and methods of treatment of chylothorax. There are no clear standards of management and the therapy is adjusted to the clinical condition of the patient.

Clinical profile of Tuberculous Pleural Effusion in Children

Clinical profile of Tuberculous Pleural Effusion in Children

Management of parapneumonic pleural effusion in children: Is there a role for corticosteroids when conventional nonsurgical management fails? A single-center 15-year experience.

Description of the use of corticosteroids for the management of parapneumonic pleural effusion in children. Retrospective single-center observational study of all children hospitalized with a diagnosis of parapneumonic pleural effusion during a 15-year period. We documented 97 cases of parapneumonic effusion during the study period, with a median age (interquartile range [IQR]) of 43 (33-61) months. Most of the children benefited from an evacuation of the pleural effusion (89/97, 91.8%): 21 patients (21.6%) were treated with needle thoracocentesis only, while a chest tube was inserted in 68 children (70.1%). Thirty-two patients (33%) were treated with intrapleural fibrinolysis. Fifty-five children (56.7%) received corticosteroids for persistent fever. The median time (IQR) between hospital admission and initiation of corticosteroids was 5.5 (4-7) days. When corticosteroids were initiated, children had been febrile for 9 (IQR: 8-11) days. The fever ceased in a median (IQR) of 0 (0-1) day after corticosteroids initiation. Only one patient required a video-assisted thoracoscopy that was necessary for morphological reasons (morbid obesity). No children treated with corticosteroids required surgery. All children were discharged from hospital. The median (IQR) hospital length of stay was 11 (8-14) days, with no difference between children with and those without corticosteroids. Our findings indicate that corticosteroids may be a part of the therapeutic armamentarium for children with parapneumonic effusion when conventional nonsurgical management fails.

Clinical Significance of Pleural Effusion in Mycoplasma pneumoniae Pneumonia in Children.

The clinical significance of pleural effusion in Mycoplasma pneumoniae (MP) pneumonia in children has not yet been elucidated. Herein, we investigated the clinical implications of pleural effusion in children with MP pneumonia. Overall, 150 children with MP pneumonia transferred to a tertiary hospital were enrolled in this study. Information on their clinical, laboratory, and radiological features was retrospectively obtained from medical chart reviews. In total, 24 (16.0%) children had pleural effusion at the time of admission. The duration of fever and length of hospitalization were significantly longer in the pleural effusion group than in the non-pleural effusion group. A significantly higher proportion of individuals in the pleural effusion group had a poor response to stepwise treatment for MP pneumonia. The mean C-reactive protein, lactate dehydrogenase, and aspartate aminotransferase levels were significantly higher in the pleural effusion group than in the non-pleural effusion group at admission. The prevalence of severe pneumonia, defined on the basis of the extent of pneumonic lesions on chest radiography, was higher in the pleural effusion group than in the non-pleural effusion group. However, there was no significant intergroup difference in the proportion of macrolide-resistant MP cases or respiratory viral coinfections. The presence of pleural effusion in children with MP pneumonia indicated a more severe clinical course and poor treatment response. The results of the present study would help in the creation of a therapeutic plan and prediction of the clinical course of MP pneumonia in children.

Analysis of the concise etiology of pleural effusion in 3707 pediatric patients in a single clinical center

Purpose: To summarize the concise etiology of pleural effusion in 3707 patients over a period of 13 years at the Children’s Hospital of Chongqing Medical University. Methods: A total of 3707 patients with pleural effusion were included from January 2007 to December 2019 at our hospital. According to etiology, pleural effusion was divided into infectious pleural effusion and noninfectious pleural effusion. The infection factors were further subdivided as being caused by tuberculous, paragonimiasis, parapneumonic factors (including multiple bacterias, multiple viruses, mycoplasma, chlamydia, chlamydia, fungus and fever, blood routine examination shows increased white blood cells and neutrophils). The noninfectious factors were further subdivided into neoplastic, trauma, other causes. They were also divided into the infants and young children group (3 y and below), the preschool group (3–6 y) and the school-age group (above 6 y) depending on age. Results: Among the 3707 children, there were 2925 (78.9%) patients with infectious pleural effusions, and 782 (21.1%) patients with noninfectious pleural effusions. The incidence of infectious pleural effusions caused by parapneumonic factors decreased significantly with increasing age; however, parapneumonic factors remained the primary etiology of infectious pleural effusion in each group. The incidence of infectious pleural effusions caused by tuberculosis and paragonimiasis increased significantly with increasing of age. Tumor was the primary cause of noninfectious pleural effusion. The incidence of noninfectious pleural effusion caused by tumor and other causes increased significantly with increasing age. The incidence of noninfectious pleural effusion caused by trauma in the preschool group was significantly greater than that of the infants and young children group and school-age group. The number of noninfectious pleural effusion caused by other causes in the school-age group were significantly greater than those of in the infants and young children group and preschool group. Conclusion: In our center, pediatric pleural effusion was primarily caused by infections. parapneumonic factors were the primary causes of infectious pleural effusions. The proportion of noninfective pleural effusions in the etiology of pleural effusion in children was small; however, some were difficult to treat, requiring long-term treatment and possibly poor prognosis. Therefore, multidisciplinary treatment should be combined.

Rare Causes of Pleural Effusion in Children: Differential Diagnosis in a Pediatric Infectious Disease Clinic

Rare Causes of Pleural Effusion in Children: Differential Diagnosis in a Pediatric Infectious Disease Clinic

Lung Ultrasonography for the Diagnosis of Pleural Effusion in Children

Background: Chest radiograph was currently the standard imaging for diagnosing pleural effusion. However, there were many limitations, namely radiation, varying interpretation, and long time to get results. Lung ultrasonography is an alternative procedure that is easy to learn and offers many benefits, including noninvasive, ra­diation free, fast, valid, and reliable. The objec­tive of this study was to determine sensiti­vity, specificity, and positive likelihood ratio (LR+)of lung ultrasonography performed by pediatric resident for diagnosing pleural effusion Subjects and Method: This was a cross sectio­nal study at pediatric intensive care unit (PICU) Dr. Moewardi Hospital, Surakarta, Indonesia. We included pediatric patients aged 1 month-18 years from November 2018 to December 2019. A sam­ple of 44 patients with suspected pleural effusion was selected by consecutive sampling. The independents variable was lung ulrasono­graphy. The dependent va­riable were pleural effusion. All subjects under­went lung ultrasono­graphy and chest radiograph. Sensitivity, speci­ficity, and positive likelihood ratio were calculated. Results: There were 44 samples with 59.1% under 1 year old and 54.5% were female. All patients came to the emergency room with complaints of shortness of breath, accom­pa­nied by fever (77.3%) or cough (63.6%). Eleven (25.0%) patients had pleural effusion based on the results of lung ultrasonography. Based on chest radiograph, seven (15.9%) patients had pleural effusion. Lung ultrasonography has sensitivity of 14.3%, specificity of 73%, and LR+ of 0.5 for diagnosing pleural effusion. Conclusion: Lung ultrasonography can be used as a tool to diagnose pleural effusion with good specificity. Keywords: lung ultrasonography; pleural effu­si­on Correspondence: Dewi Sitoresmi Ayuningtyas. Department of Child Health, Faculty of Medicine, Sebelas Maret University/ Dr. Moewardi Hospital, Surakarta, Central Java, Indonesia. Jalan Kolonel Sutarto No. 132, Surakarta, Indonesia. Email: rr.dewi­si­to­resmi@gmail.com. Journal of Maternal and Child Health (2021), 06(02): 176-182 https://doi.org/10.26911/thejmch.2021.06.02.05

Pancreatic ascites and Pleural Effusion in Children: Clinical Profile, Management and Outcomes

BackgroundPancreatic ascites (PA) and pleural effusion (PPE) are rarely encountered in children. They develop due to disruption of the pancreatic duct (PD) or leakage from an associated pancreatic fluid collection (PFC). The literature on childhood PA/PPE and its management is scarce. MethodsA retrospective review of children with PA/PPE diagnosed and managed at our center over the last 4 years was performed. The clinical, biochemical, radiological and management profiles were analyzed. Conservative management included nil per oral, octreotide and drainage using either percutaneous catheter or repeated paracentesis. Endotherapy included endoscopic retrograde cholangiopancreatography (ERCP) and transpapillary stenting. ResultsOf the 214 children with pancreatitis, 15 (7%) had PA/PPE. Median age was 9 years with a third under 2 years. Median ascitic fluid amylase was 8840 U/L and all had elevated protein (>2.5 g/dl) and low serum ascites-albumin gradient ascites (<1.1). While PA/PPE was the first manifestation of underlying chronic pancreatitis (CP) in 10 children (67%), trauma was seen in 4 (26%) and hypertriglyceridemia in 1 (7%). On imaging, PD disruption could be identified in 10 (67%) children. ERCP and stenting was done in 10 children. Conservative management alone (n = 4) and endotherapy (n = 10) was successful in 93% with only one requiring surgery. The younger children (n = 4), were managed conservatively and only 1 of them required surgery. Resolution of PA/PPE was achieved in all with no recurrences. ConclusionsConservative management and ERCP plus transpapillary stenting results in resolution of majority of pediatric PA/PPE. Children presenting with PA/PPE needs to be evaluated for CP.

Pneumococcal conjugate vaccines decrease community-acquired alveolar pneumonia with and without pleural effusion in children

Background: Radiographically-proven community-acquired alveolar pneumonia with pleural effusion (PE-CAP) has a less favourable outcome than pneumonia without pleural effusion (NPE-CAP). We assessed PE-CAP and NPE-CAP rate dynamics in children <60 months in southern Israel before and after 7- and 13-valent pneumococcal conjugate vaccine (PCV7/PCV13) implementation (2002–2016).Methods: An ongoing, prospective observational study. Our hospital serves a captive population of ∼75,000 children <60 months, enabling incidence calculation. PCV7/PCV13 were implemented in Israel in July 2009/November 2010, respectively. All chest radiographs (CXRs) were digitalized and analysed according to the WHO Standardization of Interpretation. Annual incidences of PE-CAP and NPE-CAP were calculated, 2002–2016. Incidence-rate ratios (IRRs) comparing PCV13 (2013–2016), PCV7 (2010–2011) and pre-PCV (2002–2008) periods were calculated.Results: Overall, 12,271 CAP episodes were identified; 159 (1.3%) PE-CAP and 12,112 (98.7%) NPE-CAP. In total, 65.8% and 34.2% were children <24 and 24–59 months, respectively; 61.0% and 39.0% were Bedouin and Jewish children, respectively. Following PCV7 introduction, PE-CAP rates declined by 48% (Incidence rate ratios [IRR] = 0.52; 0.26–1.03), while NPE-CAP rates declined by 20% (IRR = 0.80; 0.75–0.86). In the PCV13 period, PE-CAP and NPE-CAP rates further declined, resulting in overall 70% (IRR = 0.30; 0.18–0.50) and 55% (IRR = 0.45; 0.43–0.48) reductions, respectively, comparing the PCV13 and the pre-PCV periods. Similar trends were observed in all subgroups (Bedouin vs. Jewish and age < 24 months vs. 24–59 months).Conclusions: Following PCV7/PCV13 introduction, PE-CAP and NPE-CAP rates substantially declined. However, the rate dynamics were different, with steeper declines observed in PE-CAP rates, possibly deriving from differences in disease aetiology.

Metabolomics Reveals Anaerobic Bacterial Fermentation and Hypoxanthine Accumulation for Fibrinous Pleural Effusions in Children with Pneumonia.

Fibrin formation in infectious parapneumonic effusion (IPE) characterizes complicated parapneumonic effusion and is important for providing guidelines for the management of IPEs that require aggressive interventions. We aim to identify metabolic mechanisms associated with bacterial invasion, inflammatory cytokines, and biochemical markers in cases of fibrinous infectious pleural effusions in children with pneumonia. Pleural fluid metabolites were determined by 1H nuclear magnetic resonance spectroscopy. Metabolites that contributed to the separation between fibrinous and nonfibrinous IPEs were identified using supervised partial least squares discriminant analysis ( Q2/ R2 = 0.84; Ppermutation < 0.01). IL-1β in the inflammatory cytokines and glucose in the biochemical markers were significantly correlated with 11 and 9 pleural fluid metabolites, respectively, and exhibited significant overlaps. Four metabolites, including glucose, lactic acid, 3-hydroxybutyric acid, and hypoxanthine, were significantly correlated with plasminogen activator inhibitor type 1 in the fibrinolytic system enzymes. Metabolic pathway analysis revealed that anaerobic bacterial fermentation with increased lactic acid and butyric acid via glucose consumption and adenosine triphosphate hydrolysis with increased hypoxanthine appeared to be associated with fibrinous IPE. Our results demonstrate that an increase in lactic acid anaerobic fermentation and hypoxanthine accumulation under hypoxic conditions are associated with fibrin formation in IPE, representing advanced pleural inflammatory progress in children with pneumonia.