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The evaluation and cluster analysis of parapneumonic effusion in childhood
Mustafa Hacimustafaoglu1, Solmaz Celebi, Handan Sarimehmet
1Department of Pediatrics, Uludag University Medical Faculty, Gorukle, Bursa, Turkey. mkemal@uludag.edu.tr
Insights
Parapneumonic effusion in children often requires intervention beyond antibiotics. Fibrinolytic therapy is effective and can prevent surgery in many cases, though long-term lung function may be affected.
Area of Science:
- Pediatric Pulmonology
- Thoracic Surgery
Background:
- Parapneumonic effusion (PPE) is a common complication of pneumonia in children.
- Management strategies for PPE vary, impacting patient outcomes.
Purpose of the Study:
- To analyze clinical manifestations, treatment options, and 1-year follow-up of pediatric parapneumonic effusion.
- To evaluate the efficacy and safety of fibrinolytic therapy (FT) in managing complicated PPE.
Main Methods:
- Retrospective study of 80 children diagnosed with parapneumonic effusion.
- Analysis of treatment modalities including antibiotics, tube thoracostomy (TT), and fibrinolytic therapy (FT).
- Prospective 1-year follow-up including chest X-rays and pulmonary function tests.
Main Results:
- Antibiotics alone were effective for mild effusions (33%).
- Tube thoracostomy (TT) was used in 63% of patients; 25 required fibrinolytic therapy (FT), which was successful in 18 without complications.
- Successful FT prevented surgery in 22% of eligible patients. Rapidly progressing cases (4-6 days) had a poorer prognosis (p<0.05).
- One-year follow-up showed sequelae on chest X-ray in 28% and abnormal pulmonary function tests in 57% of patients over seven years old.
Conclusions:
- Fibrinolytic therapy is a safe and effective option for pediatric parapneumonic effusion, potentially avoiding surgery.
- Children with rapidly progressing symptoms face a higher risk of complicated outcomes.
- Long-term respiratory sequelae are common, particularly after surgical intervention for necrotizing pneumonia.
Abstract:
We studied 80 children with parapneumonic effusion (PPE) with respect to the clinical manifestations and treatment alternatives as well as prospective follow-up for 1 year. Out of the 80 patients, 59 per cent were male. The mean age of the patients was 4.0 +/- 3.1 years. Mild effusion was successfully treated by antibiotic alone in 33 per cent of the patients. Tube thoracostomy (TT) was utilized in 63 per cent of the patients. In this group, 11 healed completely, 13 patients required surgical treatment, and 25 required fibrinolytic therapy (FT). FT was successful in 18, and no complication due to FT was observed. Six patients who received FT required surgical therapy later in the course of treatment. Cluster analysis revealed a group of patients with rapid progression and a short history of symptoms (4-6 days) that showed significantly higher rate of complicated prognosis (p<0.05). Successful FT prevented surgical operation in 22 per cent of the patients who were candidates for surgical treatment. The follow-up for one year revealed sequelae on chest X-ray in 28 per cent of the patients most of whom had an operation for necrotizing pneumonia. Pulmonary function tests performed over seven years of age were abnormal in 57 per cent of the patients.
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