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Published on: April 12, 2019
[Pleural effusion in children with pneumonia: a study of 63 cases]
B Espínola Docio1, J Casado Flores, T de la Calle Cabrera
1Unidad de Cuidados Intensivos Pediátricos, Hospital del Niño Jesús, Madrid, España. blaespdo@yahoo.es
Insights
Pediatric parapneumonic pleural effusions are increasing, with Streptococcus pneumoniae as the primary cause. C-reactive protein levels can help differentiate between exudates and empyemas, guiding treatment and improving outcomes.
Area of Science:
- Pediatric critical care medicine
- Infectious diseases
- Pulmonology
Context:
- Rising incidence and severity of pediatric pleural effusions.
- Parapneumonic pleural effusion as a significant pediatric critical care concern.
- Need for better diagnostic and therapeutic strategies.
Purpose:
- To describe the epidemiological characteristics, clinical findings, and treatment of pediatric parapneumonic pleural effusions.
- To investigate the correlation between C-reactive protein levels and effusion type (exudate vs. empyema).
- To analyze treatment outcomes based on effusion characteristics.
Summary:
- Retrospective study of 63 pediatric patients with parapneumonic pleural effusion.
- Streptococcus pneumoniae identified as the most common etiology.
- Elevated C-reactive protein (>170 mg/L) correlated with empyema, while lower levels (<100 mg/L) indicated exudate.
- Exudative effusions required less fibrinolytic therapy and shorter chest tube/PICU stays compared to empyemas.
Impact:
- Highlights the increasing trend of complicated pediatric pneumonias.
- Demonstrates the utility of C-reactive protein in distinguishing pneumonia severity.
- Suggests that effusion characteristics influence treatment intensity and duration, impacting patient recovery.
Introduction:
An increase in the number and severity of pleural effusions has been observed in the last few years. The aim of the study is to describe the epidemiological characteristics, clinical findings and the treatment of this disease.
Material And Methods:
This is a retrospective study of patients admitted into the PICU in Hospital Niño Jesús with parapneumonic pleural effusion from January 2005 to May 2006.
Results:
Sixty-three patients were included in the study. An increase of 29 % was observed in the number of patients admitted with parapneumonia effusion from 2005 to 2006. The most common aetiology was Streptococcus pneumoniae. In 65 % of patients pleural effusion was an empyema and in 33 % it was an exudate. In all patients with C-reactive protein below 100 mg/L the effusion was an exudate, whereas 81 % of patients with C-reactive protein above 170 mg/L had an empyema, p < 0.05. The patients who had an exudate needed lower doses of fibrinolytics than those who had an empyema (1.6 vs. 4.5, p < 0.05). The number of days having a chest tube or admitted in PICU was lower in patients with exudate (3 days each) than those with empyema (7 and 9 days respectively) (p < 0.05).
Conclusions:
An increase in the number of complicated pneumonias is observed amongst children in our country, S. pneumoniae being the main aetiology. Using laboratory techniques such as C-reactive protein can help to distinguish between complicated and uncomplicated pneumonia. Pleural effusion characteristics seem to have an influence on the need for fibrinolytic and the length of chest tube treatment.
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