Conservative Treatment of Parapneumonic Effusion in Children: Experience From a 10-Year Consecutive Case Series
Steven J Lohuis1, Eric de Groot1, Arvid W A Kamps2
1From the Department of Paediatrics, Isala, Zwolle, The Netherlands.
Insights
Most children with parapneumonic effusion (PPE) can be treated with antibiotics alone. Pleural drainage is often unnecessary unless the child shows signs like mediastinal shift or extensive effusions.
Area of Science:
- Pediatric Pulmonology
- Thoracic Medicine
- Infectious Diseases
Background:
- Parapneumonic effusion (PPE) in children presents a management dilemma regarding antibiotic-only treatment versus pleural drainage.
- Clinical features and outcomes of pediatric PPE cases require further evaluation to guide treatment decisions.
Purpose of the Study:
- To evaluate clinical features and treatment outcomes in children diagnosed with parapneumonic effusion.
- To determine criteria for selecting conservative management versus pleural drainage for pediatric PPE.
Main Methods:
- A retrospective, multicentre cohort study involving 136 children (ages 1-18) treated for PPE between 2010 and 2020.
- Analysis of clinical and radiological features, treatment strategies (conservative vs. pleural drainage), and patient outcomes.
Main Results:
- 117 patients (86%) received conservative antibiotic treatment; 19 (14%) underwent pleural drainage.
- Pleural drainage was associated with mediastinal shift, septations/pockets, pleural thickening, and larger effusion size.
- Conservative management showed success rates varying by radiological signs, with shorter hospitalization (5 vs. 19 days) but similar readmission rates.
Conclusions:
- A significant proportion of pediatric parapneumonic effusions can be managed effectively with antibiotics alone.
- Absence of mediastinal shift, septations/pockets, pleural thickening, or extensive effusions supports conservative treatment.
- This study suggests a more selective approach to pleural drainage in pediatric PPE, favoring conservative management when feasible.
Background:
In children with parapneumonic effusion (PPE), it remains unclear when conservative treatment with antibiotics suffixes or when pleural drainage is needed. In this study we evaluate clinical features and outcomes of children with PPE.
Methods:
A retrospective, multicentre cohort study at 4 Dutch pediatric departments was performed, including patients 1-18 years treated for PPE between January 2010 and June 2020.
Results:
One hundred thirty-six patients were included (mean age 8.3 years, SD 4.8). 117 patients (86%) were treated conservatively and 19 (14%) underwent pleural drainage. Patients undergoing pleural drainage had mediastinal shift more frequently compared with conservatively treated patients (58 vs. 3%, difference 55%; 95% CI: 32%-77%). The same accounted for pleural septations/pockets (58 vs. 11%, difference 47%; 95% CI: 24%-70%), pleural thickening (47 vs. 4%, difference 43%; 95% CI: 20%-66%) and effusion size (median 5.9 vs. 2.7 cm; P = 0.032). Conservative management was successful in 27% of patients (4 of 15) with mediastinal shift, 54% of patients (13 of 24) with septations/pockets, 36% of patients (5 of 14) with pleural thickening, and 9% of patients (3 of 32) with effusions >3 cm, all radiological signs generally warranting pleural drainage. In patients treated conservatively, median duration of hospitalization was 5 days (IQR 4-112) compared with 19 days (IQR 15-24) in the drainage group ( P < 0.001), without significant difference in readmission rate (11 vs. 4%, difference 6%; 95% CI: -8%-21%).
Conclusion:
This study suggests that the greater amount of children with PPE could be treated conservatively with antibiotics only, especially in absence of mediastinal shift, pleural septations/pockets, pleural thickening or extensive effusions.
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