The Risk of Pneumothorax With Intrapleural Urokinase in Children With Parapneumonic Effusion
Gili Kadmon1,2, Adi Schoen3, Elhanan Nahum1
1Pediatric Intensive Care Unit, Schneider Children's Medical Center in Israel, Petach Tikva, Israel.
Pediatric Pulmonology
|December 13, 2024
Summary
Intrapleural urokinase in children with parapneumonic effusion increased pneumothorax (PNX) risk and did not shorten hospital stays. This fibrinolytic therapy requires careful consideration due to potential complications.
Area of Science:
- Pediatric Pulmonology
- Thoracic Surgery
- Critical Care Medicine
Background:
- Fibrinolytic therapy is frequently used in pediatric parapneumonic effusions to aid drainage.
- Limited data exists on the complications of fibrinolytic treatment in children.
- Intrapleural urokinase is a common fibrinolytic agent used in this population.
Purpose of the Study:
- To determine the incidence of pneumothorax (PNX) associated with intrapleural urokinase in children.
- To compare complications and clinical outcomes between children treated with and without urokinase.
Main Methods:
- Retrospective analysis of pediatric patients with parapneumonic effusion undergoing chest drain insertion.
- Comparison of clinical course and complications, specifically PNX incidence, between urokinase-treated and non-urokinase-treated groups.
Main Results:
- The study included 120 children; 57 received urokinase.
- Pneumothorax incidence was significantly higher in the urokinase group (35% vs. 6%, p < 0.001).
- Median chest drain duration was longer in the urokinase group (6 vs. 4 days, p < 0.001).
Conclusions:
- Intrapleural urokinase in pediatric parapneumonic effusion is linked to a higher PNX rate.
- Urokinase treatment did not reduce hospitalization duration in this cohort.
- Findings suggest a need for caution when using intrapleural urokinase in children.
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