Long-Term Outcomes of Necrotizing Pneumonia and Parapneumonic Effusion in Children

Complications such as parapneumonic effusion (PPE) and necrotizing pneumonia (NP) can be noted in 3% of patients with community-acquired pneumonia and may cause functional lung damage.

We aimed to investigate the short- and long-term effects of PPE and NP on lung function and the impact of treatment modalities and radiological sequelae on results.

This multicenter retrospective study includes children aged 0-18 years hospitalized for PPE and NP after community-acquired pneumonia. Demographic, clinical, radiological, and spirometry findings were collected during diagnosis and follow-up.

Of 123 children (62 female, median age 57 [interquartile range 71.5] months), 78 were diagnosed with NP and 45 with PPE. According to the defined periods, spirometric evaluation was performed in the first 3 months in 23 patients, between the 3rd and 6th months in 27 patients, and between the 6th and 9th months in 37 patients. At 3 months post-discharge, abnormal spirometry (18.18% restrictive, 36.36% combined spirometry) was observed with a rate of 54.54% in NP, and with a rate of 25.0% (8.33% restrictive, 16.66% combined spirometry) in PPE. At 6-9 months, normal spirometry was observed with a rate of 87% in both groups. FVC% values increased over time in both the NP and PPE groups; however, statistically significant improvement was observed only in the PPE group. In this group, FVC% was significantly higher in the patients who received antibiotics with chest tube and/or fibrinolytic therapy (p = 0.022). Furthermore, those without radiological sequelae had significantly higher FVC% values compared to those with sequelae (p = 0.023) in the PPE group.

Radiological sequelae and restrictive spirometric patterns were initially more common in NP compared to PPE. However, spirometry indicated significant improvement in both groups by the end of the 9-month follow-up period.