Related Experiment Video
Updated: Jan 15, 2026
A Modified Sonographic Algorithm for Image Acquisition in Life-Threatening Emergencies in the Critically Ill Newborn
Published on: April 7, 2023
Paediatric parapneumonic effusion - a twenty-year clinical narrative
Leonie Bregy1, Philipp K A Agyeman1, Andrea Duppenthaler1
1Division of Paediatric Infectious Disease, Department of Paediatrics, Bern University Hospital, Inselspital, University of Bern, Bern, CH-3010, Switzerland.
Insights
Paediatric parapneumonic effusion (PPE) management has evolved, with increased use of pleural drainage and shorter antibiotic courses. Streptococcus pneumoniae causes more lung damage than Streptococcus pyogenes in children with PPE.
Area of Science:
- Pediatric Pulmonology
- Infectious Diseases
- Critical Care Medicine
Background:
- Paediatric parapneumonic effusion (PPE) carries risks of sepsis and lung sequelae.
- Current treatment guidelines for PPE are lacking.
- Management strategies vary, impacting patient outcomes.
Purpose of the Study:
- To analyze trends in PPE management over time.
- To evaluate the influence of management strategies on short-term outcomes.
- To compare clinical differences in PPE caused by distinct pathogens.
Main Methods:
- Retrospective observational single-centre study.
- Analysis of 255 patients with PPE admitted between 2004 and 2024.
- Jonckheere-Terpstra test used for trend analysis.
Main Results:
- Pleural drainage increased from 20% to 65% over the study period.
- Intravenous antibiotic duration decreased from 15 to 11 days.
- Streptococcus pneumoniae was linked to greater lung damage, while Streptococcus pyogenes was more associated with sepsis/toxic shock.
Conclusions:
- Significant clinical differences exist between PPE caused by S. pneumoniae and S. pyogenes.
- S. pneumoniae infections result in more severe lung damage.
- Evolving management strategies may influence PPE outcomes.
Purpose:
Paediatric parapneumonic effusion (PPE) is accompanied by an increased risk of complications, e.g., sepsis or lung sequelae. Treatment strategies span from antibiotics alone to surgical interventions, but an internationally accepted guideline is lacking. With this study, we aim to better understand how management strategies influence short-term outcome parameters, like length of stay, antibiotic treatment duration, and lung damage.
Methods:
Retrospective observational single-centre study. Patients admitted from 1 July 2004 to 30 June 2024 with PPE to our tertiary hospital were analysed. We used the exact Jonckheere-Terpstra test to analyse trends over time.
Results:
A total of 278 patients were included, 23 (8%) had to be excluded for lack of informed consent. A majority (173/255, 68%) were treated with pleural drainage. Over time, drains were increasingly more often inserted without surgery, 20% vs. 65% (p = 0.001) in 2004-2008 vs. 2020-2024. Intravenous antibiotic treatment duration declined from 15 days in 2004-2008 to 11 days in 2020-2024, p = 0.002. The most commonly identified pathogen was S. pneumoniae (39%), followed by S. pyogenes (18%). S. pyogenes compared to S. pneumoniae was more often associated with sepsis or toxic shock (45% vs. 6%, p < 0.0001), but fewer patients showed radiologic evidence for acute lung damage (68% vs. 23%, p < 0.001).
Conclusion:
We found considerable clinical differences in patients with PPE caused by S. pneumoniae vs. S. pyogenes. The former was associated with substantially greater lung damage.
Related Concept Videos
01:28Pleural Effusion II: Symptoms and Management
A pleural effusion is the abnormal collection of fluid between the parietal and visceral pleura layers of tissue that form the lining of the lungs and chest cavity. It can occur independently or due to surrounding parenchymal diseases, such as infection, malignancy, or inflammatory conditions.
Clinical Manifestations:
01:25Pleural Effusion I: Introduction
There are two main types of pleural effusion: transudative and exudative. They are differentiated using Light's...
01:29Pneumonia II: Pathophysiology
01:30Pneumonia III: Complications and Assessment
01:30Pneumonia V: Nursing management and Prevention
The nurse must practice strict medical asepsis and adhere to infection control guidelines to minimize healthcare-associated infections.
Enhance airway patency
Position the patient correctly to facilitate drainage of the affected lung segments. Manual or mechanical percussion and vibration can also be employed....
01:30Pneumonia I: Introduction
Risk Factors
Various factors influence the likelihood of developing pneumonia. Age plays a crucial role, with infants, children under two, and individuals over 65 at increased risk due to their...