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Management of Pediatric Parapneumonic Pleural Effusion: Interventional Versus Conservative Approaches in an 11-Year
Bernat Servitje-Verdaguer1,2, Romina Conti-Degiorgis2,3, Roser Ayats-Vidal4
1Department of Pediatrics, Parc Taulí University Hospital, 08208 Sabadell, Catalonia, Spain.
Insights
A shift to conservative management for pediatric parapneumonic pleural effusion (PPE) showed improved outcomes. This approach, reserving drainage for severe cases, is safe and effective for children with complicated PPE.
Area of Science:
- Pediatric Pulmonology
- Thoracic Medicine
- Infectious Diseases
Background:
- Parapneumonic pleural effusion (PPE) is a significant complication of pediatric pneumonia.
- Management strategies for complicated PPE (cPPE) are evolving towards less invasive methods.
- Current data on pediatric PPE epidemiology, treatment, and outcomes are limited.
Purpose of the Study:
- To evaluate the impact of a shift in management strategy for pediatric PPE.
- To compare outcomes between interventional and conservative approaches to cPPE.
- To identify factors influencing pleural drainage decisions in a conservative setting.
Main Methods:
- Retrospective cohort study of 122 children with radiologically confirmed PPE (2015-2025).
- Defined two periods: interventional-prone and conservative management.
- Compared clinical outcomes, treatment duration, and radiological resolution between periods.
Main Results:
- The conservative period saw less frequent pleural drainage (24% vs. 55%).
- Patients in the conservative group experienced shorter antibiotic courses, hospital stays, and faster radiological recovery.
- Drainage in the conservative period was reserved for patients with higher clinical and radiological severity.
Conclusions:
- A conservative management strategy for pediatric PPE is associated with favorable outcomes.
- Pleural drainage is appropriately reserved for more severe pediatric PPE cases.
- A severity-guided approach supports conservative management for selected pediatric PPE patients.
Abstract:
Background: Parapneumonic pleural effusion (PPE) remains a relevant complication of pediatric pneumonia, with a substantial burden of morbidity, particularly in complicated forms. Optimal management strategies remain debated, with a recent shift toward more conservative approaches. Contemporary data on epidemiology, management practices, and outcomes are therefore needed. Methods: We conducted a retrospective cohort study of children admitted to our center with radiologically confirmed PPE between 2015 and 2025. Two study phases were defined to reflect the progressive shift in clinical practice: an interventional-prone period, in which complicated PPE (cPPE) was systematically drained, and a conservative period, in which drainage was reserved for patients with clinical deterioration. Data were compared between periods, and risk factors associated with pleural drainage during the conservative period were analyzed. Results: A total of 122 children with PPE were included (median age 4.1 years, 50% female), of whom 62.3% had cPPE. Pleural drainage was performed more frequently during the interventional period (55% vs. 24%). Patients managed during the conservative period had shorter duration of intravenous antibiotic therapy, shorter hospital stays, and faster radiological resolution, adjusting for disease severity. Within the conservative period, patients requiring pleural drainage (24.4%) had greater clinical and radiological severity, including higher rates of respiratory support and need for intensive care. Conclusions: In this cohort, the shift from a predominantly invasive to a more conservative strategy was not associated with worse clinical outcomes after adjusting for baseline severity. Pleural drainage was mainly reserved for patients with greater clinical compromise. These findings support a severity-guided approach to pleural drainage in pediatric PPE, in which conservative management with medical therapy alone may be safely considered in appropriately selected cases.
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