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Conservative treatment of empyema in children
1Department of Pediatrics, Hacettepe University School of Medicine, Ankara, Turkey.
Insights
Most childhood empyema cases resolve with tube drainage, not radical surgery. Staphylococcus aureus infection prolonged drainage, but long-term outcomes were excellent for all children.
Area of Science:
- Pediatric Pulmonology
- Thoracic Surgery
- Infectious Diseases
Background:
- Childhood empyema, a serious pleural infection, traditionally required aggressive surgical intervention.
- Recent evidence suggests less invasive methods may be effective for pediatric empyema management.
Purpose of the Study:
- To evaluate the effectiveness of conservative management for childhood empyema.
- To identify factors influencing treatment duration and long-term outcomes in pediatric empyema.
Main Methods:
- Retrospective analysis of 72 children treated for empyema without underlying diseases.
- Focus on tube drainage versus radical surgical approaches (decortication).
- Microbiological analysis (Staphylococcus aureus) and correlation with treatment duration and radiographic/functional outcomes.
Main Results:
- Only 3 of 72 children required decortication; 66 were treated with tube drainage.
- Staphylococcus aureus was identified in 44% of cases and associated with longer tube drainage duration (p < 0.05).
- Chest X-ray normalization occurred within 3 months in most children; all had normal radiograms and pulmonary function at 18 months.
Conclusions:
- Conservative management, primarily tube drainage, is highly effective for childhood empyema.
- Avoiding radical surgery is recommended, as it is unnecessary for most pediatric empyema cases.
- Excellent long-term pulmonary health is achievable following appropriate treatment.
Abstract:
Seventy-two children with no underlying diseases were treated for empyema. Radical surgical approaches like decortication were necessary for only 3 children. In 66 children tube drainage was applied. Staphylococcus aureus was cultured or was shown in Gram's stain in 32 (44%) and children with this microorganism had longer duration of tube drainage (p < 0.05). The period for normalization of chest X-ray was positively related with the age of the patient (p < 0.05). In 60 of 72 children, chest X-ray was normal after 3 months. Follow-up of the patients 18 months after the infection revealed that pulmonary radiograms were normal in all cases and pulmonary function tests were within normal limits in all of the tested children (n = 25). It is emphasized that avoiding major surgical approaches must be encouraged in childhood empyema.