Pleural fluid in hospitalized pediatric patients
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1Section of Pediatric Respirology, Children's Hospital of Winnipeg, Canada.
Insights
Pediatric pleural effusion has diverse causes, with parapneumonic effusions being most common. Invasive procedures like thoracentesis are used less frequently, possibly due to antibiotic use.
Area of Science:
- Pediatric Pulmonology
- Infectious Diseases
- Thoracic Medicine
Background:
- Pleural effusion is a significant condition in pediatric hospitalizations.
- Understanding the causes and management of pediatric pleural effusion is crucial for effective treatment.
- Previous studies have highlighted varying etiologies and treatment approaches in children.
Purpose of the Study:
- To investigate the spectrum of etiologies for pleural effusion in hospitalized children.
- To analyze the diagnostic methods and microbial findings in pediatric pleural effusion.
- To evaluate the utilization of thoracentesis and chest tube drainage in managing pediatric pleural effusions.
Main Methods:
- Retrospective chart review of 105 children hospitalized with pleural effusion.
- Analysis of patient demographics, clinical data, microbial cultures, and pleural fluid analysis.
- Assessment of diagnostic procedures, including thoracentesis and chest tube insertion.
Main Results:
- Parapneumonic effusions were the most frequent diagnosis (61%).
- Haemophilus influenzae and Staphylococcus aureus were the most common bacterial pathogens identified.
- Thoracentesis and chest tube drainage were employed in a minority of suspected infectious cases (39% and 27%, respectively).
Conclusions:
- Pediatric pleural effusion presents with a broad range of causes, predominantly parapneumonic.
- Reduced use of invasive procedures may be linked to empiric broad-spectrum antibiotic administration.
- Further research is needed to validate adult criteria for pleural fluid exudate/transudate classification in children.
Abstract:
We reviewed 105 charts of children who were hospitalized in a major teaching hospital between 1987 and 1993 with a diagnosis of pleural effusion established by radiographic study of the chest. There were 75 males and 30 females; mean age was 7.2 years (range 1 day-18 years). Pleural fluid was secondary to trauma, renal disease, or malignancy in 31.5% of patients. Parapneumonic effusions were found in the majority of patients, 64/105 (61%). However, in only 38 of the 64 patients (59%) was an organism isolated from any source. The most common bacterial organism cultured was Haemophilus influenzae (11 patients), followed by Staphylococcus aureus (seven patients). In five of 38 patients, a viral etiology was diagnosed. Pleural fluid was examined in only 35 patients (34%) and a pathogen found in only five (three bacterial, one Candida, one respiratory syncytial virus). It was possible to classify only 17 cases as exudate (fluid/blood protein ratio > or = 0.5) and six cases as transudate (fluid/blood protein < 0.5). Of 64 patients with suspected pleural fluid secondary to infection, 25 (39%) underwent thoracentesis and only 17 (27%) required tube drainage. This study demonstrates a wide spectrum of etiologies for pleural fluid in children, as well as the reduced use of thoracentesis or chest tube drainage in suspected infection. We speculate that this is probably because of the extensive empiric use of broad-spectrum antibiotics. The biochemical criteria established for adults for distinguishing pleural fluid exudates and transudates need to be studied in children.