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European Journal of Pediatrics

, Volume 159, Issue 9, pp 684–688 | Cite as

Necrotising pneumonitis in children

  • Kin Sun Wong
  • Cheng Hsun Chiu
  • Kee Min Yeow
  • Yhu Chering Huang
  • Hui Ping Liu
  • Tzou Yien Lin
ORIGINAL PAPER

Abstract

We retrospectively analysed the clinical features and outcome of children under 17 years of age with necrotising pneumonitis (NP). The radiographs and CT scans of the chest of children under 17 years of age between July 1995 and March 1999 who had complicating community-acquired pneumonia were reviewed. CT scans were obtained for persistent fever, respiratory distress and sepsis despite empiric antibiotic therapy and closed tube drainage. A total of 21 children had the radiographic features of NP of whom 11 (52%) patients were successfully managed using antibiotic therapy with or without closed tube drainage. Ten patients required thoracoscopic decortications and/or lysis of pleural adhesions or debridement of empyema due to refractory pleural sepsis, failure of pulmonary re-expansion and persistent air-leaks. The most common pathogens identified were Streptococcus pneumoniae (n=3),Staphylococcus aureus (n=2), and Haemophilus influenzae type b (n=2). The days of hospital stay, duration of fever and days of C-reactive protein return to normal were significantly less for the medically versus the surgically treated children (P < 0.05).

Conclusion The clinical course of necrotising pneumonitis in children following complicated pneumonia is often prolonged despite adequate antibiotic therapy. Necrotising pneumonitis with co-existing multiple loculations, pneumothorax/bronchopleural fistula in the empyema and extensive pleural peel are poor prognostic factors for medical therapy. Thoracoscopic removal of loculated empyema, lysis of adhesions and/or decortication are effective in relieving tachypnoea, chest pain, and controlling fever and improve the outcome, especially in children with empyema.

Key words Childhood necrotising pneumonitis Empyema Video-assisted thoracoscopic surgery 

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Copyright information

© Springer-Verlag Berlin Heidelberg 2000

Authors and Affiliations

  • Kin Sun Wong
    • 1
  • Cheng Hsun Chiu
    • 2
  • Kee Min Yeow
    • 3
  • Yhu Chering Huang
    • 2
  • Hui Ping Liu
    • 4
  • Tzou Yien Lin
    • 2
  1. 1.Division of Paediatric Pulmonology, Chang Gung Children's Hospital, 5, Fu Hsin Street, Taoyuan, Taiwan e-mail: pulmonol@tpts5.seed.net.tw Fax: +886-3-3288957TW
  2. 2.Department of Paediatrics, Chang Gung Children's Hospital, Taoyuan, TaiwanTW
  3. 3.Department of First Diagnostic Radiology, Chang Gung Memorial Hospital, TaiwanTW
  4. 4.Department of Cardiovascular and Thoracic Surgery, Chang Gung Memorial Hospital, TaiwanTW

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