Long-Term Outcomes of Necrotizing Pneumonia and Parapneumonic Effusion in Children

Abstract

BackgroundComplications such as parapneumonic effusion (PPE) and necrotizing pneumonia (NP) can be noted in 3% of patients with community-acquired pneumonia and may cause functional lung damage.ObjectiveWe aimed to investigate the short- and long-term effects of PPE and NP on lung function and the impact of treatment modalities and radiological sequelae on results.Material and MethodsThis multicenter retrospective study includes children aged 0-18 years hospitalized for PPE and NP after community-acquired pneumonia. Demographic, clinical, radiological, and spirometry findings were collected during diagnosis and follow-up.ResultsOf 123 children (62 female, median age 57 [interquartile range 71.5] months), 78 were diagnosed with NP and 45 with PPE. According to the defined periods, spirometric evaluation was performed in the first 3 months in 23 patients, between the 3rd and 6th months in 27 patients, and between the 6th and 9th months in 37 patients. At 3 months post-discharge, abnormal spirometry (18.18% restrictive, 36.36% combined spirometry) was observed with a rate of 54.54% in NP, and with a rate of 25.0% (8.33% restrictive, 16.66% combined spirometry) in PPE. At 6-9 months, normal spirometry was observed with a rate of 87% in both groups. FVC% values increased over time in both the NP and PPE groups; however, statistically significant improvement was observed only in the PPE group. In this group, FVC% was significantly higher in the patients who received antibiotics with chest tube and/or fibrinolytic therapy (p = 0.022). Furthermore, those without radiological sequelae had significantly higher FVC% values compared to those with sequelae (p = 0.023) in the PPE group.ConclusionRadiological sequelae and restrictive spirometric patterns were initially more common in NP compared to PPE. However, spirometry indicated significant improvement in both groups by the end of the 9-month follow-up period.