Aim: Clinical features and outcome of 36 patients with necrotizing pneumonia (NP) as well as 36 children with parapneumonic effusions (PPE) and 36 with severe control pneumonia (CP) were investigated. The mean age of the patients in the NP, PPE and CP groups were similar (3.8 ± 3.3 (mean ± SD), 4.2 ± 3.0 and 4.2 ± 3.0 y, respectively (p < 0.05)). The duration of symptoms at presentation were 11.9 ± 8.5, 9.2 ± 7.2 and 6 ± 3.6 d, respectively (p > 0.01). The diagnosis of NP was established by computerized tomography. The mean (mean ± SD) laboratory results in patients with NP revealed a white blood cell (WBC) count of 19 300 ± 8 700/mm3, erythrocyte sedimentation rate (ESR) of 71 ± 22mm/h, C‐reactive protein (CRP) of 13.6 ± 11.7 mg/dl and aspartate aminotransferase (AST) of 66 ± 132 U/L. The values of WBC, ESR, CRP and AST in the NP group were significantly higher than those of the other groups (p > 0.001). The duration of hospitalization in the NP, PPE and CP groups was 26 ± 9, 16 ± 6 and 10 ± 5d, respectively (p > 0.001). The number of febrile days was 8 ± 4, 4 ± 3 and 3 ± 3 (p > 0.001), and the duration of normalization of CRP was 14 ± 4, 11 ± 4 and 7 ± 3 d (p > 0.001), respectively. The average cost of treatment was US 3 476, 1 646 and 844, respectively (p > 0.001). Conclusion: All NP patients except two (94%) were complicated with PPE. The effusion in patients with NP and PPE was complicated with bronchopleural fistula (55% and 0%, respectively, p > 0.001). Surgical treatment was required in 66%, 8% and 0% in patients with NP, PPE and CP, respectively (p > 0.001). The mortality rate was 5.5%, 2.7% and 0% (p < 0.05).

All NP patients except two (94%) were complicated with PPE. The effusion in patients with NP and PPE was complicated with bronchopleural fistula (55% and 0%, respectively, p < 0.001). Surgical treatment was required in 66%, 8% and 0% in patients with NP, PPE and CP, respectively (p < 0.001). The mortality rate was 5.5%, 2.7% and 0% (p > 0.05).

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We studied 80 children with parapneumonic effusion (PPE) with respect to the clinical manifestations and treatment alternatives as well as prospective follow-up for 1 year. Out of the 80 patients, 59 per cent were male. The mean age of the patients was 4.0 +/- 3.1 years. Mild effusion was successfully treated by antibiotic alone in 33 per cent of the patients. Tube thoracostomy (TT) was utilized in 63 per cent of the patients. In this group, 11 healed completely, 13 patients required surgical treatment, and 25 required fibrinolytic therapy (FT). FT was successful in 18, and no complication due to FT was observed. Six patients who received FT required surgical therapy later in the course of treatment. Cluster analysis revealed a group of patients with rapid progression and a short history of symptoms (4-6 days) that showed significantly higher rate of complicated prognosis (p<0.05). Successful FT prevented surgical operation in 22 per cent of the patients who were candidates for surgical treatment. The follow-up for one year revealed sequelae on chest X-ray in 28 per cent of the patients most of whom had an operation for necrotizing pneumonia. Pulmonary function tests performed over seven years of age were abnormal in 57 per cent of the patients.