Loculated empyema in a neonate successfully treated with chest tube thoracostomy and antibiotics

Abstract

Empyema thoracis, defined as the accumulation of pus in the pleural space, is a rare entity in the neonatal period. There are very few cases described in the medical literature and there are still no treatment protocols in the management of empyema in neonates. In older infants and children, intrapleural fibrinolytics and surgery are often utilized since treatment of complicated parapneumonic effusions with chest tube and antibiotics alone often fail due to the viscous fluid and presence of loculations. Presented here is a case of a term neonate who exhibited symptoms of respiratory distress on the sixth day of life. Imaging modalities revealed massive left sided pleural effusion with loculations and mass effects. Pleural fluid was grossly pus and exudative in nature. Gram stain revealed gram-positive cocci but culture was negative. Empiric broad-spectrum antibiotics and chest tube drainage were utilized and patient was discharged after forty-seven days of hospital admission. In spite of prolonged hospital stay, patient survived with no complications. Therefore, nonoperative therapy could still be an option for neonates with loculated empyema. The key to success in treatment is immediate identification of effusion, prompt initiation of antibiotics, and early effective chest tube drainage.

A rare case of multiloculated thoracic empyema in a neonate

“…Overall, 0.6% of childhood pneumonias are complicated by parapneumonic effusion which may progress to thoracic empyema. It predominantly involves the right lung and 7.1% of all cases are bilateral [ 1 , 2 , 3 ]. In the pre-antibiotic era, empyema was a common complication of pneumonia, usually caused by pneumococcal, and streptococcal organisms.…”

“…In neonatal period, however, thoracic empyema is less likely due to the immaturity of the immune system; which limits localization of infection to the pleural space, and the capacity of the pleura to produce enough exudates. If it occurs in neonate, the appropriate treatment should be given immediately as thoracic empyema may lower the lung function and lead to more complications, such as formation of pneumatocele lead to persistent sepsis, disseminated abscess, bronchopleural or bronchocutaneous fistula or progress to restrictive lung [ 1 , 2 , 4 , 5 ].…”

“…Thoracic empyema is defined as accumulation of pus in pleural cavity [ 1 , 2 , 3 ]. It is relatively common in children, especially in malnourished, and immunocompromised patients [2] .…”

Empyema thoracis in a Nigerian neonate: case report and brief literature review

“…8,9 Chest echocardiography was used in a few studies to calculate the volume of pleural fluid and for subsequent follow up, but this function can be achieved with the chest ultrasound. [9][10][11] Pleural fluid culture though an important diagnostic tool in ET has been reported to have positive bacterial culture yield of 60-80% while blood culture is 13-31%. 12 The commonest causative pathogen from the pleural fluid microscopy among prior reported cases of neonatal ET was Staphylococcus aureus, just like in our study.…”

Haemophilus Influenzae Empyema in a Two-Month-Old Infant

“…Empyema can rarely complicate pneumonia in neonates. 1 It carries high morbidity and mortality in this population. 1,4,5 It is defined as a progressive pleural pus build up, which is mainly seen as a complication in patients with pneumonia.…”