Lung Resection in Children with Necrotizing Pneumonia: Outcome and Follow-up

Abstract

Introduction The number of patients with necrotizing pneumonia has increased in recent years. The aim of this study is to review the incidence, management, and outcome of pediatric necrotizing pneumonia requiring surgical therapy and to prove that lung resection results in favorable development of patients. We hypothesize that overall lung function in children after lung resection does not differ from that of the healthy population. Materials and Methods A retrospective tertiary referral center study with a prospective follow-up spirometric study of patients with necrotizing pneumonia managed between January 2010 and December 2019 was performed. Results The study cohort consisted of 1,295 patients admitted to the pediatric department for community-acquired pneumonia; 47 patients developed necrotizing pneumonia, 36 of whom underwent parenchymal lung resection. A 5-year rise in the occurrence of necrotizing pneumonia requiring resection was 77%, with a significant increase in the last 3 years (p < 0.05). The median age at the time of surgery was 32.5 (interquartile range [IQR]: 32.25) months. Streptococcus pneumoniae was the most prevalent pathogen (83%), although 53.3% of these patients were vaccinated against the agent. In 67% of patients, preresection procedures were performed: drainage of pneumothorax (17%), drainage of empyema (46%), drainage of empyema with use of alteplase (25%), and thoracoscopic decortication (12%). Surgical procedures included lobectomy (72.2%), wedge resection (13.9%), bilobectomy (8.3%), and pneumonectomy (5.6%). The postoperative complication was bronchopleural fistula in three patients. There were two (5.5%) postoperative deaths due to multiple organ failure. The follow-up spirometry was performed 43.3 (median, IQR 23.8–66.7) months after surgical intervention. Normal lung function was detected in 35 (64.8%) patients, restrictive pattern in 6 (11.1%) patients, obstructive pattern in 11 (20.4%) patients, and combined in 2 (3.7%) patients. Conclusion The number of patients with necrotizing pneumonia requiring resection has increased significantly in the last 3 years (p < 0.05). Aggressive surgical treatment results in significant clinical improvement in most cases and favorable lung function outcome. Long-term follow-up showed normal spirometry in 64.8% of cases.

Methicillin-Resistant Staphylococcus aureus Pneumatoceles in a Neonate With Sotos Syndrome

“…Follow-up spirometry was within normal ranges in 64.8% of cases. 15 Lobectomy has an increased risk of mortality following surgery compared with nonsurgical management. In addition, some viable tissue needs to be salvageable; if too much tissue must be removed, lobectomy is not an optimal intervention.…”

“…These pathological connections between the airways can necessitate further surgical interventions. 15…”

“…Lobectomy is associated with lower postsurgical risk of infection, further necrosis, and a lower risk of the need for follow-up surgical interventions compared with surgical resection. Frybova et al15 note that patients requiring surgical resection had increased significantly in the past 3 years and that surgical treatments resulted in significant clinical improvement. Follow-up spirometry was within normal ranges in 64.8% of cases 15…”

“…Frybova et al15 note that patients requiring surgical resection had increased significantly in the past 3 years and that surgical treatments resulted in significant clinical improvement. Follow-up spirometry was within normal ranges in 64.8% of cases 15…”

Predictive role of bactericidal/permeability-increasing protein and C-reactive protein in a personalized approach to the treatment of children with acute pneumonia

“…Thus, the authors did not detect an increase in anti-BPI IgA in saliva. However, the mucous surface is where bacteria with neutrophils are present, which accumulate during the infectious process [24,25]. However, saliva may have an unusual BPI concentration [21].…”