Prevalence of Para-Pneumonic Effusion and the Associated Factors among Children: A 3-Year Experience in a Single Tertiary Hospital

Authors

  • Yousef Alanazi Department of Pediatrics, College of Medicine, Majmaah University, Majmaah, Saudi Arabia https://orcid.org/0000-0003-1254-0541
  • Abdullatif Alkhurayji Pediatric Emergency Department, King Abdullah Specialist Children’s Hospital, King Abdulaziz Medical City, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia and King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
  • Omar Alawni Pediatric Emergency Department, King Abdullah Specialist Children’s Hospital, King Abdulaziz Medical City, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia and King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
  • Hamad Alkhalaf King Abdullah International Medical Research Center, Riyadh, Saudi Arabia and Department of Pediatrics, King Abdullah Specialist Children’s Hospital, King Abdulaziz Medical City, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia

DOI:

https://doi.org/10.6000/1929-4247.2024.13.02.4

Keywords:

Para-pneumonic effusion, pediatric pneumonia, prevalence, associated factors

Abstract

Background: Previous studies have highlighted the significant morbidity associated with para-pneumonic effusions in pediatric populations. However, comprehensive data on the prevalence and associated factors in children remain limited, particularly in tertiary care settings.

Methods: A retrospective cohort study was conducted over a three-year period at a single tertiary hospital. Medical records of pediatric patients diagnosed with pneumonia were reviewed to identify cases of para-pneumonic effusion. The study analyzed demographic data, clinical presentations, laboratory findings, and management approaches to determine factors associated with the development of para-pneumonic effusions.

Results: 150 patients were identified with para-pneumonic effusions. The majority of patients with effusions were male (60%) and under five years of age (70%). Factors significantly associated with the development of effusions included the presence of comorbidities (p<0.01), higher CRP levels (p<0.05), and hospital-acquired pneumonia (p<0.001). The length of hospital stay was notably longer in patients with effusions than those without (p<0.001).

Conclusion: The study found a considerable prevalence of para-pneumonic effusions among children with pneumonia in a tertiary hospital setting. Notably, associated factors were underlying comorbidities, elevated inflammatory markers, and hospital-acquired infections. These findings underscore the need for heightened surveillance and tailored management strategies in high-risk pediatric populations to mitigate the impact of effusions.

References

Hendaus MA, Janahi IA. Parapneumonic Effusion in Children: An Up-to-Date Review. Clin Pediatr (Phila) 2016; 55(1): 10-8. https://doi.org/10.1177/0009922815589917 DOI: https://doi.org/10.1177/0009922815589917

Antachopoulos C, Tsolia MN, Tzanakaki G, Xirogianni A, Dedousi O, Markou G, Zografou SM, Eliades A, Kirvassilis F, Kesanopoulos K, Roilides E. Parapneumonic pleural effusions caused by Streptococcus pneumoniae serotype 3 in children immunized with 13-valent conjugated pneumococcal vaccine. Pediatr Infect Dis J 2014; 33(1): 81-3. https://doi.org/10.1097/INF.0000000000000041 DOI: https://doi.org/10.1097/INF.0000000000000041

Israel EN, Blackmer AB. Tissue plasminogen activator for the treatment of parapneumonic effusions in pediatric patients. Pharmacotherapy 2014; 34(5): 521-32. https://doi.org/10.1002/phar.1392 DOI: https://doi.org/10.1002/phar.1392

Buckingham SC, King MD, Miller ML. Incidence and etiologies of complicated parapneumonic effusions in children, 1996 to 2001. Pediatr Infect Dis J 2003; 22(6): 499-504. https://doi.org/10.1097/01.inf.0000069764.41163.8f DOI: https://doi.org/10.1097/01.inf.0000069764.41163.8f

Padman R, King KA, Iqbal S, Wolfson PJ. Parapneumonic effusion and empyema in children: retrospective review of the duPont experience. Clin Pediatr (Phila) 2007; 46(6): 518-22. https://doi.org/10.1177/0009922806299096 DOI: https://doi.org/10.1177/0009922806299096

Wexler ID, Knoll S, Picard E, Villa Y, Shoseyov D, Engelhard D, Kerem E. Clinical characteristics and outcome of complicated pneumococcal pneumonia in a pediatric population. Pediatr Pulmonol 2006; 41(8): 726-34. https://doi.org/10.1002/ppul.20383 DOI: https://doi.org/10.1002/ppul.20383

Picard E, Joseph L, Goldberg S, Mimouni FB, Deeb M, Kleid D, Raveh D. Predictive factors of morbidity in childhood parapneumonic effusion-associated pneumonia: a retrospective study. Pediatr Infect Dis J 2010; 29(9): 840-3. https://doi.org/10.1097/INF.0b013e3181dd1fc4 DOI: https://doi.org/10.1097/INF.0b013e3181dd1fc4

Masarweh K, Gur M, Toukan Y, Bar-Yoseph R, Kassis I, Gut G, Hakim F, Nir V, Bentur L. Factors associated with complicated pneumonia in children. Pediatr Pulmonol 2021; 56(8): 2700-2706. https://doi.org/10.1002/ppul.25468 DOI: https://doi.org/10.1002/ppul.25468

Soares P, Barreira J, Pissarra S, Nunes T, Azevedo I, Vaz L, et al. Pediatric parapneumonic pleural effusions: Experience in a university central hospital. Revista portuguesa de pneumologia 2009; 15(2): 241-59. https://doi.org/10.1016/S0873-2159(15)30130-6 DOI: https://doi.org/10.1016/S2173-5115(09)70108-3

Balfour-Lynn IM, Abrahamson E, Cohen G, Hartley J, King S, Parikh D, et al. BTS guidelines for the management of pleural infection in children. Thorax 2005; 60: i1-21. https://doi.org/10.1136/thx.2004.030676 DOI: https://doi.org/10.1136/thx.2004.030676

Islam S, Calkins CM, Goldin AB, Chen C, Downard CD, Huang EY, et al. The diagnosis and management of empyema in children: a comprehensive review from the APSA outcomes and clinical trials committee. J Pediatr Surg 2012; 47. https://doi.org/10.1016/j.jpedsurg.2012.07.047 DOI: https://doi.org/10.1016/j.jpedsurg.2012.07.047

Feola GP, Hogan MJ, Baskin KM, Cahill AM, Connolly BL, Crowley JJ, et al. Quality improvement standards for the treatment of pediatric empyema. J Vasc Interv Radiol 2018; 29: 1415-22. https://doi.org/10.1016/j.jvir.2018.04.027 DOI: https://doi.org/10.1016/j.jvir.2018.04.027

Hafen GM, Grenzbach AC, Moeller A, Rochat MK. Lack of concordance in parapneumonic effusion management in children in central Europe. Pediatr Pulmonol 2016; 51: 411-7. https://doi.org/10.1002/ppul.23263 DOI: https://doi.org/10.1002/ppul.23263

Richards MK, McAteer JP, Edwards TC, Hoffman LR, Kronman MP, Shaw DW, et al. Establishing equipoise: National survey of the treatment of pediatric para-pneumonic effusion and empyema. Surg Infect (Larchmt) 2017; 18: 137-42. https://doi.org/10.1089/sur.2016.134 DOI: https://doi.org/10.1089/sur.2016.134

Epaud R, Aubertin G, Larroquet M, Ducou-le Pointe H, Helardot P, Clement A, et al. Conservative use of chest-tube insertion in children with pleural effusion. Pediatr Surg Int 2006; 22: 357-62. https://doi.org/10.1007/s00383-006-1645-4 DOI: https://doi.org/10.1007/s00383-006-1645-4

Carter E, Waldhausen J, Zhang W, Hoffman L, Redding G. Management of children with empyema: pleural drainage is not always necessary. Pediatr Pulmonol 2010; 45: 475-80. https://doi.org/10.1002/ppul.21200 DOI: https://doi.org/10.1002/ppul.21200

Proesmans M, Gijsens B, Van de Wijdeven P, De Caluwe H, Verhaegen J, Lagrou K, et al. Clinical outcome of parapneumonic empyema in children treated according to a standardized medical treatment. Eur J Pediatr 2014; 173: 1339-45. https://doi.org/10.1007/s00431-014-2319-1 DOI: https://doi.org/10.1007/s00431-014-2319-1

Long AM, Smith-Williams J, Mayell S, Couriel J, Jones MO, Losty PD. 'Less may be best'-Pediatric parapneumonic effusion and empyema management: Lessons from a UK center. J Pediatr Surg 2016; 51(4): 588-91. https://doi.org/10.1016/j.jpedsurg.2015.07.022 DOI: https://doi.org/10.1016/j.jpedsurg.2015.07.022

Goldin AB, Parimi C, LaRiviere C, Garrison MM, Larison CL, Sawin RS. Outcomes associated with type of intervention and timing in complex pediatric empyema. Am J Surg 2012; 203: 665-73. https://doi.org/10.1016/j.amjsurg.2012.01.005 DOI: https://doi.org/10.1016/j.amjsurg.2012.01.005

Dorman RM, Vali K, Rothstein DH. Trends in the treatment of infectious parapneumonic effusions in US children's hospitals, 2004-2014. J Pediatr Surg 2016; 51: 885-90. https://doi.org/10.1016/j.jpedsurg.2016.02.047 DOI: https://doi.org/10.1016/j.jpedsurg.2016.02.047

Segerer FJ, Seeger K, Maier A, Hagemann C, Schoen C, van der Linden M, et al. Therapy of 645 children with parapneumonic effusion and empyema—a German nationwide surveillance study. Pediatr Pulmonol 2017; 52: 540-7. https://doi.org/10.1002/ppul.23562 DOI: https://doi.org/10.1002/ppul.23562

Erlichman I, Breuer O, Shoseyov D, Cohen-Cymberknoh M, Koplewitz B, Averbuch D, Erlichman M, Picard E, Kerem E. Complicated community acquired pneumonia in childhood: Different types, clinical course, and outcome. Pediatr Pulmonol 2017; 52(2): 247-254. https://doi.org/10.1002/ppul.23523 DOI: https://doi.org/10.1002/ppul.23523

Moral L, Toral T, Clavijo A, Caballero M, Canals F, Forniés MJ, et al. Population-Based Cohort of Children With Parapneumonic Effusion and Empyema Managed With Low Rates of Pleural Drainage. Front Pediatr 2021; 9: 621943. https://doi.org/10.3389/fped.2021.621943 DOI: https://doi.org/10.3389/fped.2021.621943

Krenke K, Sadowy E, Podsiadły E, Hryniewicz W, Demkow U, Kulus M. Etiology of parapneumonic effusion and pleural empyema in children. The role of conventional and molecular microbiological tests. Respir Med 2016; 116: 28-33. https://doi.org/10.1016/j.rmed.2016.05.009 DOI: https://doi.org/10.1016/j.rmed.2016.05.009

Carrie LB, LaShonda YS, Timothy AJ, Andrew TP, Daniel A, Edward OM, et al. An Epidemiological Investigation of a Sustained High Rate of Pediatric Parapneumonic Empyema: Risk Factors and Microbiological Associations, Clinical Infectious Diseases 2002; 34(4): 434-40. https://doi.org/10.1086/338460 DOI: https://doi.org/10.1086/338460

Arêas CGS, Normando Júnior GR, Farias Júnior OS, Carneiro ICDRS. Parapneumonic pleural effusion: reality and strategies in an Amazon university hospital. Rev Col Bras Cir [Internet] 2016; 43(6): 424-9. https://doi.org/10.1590/0100-69912016006003 DOI: https://doi.org/10.1590/0100-69912016006003

Kirvassilis F, Hatziagorou E, Darda V-M, Kontouli K, Roilidis E, Tsanakas J. Decreasing incidence of parapneumonic pleural effusions (PPE) in children. European Respiratory Journal 2016; 48(Suppl 60): PA1282. https://doi.org/10.1183/13993003.congress-2016.PA1282 DOI: https://doi.org/10.1183/13993003.congress-2016.PA1282

Liese JG, Schoen C, van der Linden M, Lehmann L, Goettler D, Keller S, Maier A, Segerer F, Rose MA, Streng A. Changes in the incidence and bacterial aetiology of paediatric parapneumonic pleural effusions/empyema in Germany, 2010-2017: a nationwide surveillance study. Clin Microbiol Infect 2019; 25(7): 857-864. https://doi.org/10.1016/j.cmi.2018.10.020 DOI: https://doi.org/10.1016/j.cmi.2018.10.020

Published

2024-04-29

How to Cite

Alanazi, Y. ., Alkhurayji, A. ., Alawni, O. ., & Alkhalaf, H. . (2024). Prevalence of Para-Pneumonic Effusion and the Associated Factors among Children: A 3-Year Experience in a Single Tertiary Hospital. International Journal of Child Health and Nutrition, 13(2), 88–99. https://doi.org/10.6000/1929-4247.2024.13.02.4

Issue

Section

General Articles