Eur J Pediatr Surg
DOI: 10.1055/s-0041-1725188
Original Article

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

1  Department of Pediatric Surgery, Second Faculty of Medicine, Charles University, Motol University Hospital, Prague, Czech Republic
,
Vaclav Koucky
2  Department of Pediatrics, Motol University Hospital, Praha, Czech Republic
,
Petr Pohunek
2  Department of Pediatrics, Motol University Hospital, Praha, Czech Republic
,
Kristyna Cejnarova
1  Department of Pediatric Surgery, Second Faculty of Medicine, Charles University, Motol University Hospital, Prague, Czech Republic
,
Stepan Coufal
3  Institute of Microbiology Czech Academy of Sciences, Institute of Microbiology, Praha, Czech Republic
,
Alena Kokesova
1  Department of Pediatric Surgery, Second Faculty of Medicine, Charles University, Motol University Hospital, Prague, Czech Republic
,
Vojtech Dotlacil
1  Department of Pediatric Surgery, Second Faculty of Medicine, Charles University, Motol University Hospital, Prague, Czech Republic
,
Natalia Petrasova
1  Department of Pediatric Surgery, Second Faculty of Medicine, Charles University, Motol University Hospital, Prague, Czech Republic
,
Lucie Pos
1  Department of Pediatric Surgery, Second Faculty of Medicine, Charles University, Motol University Hospital, Prague, Czech Republic
,
Jiri Snajdauf
1  Department of Pediatric Surgery, Second Faculty of Medicine, Charles University, Motol University Hospital, Prague, Czech Republic
,
Stepan Hlava
4  Department of Internal Medicine, Motol University Hospital, Praha, Czech Republic
,
Natali Polivka
1  Department of Pediatric Surgery, Second Faculty of Medicine, Charles University, Motol University Hospital, Prague, Czech Republic
,
Michal Rygl
1  Department of Pediatric Surgery, Second Faculty of Medicine, Charles University, Motol University Hospital, Prague, Czech Republic
› Author Affiliations

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.



Publication History

Received: 06 January 2021

Accepted: 18 January 2021

Publication Date:
07 March 2021 (online)

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