Complicated pneumonias with empyema and/or pneumatocele in children

To investigate the incidence, procedure type, characteristics of pleural fluid and pneumatoceles, and evolution of pneumonia complicated with empyema and/or pneumatoceles. Review of 394 pediatric pneumonia in patients at S (a) over capo Paulo State University Hospital during 2 years. We studied those with complications such as pleural effusion and pneumatocele. There were 121 (30.71%) with complications such as pleural effusion and pneumatocele; these were significantly higher in infants. One hundred and six children were needle aspirated, of these 78 underwent drainage, and 15 observation only. From the drained, seven needed thoracotomy or pleurostomy. Fluid was purulent in 50%, and pneumatoceles were seen in 33 cases (8.3%) with spontaneous involution in 28 (85%). Pleural fluid culture was negative in 51% cases; in positive cultures, Streptococcus pneumoniae was the most common agent. Complicated pneumonia incidence was higher in the second year of life and more than 70% occurred before 4 years of age. Closed thoracic drainage was effective in over 90%. Large effusions and mediastinal deviations were submitted to more aggressive procedures. Pneumatoceles predominated in the under 3s and were generally evident in the first chest X-ray. Most cases had spontaneous pneumatocele involution, and in almost half the cases were still present at drain tube removal

Fatores associados às complicações em crianças pré-escolares com pneumonia adquirida na comunidade Factors associated with complications of community-acquired pneumonia in preschool children

OBJETIVO: Identificar os fatores socioeconômicos e clínicos associados à evolução para complicações em crianças internadas com pneumonia adquirida na comunidade (PAC). MÉTODOS: Estudo longitudinal prospectivo em crianças diagnosticadas com PAC (12-59 meses de idade) internadas em enfermarias gerais de pediatria de dois hospitais na região de Campinas (SP). Os critérios de exclusão foram ter fibrose cística, cardiopatia, malformação pulmonar, neuropatias e doenças genéticas. PAC foi diagnosticada por características clínicas e radiológicas. Os dados foram coletados dos prontuários médicos e por um questionário semiestruturado. Os sujeitos foram divididos em dois grupos (PAC complicada e não complicada). Foram comparadas variáveis socioeconômicas e clínicas, e foi realizada análise de regressão logística multivariada. RESULTADOS: Das 63 crianças incluídas, 29 e 34, respectivamente, apresentaram PAC não complicada e PAC complicada. Não houve diferenças estatisticamente significantes entre os grupos quanto a idade na admissão, idade gestacional, peso ao nascer, gênero ou variáveis socioeconômicas. Houve diferenças significantes entre os grupos em relação a pneumonia anterior (p = 0,03), antibioticoterapia prévia (p = 0,004), tempo de início da doença (p = 0,01), duração da febre antes da internação (p < 0,001), duração da antibioticoterapia (p < 0,001) e tempo de internação (p < 0,001). Na análise multivariada, somente permaneceu no modelo a duração da febre antes da internação (OR = 1,97; IC95%: 1,36-2,84; p < 0,001). CONCLUSÕES: Variáveis biológicas, com destaque para o tempo de febre anterior à internação, parecem estar associadas com a evolução para complicação em crianças com PAC.<br>OBJECTIVE: To identify socioeconomic factors and clinical factors associated with the development of complications in preschool children hospitalized with community-acquired pneumonia (CAP). METHODS: This was a prospective longitudinal study involving children (12-59 months of age) diagnosed with CAP and admitted to the pediatric wards of two hospitals in the metropolitan area of Campinas, Brazil. Children with cystic fibrosis, heart disease, pulmonary malformations, neurological disorders, or genetic diseases were excluded. The diagnosis of CAP was based on clinical and radiological findings. Data were collected from the medical records and with a semi-structured questionnaire. The subjects were divided into two groups (complicated and uncomplicated CAP). Socioeconomic and clinical variables were compared, and multivariate logistic regression analysis was performed. RESULTS: Of the 63 children included, 29 and 34, respectively, presented with uncomplicated and complicated CAP. No statistically significant differences were found between the groups regarding age at admission, gestational age, birth weight, gender, or socioeconomic variables. Significant differences were found between the groups regarding history of pneumonia (p = 0.03), previous antibiotic therapy (p = 0.004), time elapsed since the onset of CAP (p = 0.01), duration of fever prior to admission (p < 0.001), duration of antibiotic therapy (p < 0.001), and length of hospital stay (p < 0.001). In the multivariate analysis, only duration of fever prior to admission remained in the model (OR = 1.97; 95% CI: 1.36-2.84; p < 0.001). CONCLUSIONS: Biological variables, especially duration of fever prior to admission, appear to be associated with the development of complications in children with CAP