•  
  •  
 

Abstract

Introduction: Necrotizing pneumonia, an uncommon but serious condition in children, lacks comprehensive multicenter pediatric data. The objective was to assess treatment strategies and outcomes of necrotizing pneumonia in children. Methods: The Pediatric Health Information System was queried for patients, ages 30 days to 19 years, with lung necrosis. Children who received alteplase were compared with those who did not. The chi-square test, Mann-Whitney-U test, multivariable regression analysis, and propensity score matching were performed. Results: Out of a total of 2,177 children with necrotizing pneumonia, 59% had pleural effusion. A complex chronic condition (CCC) was present in 51% of patients. Resources utilized included chest tube placement (42%), alteplase administration (38.8%), admission to the intensive care unit (45%), mechanical ventilation (28%), and video-assisted thoracoscopic surgery (VATS) (4.5%). Cephalosporins (83%) and anti-staphylococcal antibiotics (62%) were the most commonly used antibiotics. The mortality rate was 3.9%. Univariate analysis revealed that alteplase (OR 3.86; CI 2.99-4.98) and VATS (OR 2.24; CI 1.4-3.6) were associated with increased odds of pneumothorax. Mechanical ventilation (OR 15.9; CI 7.1 – 35.8), ECMO (OR 7.5; CI 4.27 – 13.0), and CCC (OR 3.9; CI 1.7- 9.1) were all associated with an increases odds of mortality. Propensity score matched analysis showed that alteplase use was associated with increased odds of pneumothorax, higher charges, and longer length of stay but not associated with increased odds of bronchopleural fistula. Conclusions: Alteplase is commonly used in pediatric necrotizing pneumonia and is associated with increased odds of pneumothorax, but not with bronchopleural fistula.

Additional Files
JPIC-15-1_10_supplemental.pdf (89 kB)
Download

Share

COinS