Corticosteroids for the management of parapneumonic pleural effusion in children: a 15-year experience

Abstract

Objective: Description of the use of corticosteroids for the management\nof parapneumonic pleural effusion in children. Methods: Retrospective\nmonocenter cohort study of all children hospitalized with a discharge\ndiagnosis of parapneumonic pleural effusion during a 15-year period.\nResults: We documented 97 cases of parapneumonic effusion during the\nstudy period, with a median age (interquartile range (IQR)) of 43\n(33-61) months. Most of the children benefited from an evacuation of the\npleural effusion (89/97, 91.8%): 21 patients (21.6%) were treated with\nneedle thoracocentesis only, while a chest tube was inserted in 68\nchildren (70.1%). Thirty-two patients (33%) were treated with\nintrapleural fibrinolysis. Fifty-five children (56.7%) received\ncorticosteroids for persistent fever. The median time (IQR) between\nhospital admission and initiation of corticosteroids was 5.5 (4-7) days.\nWhen corticosteroids were initiated, children were febrile since 9 (IQR\n8-11) days. The fever ceased in a median (IQR) of 0 (0-1) day after\ncorticosteroids initiation. Only 1 patient required a video-assisted\nthoracoscopy that was provided because of morphological reasons (morbid\nobesity). No children treated with corticosteroids required surgery. All\nchildren were discharged alive from hospital. The median (IQR) hospital\nlength of stay was 11 (8-14) days, with no difference between children\nwith and without corticosteroids. Conclusion: Our results indicate that\ncorticosteroids could be associated with a significant reduction in the\nuse of surgical procedures and with a prompt clinical improvement.\nCorticosteroids could thus offer a non-invasive therapeutic alternative\nfor children with parapnemonic effusions when antibiotics and pleural\ndrainage are considered a failure.