Chito Thokchom1 , Chinglensana Laitonjam2 , Mackson Singh Nongmaithem
BACKGROUND Pleural effusions, parapneumonic effusions and empyema thoracis are known complications of bacterial pneumonia Underlying disorders as well as treatment approaches dramatically reduce the rate of morbidity and mortality in children. METHODS Forty-six children below 12 years of age admitted with pleural effusions or empyema thoracis between October 2016 and May 2019 were prospectively analysed. Thoracocentesis and pleural fluid specimens were checked within 30 minutes of collection, for anaerobic organisms. Daily thoracocentesis, intercostal tube drainage (ICD), open thoracotomy and decortication were performed among appropriate patients. RESULTS Patient required thoracocentesis in 14 (30.4%) cases with thin pleural fluid and tube drainage in 32 (69.6%) patients with frank pus. Four of fourteen children (28.5%) on serial thoracocentesis underwent ICD for failure of resolution. 4 of 32 (12.5%) cases on ICD required decortication. Median length of stay was 12.4 days for patients treated with serial thoracocentesis, 18.6 days for patients treated with ICD and 29.2 days for operated patients. CONCLUSIONS Conservative management (with either thoracentesis or tube thoracostomy) of pleural effusions or empyema thoracis with antibiotics covering S. aureus and S. pneumoniae along with ICD is safe and effective without the need for prolonged hospital stay. Surgical intervention is needed only when conservative approach fails.
