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

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