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.