A retrospective study of children with necrotizing pneumonia: Four years of tertiary care experience

<bold>Background:</bold> Necrotizing pneumonia (NP) is relatively uncommon in children. <bold>Objective:</bold> To evaluate the aetiology, clinical features, management, and outcome of NP in children. <bold>Methods:</bold> A retrospective single-centre study in Western India. Children of age <18 years diagnosed as NP based on CT thorax between January 2019 to July 2023 were included. The data collected included information on demographic, clinical, laboratory parameters, and final outcome. Results:A total of 36 children were included. The median age was 4 years (2.0-9.5) with 64% (n=23) boys. Malnutrition was seen in two-thirds of patients. NP was identified by Chest X-ray in 3 and by Ultrasonography thorax in 8 patients. Aetiology was identified in 11/36 patients (31%) with Methicillin-sensitive Staphylococcus aureus in 4/36 (11%) being the most common. Interestingly, Mycobacterium tuberculosis was identified in 3 patients, and one each yielded MRSA, Klebsiella, Invasive Aspergillus, and Streptococcus pneumoniae. Among the complications, empyema was noted in 39%, broncho-pleural fistula in 17%, and pneumothorax in 6%. Intercostal drainage was placed at 58%. Surgical interventions were required in 28%, of which 2 underwent lobectomy. The median duration of hospital stay was 15.5 days (8- 31). A total of 17/36 (47%) required ICU admission; among which ARDS was seen in 2 patients and a total of 2 patients had expired in our study. <bold>Conclusions:</bold> Necrotizing pneumonia is an emerging complication of pneumonia in children. Appropriate and timely antibiotics may curtail the need for surgical intervention.