Role of two-day injectable dexamethasone therapy in the resolution of uncomplicated parapneumonic effusion: A single-blinded randomized trial

<h2>Abstract</h2><h3>Objective</h3> To assess the effect of two days of intravenous dexamethasone therapy on the resolution of uncomplicated parapneumonic effusion in hospitalized children aged 1 month to 14 years, as measured by <b>standardized pleural fluid volume estimation on bedside ultrasonography (posterior axillary and interscapular views, using Eibenberger's formula) on days 3–4 of admission.</b> <h3>Methods</h3> This single-center, randomized, single-blind, parallel-group clinical trial included 62 children diagnosed with community-acquired pneumonia (CAP) and pleural effusion. Participants were randomized into two groups: the intervention group received intravenous dexamethasone (0.25 mg/kg/dose) four times daily for two days along with antibiotics and usual care, while the control group received only antibiotics and usual care. The primary outcome was the resolution of pleural effusion based on ultrasonographic volume. <b>Secondary outcomes included changes in inflammatory markers, hospital length of stay, need for pleural intervention, and adverse events.</b> <h3>Results</h3> All 62 patients (mean age 2 years; 61.3% male) completed the study. In the intervention group, the mean pleural fluid volume decreased significantly from 13.97 ± 6.61 ml on admission to 3.22 ± 3.99 ml by day 4. In contrast, the control group showed an increase from 15 ± 7.53 ml to 17.07 ± 12.36 ml (p < 0.001). The intervention group also showed a significant reduction in C-reactive protein (CRP) and total leukocyte count compared to controls (p < 0.001). <b>Mean hospital stay was significantly shorter in the dexamethasone group (5.8 ± 1.2 vs 7.3 ± 1.6 days, p=0.01). None of the patients required pleural drainage.</b> Multivariate linear regression identified dexamethasone intervention as the only significant predictor of effusion resolution (p = 0.0001). No significant differences in complications or adverse events were observed between groups. <h3>Conclusion</h3> Short-course intravenous dexamethasone therapy significantly accelerates the resolution of uncomplicated parapneumonic effusion in children without increasing adverse effects. <b>It also reduces hospital stay without increasing the need for drainage and may serve as a safe and effective adjunct to standard antibiotic therapy in pediatric patients with CAP-associated effusion.</b>