Retrospective Study of Complicated Pneumonia at the Pediatric Department of the University Hospital of Padua: Experience from 2022 to 2024

<b>Background:</b> Community-acquired pneumonia (CAP) in children may be complicated by necrotizing pneumonia (NP), complicated parapneumonic effusion (CPPE), and lung abscess. These complications prolong hospitalization and require medical and surgical intervention. Objectives. To describe clinical course, diagnostic workup, and management of cCAP (complicated CAP) in children admitted to the Women's and Children's Health Department, Padua University Hospital, between January 2022 and September 2024. To identify factors associated with disease severity and evaluate outcomes. <b>Methods:</b> All children hospitalized for cCAP during the study period were included. Data collected comprised clinical features, laboratory and imaging findings, medical and surgical management, and outcomes. <b>Results:</b> Forty patients (mean age 4.4 y; 13.15% of pneumonia admission) were included: 67.5% had NP with CPPE, 22.5% isolated effusion, 10% NP without effusion. All patients were febrile at onset, 62.2% had cough, 32.5% abdominal pain, 30% rhinitis. NP was confirmed by contrast-enhanced chest CT. Thirty patients (75%) had positive microbiological testing, mainly <i>Streptococcus pneumoniae</i> and <i>Streptococcus pyogenes</i>. 77.5% required oxygen therapy (five invasive ventilation and one with ECMO). Median fever duration 18 days (IQR 15-27) with elevated CRP (median peak 300 mg/L). Pleural drainage was performed in 66.7%, fibrinolytics in 17.5%, thoracoscopic decortication in 12.5%, and lobectomy in one patient. Radiological resolution occurred at a median of 31 days post-discharge, with normal pulmonary function at a median of 15 months. <b>Conclusions:</b> Despite pediatric cCAP severity, short- and long-term outcomes are favorable. Early recognition and integrated management are crucial, and further prospective studies are warranted to optimize care and identify severity predictors.