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Clinical characteristics analysis and follow-up study of children with necrotizing pneumonia：A report of 80 cases
WANG Min-min*，WANG Ting，DAI Ge，et al
2021, 36(5):
369-375.
DOI: 10.19538/j.ek2021050613
Objective To explore the clinical features，treatment and prognosis of children with necrotizing pneumonia，and to improve the awareness and the level of diagnosis and treatment. Methods Make a retrospective analysis of the etiology，clinical manifestations，laboratory examinations，imaging changes，complications，treatment methods，and follow-up of children diagnosed with necrotizing pneumonia in the Children’s Hospital of Soochow University from January 2014 to December 2019. Results There were 80 children with necrotizing pneumonia in children，39 males and 41 females，aged 3.4（1.5，8.2） years old. All children had high fever，cough，and sputum expectoration. The heat peak was 39.9（39.2，40.0） ℃， the heat duration was 13.4（7.0，16.0） days，and the hospital stay was 20.0（16.0，29.8） days. WBC count in peripheral blood was 18.3（13.0，22.6）×109/L；neutrophil ratio was 83.5（75.7，89.5）%；C-reactive protein was 105.0（41.8，183.3） mg/L；calcitonin was 0.4（0.2，2.9） ng/L； erythrocyte sedimentation rate was 21.0（10.3，47.8） mm/h； lactate dehydrogenase was 525.4（365.3，792.0） U/L；fibrinogen was 5.2（3.8，6.3） g/L. The D-dimer was 2040.5（890.0，5351.3） μg/L. The pathogen detection rate was 71.3%（57/80），among which bacteria was 41.3%（33/80）. Mycoplasma pneumoniae was 28.8%（23/80），and virus was 25.0%（20/80）. The top five pathogens in turn were：Mycoplasma pneumoniae accounting for 28.8%（23/80），Streptococcus pneumoniae accounting for 27.5%（22/80），Staphylococcus aureus accounting for 11.3%（9/80），Boca virus and rhinovirus accounting for 7.5%（6 /80），and adenovirus accounting for 6.3%（5/80）. The mixed infection rate was 26.3%（21/80），and influenza viruses mixed with Streptococcus pneumoniae was common. A total of 55 cases of children had pulmonary complications，which mainly were pleural effusion，empyema，bronchopleural fistula and pneumothorax. After drug treatment with antibiotics，glucocorticoids，gamma globulin，and symptomatic treatment of bronchoalveolar lavage and closed chest drainage，clinical symptoms were relieved and the patients were discharged. About 62.5%（50/80） of the children were followed up for 3 months to 1 year. None of the children had obvious respiratory symptoms. Re-examination by chest CT or chest X-ray，10 cases had a little patchy shadow，2 cases had fiber stripe shadow left，and 3 cases were left with lung cavity lesions，but the remaining lung lesions disappeared. Conclusion The common pathogens in children with necrotizing pneumonia are Mycoplasma pneumoniae，Streptococcus pneumoniae，and Staphylococcus aureus，while a few are boca virus，adenovirus and influenza virus. Its condition is serious，often complicated by pleural effusion：after active anti-infection，anti-inflammation and symptomatic treatment，the prognosis is good，and very few have destruction of lung structure.
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