Paediatric Surgery (Ukraine). 2026. 2(91): 51-59. doi: 10.15574/PS.2026.2(91).5159
Dihtiar V. A., Halahan A. A., Lukianenko D. M.
Dnipro State Medical University, Ukraine

For citation: Dihtiar VA, Halahan AA, Lukianenko DM. (2026). Clinical analysis of acute necrotising pneumonia treatment cases in children. Paediatric Surgery (Ukraine). 2(91): 51-59. doi: 10.15574/PS.2026.2(91).5159.
Article received: Mar 23, 2026. Accepted for publication: Jun 15, 2026.

The problem of treating purulent-destructive diseases of the bronchopulmonary system and their prevention in children remains relevant, which is associated with a large number of pulmonary-pleural forms and complications of acute destructive pneumonia.
Aim – to analyze the course of the disease in patients with complicated and uncomplicated acute purulent destructive pneumonia (APDP), by investigating inflammatory changes according to clinical and biochemical research methods, the effectiveness of ultrasound monitoring of pleural cavities, and the effectiveness of various surgical treatment methods.
Materials and methods. A total of 109 children were under observation: group 1 – 38 patients with community-acquired pneumonia and APDP complications, and group 2 – 71 patients without complications. Changes in complete and biochemical blood tests and changes in pleural cavities were studied using instrumental research methods, in particular X-ray, ultrasound, and multispiral computed tomography (presence of effusion, gas, and changes in pleural sheet thickness).
Results. In almost one-third (31.6%) of patients in group 1, surgical procedures or interventions were not performed, and patients received only conservative therapy. In the most favorable cases (in the presence of serous content with a volume of no more than 1/3 of the pleural cavity), a puncture method of managing exudative pleurisy under ultrasound guidance was used. In group 2, all patients required surgical intervention.
Conclusions. Early hospitalization of children with APDP significantly improves the prognosis and reduces the length of hospital stay, which leads to increased economic efficiency of treatment. The duration of inpatient treatment for APDP complicated by pyofibrinothorax is 2.2 times higher than in the uncomplicated course. To increase treatment efficacy, it is recommended to conduct ultrasound monitoring of the condition of pleural cavities, which provides the opportunity for early detection of pyofibrinothorax signs and serves as an indication for videothoracoscopy.
The study was conducted in accordance with the principles of the Declaration of Helsinki. Informed consent for conducting the research was obtained from the parents or guardians of the children.
The authors declare no conflict of interest.
Keywords: acute purulent destructive pneumonia, complications, diagnosis, treatment, children.

REFERENCES

1. Al Omran HI. (2021). Unilateral double round pneumonia in a child: A case report and literature review. Radiol Case Rep. 16(11): 3266-3269. https://doi.org/10.1016/j.radcr.2021.07.066; PMid:34484528 PMCid:PMC8403706

2. Australian Commission on Safety and Quality in Health Care. (2021). Antimicrobial stewardship in Australian health care. Sydney: Australian Commission on Safety and Quality in Health Care.

3. Avansino JR, Goldman B, Sawin RS, Flum DR. (2005). Primary operative versus nonoperative therapy for pediatric empyema: A meta-analysis. Pediatrics. 115(6): 1652-1659. https://doi.org/10.1542/peds.2004-1405; PMid:15930229

4. Bradley JS, Byington CL, Shah SS, Alverson B, Carter ER, Harrison C et al. (2011). The management of community-acquired pneumonia in infants and children older than 3 months of age: Clinical practice guidelines by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America. Clin Infect Dis. 53(7): e25-e76. https://doi.org/10.1093/cid/cir531; PMid:21880587

5. Cornaglia G, Courcol R, Herrmann J-L, Kahlmeter G, Peigue-Lafeuille H, Vila J. (2012). ESCMID: European manual of clinical microbiology. 1st ed.: 472.

6. De Benedictis FM, Kerem E, Chang AB, Colin AA, Zar HJ, Bush A. (2020). Complicated pneumonia in children. Lancet. 396(10253): 786-798. https://doi.org/10.1016/S0140-6736(20)31550-6; PMid:32919518

7. Dihtiar VA, Halahan AA, Lukianenko DM. (2025). Diagnosis of pulmonary and pleural complications of acute necrotizing pneumonia in children. Child's Health. 20(3): 183-188. https://doi.org/10.22141/2224-0551.20.3.2025.1827

8. Halahan AA, Lukianenko DM, Savenko MV. (2023). Ultrozvukova diahnostyka plevralnykh uskladnen hostroi destruktyvnoi pnevmonii u ditei. The XXIV International Scientific and Practical Conference «Current scientific opinions on the development of current education», June 19-21, 2023, Milan, Italy: 132-135.

9. Halahan AA, Dihtiar VA, Lukianenko DM. (2023). Acute necrotizing pneumonia and pyofibrinothorax in an experiment. Paediatric Surgery (Ukraine). 3(80): 21-26. https://doi.org/10.15574/PS.2023.80.21

10. Principi N, Esposito S. (2011). Management of severe community-acquired pneumonia of children in developing and developed countries. Thorax. 66(9): 815-822. https://doi.org/10.1136/thx.2010.142604; PMid:20965930