Masters IB, et al. Necrotizing pneumonia: an emerging problem in children? Pneumonia (Nathan). 2017 Jul 25;9:11.
“NP is an uncommon but increasingly recognized severe complication of pneumonia in previously healthy young children. The major pathogens are S. pneumoniae and S. aureus and the diagnosis should be considered when, despite appropriate antibiotics, the child remains febrile and unwell with persistent signs of respiratory distress and pneumonia. Most will have a PPE, empyema and/or BPF that has not improved despite chest drainage or surgical intervention. The diagnosis is confirmed by chest imaging, usually by a CT scan or sonography, while treatment requires prolonged IV antibiotics, which can be changed to oral medication for an additional 10–14 days, once the child is afebrile and clinically stable. Ideally, surgical intervention is kept to a minimum, but this is not always possible if there are mass effects from gas and fluid in the pleural cavity or pulmonary gangrene leading to massive hemoptysis, uncontrolled sepsis, or difficulties with assisted ventilation. Nevertheless, despite its severity, mortality in children is uncommon; the children improve clinically within a couple of months, radiographic changes are largely resolved after 5–6 months, and only a minority are left with mildly impaired lung function. Important targets for future research include identifying host–pathogen interactions leading to disease, improving the microbiologic diagnostic gap, optimizing medical and surgical management, and ultimately preventing this severe complication of pediatric pneumonia.”