Diez John Robyn V, Perez Ma Lucila M, Malayan Grace V, Cenabre Maria Vanessa L
Department of Pediatrics, Ospital ng Makati Sampaguita cor Gumamela St, Pembo, Makati NCR, 1218, Philippines.
Respir Med Case Rep. 2020 Nov 4;31:101274. doi: 10.1016/j.rmcr.2020.101274. eCollection 2020.
Empyema thoracis, defined as the accumulation of pus in the pleural space, is a rare entity in the neonatal period. There are very few cases described in the medical literature and there are still no treatment protocols in the management of empyema in neonates. In older infants and children, intrapleural fibrinolytics and surgery are often utilized since treatment of complicated parapneumonic effusions with chest tube and antibiotics alone often fail due to the viscous fluid and presence of loculations. Presented here is a case of a term neonate who exhibited symptoms of respiratory distress on the sixth day of life. Imaging modalities revealed massive left sided pleural effusion with loculations and mass effects. Pleural fluid was grossly pus and exudative in nature. Gram stain revealed gram-positive cocci but culture was negative. Empiric broad-spectrum antibiotics and chest tube drainage were utilized and patient was discharged after forty-seven days of hospital admission. In spite of prolonged hospital stay, patient survived with no complications. Therefore, nonoperative therapy could still be an option for neonates with loculated empyema. The key to success in treatment is immediate identification of effusion, prompt initiation of antibiotics, and early effective chest tube drainage.
脓胸是指胸腔内积聚脓液，在新生儿期是一种罕见的病症。医学文献中描述的病例很少，目前仍没有针对新生儿脓胸的治疗方案。在大龄婴儿和儿童中，常采用胸膜内纤维蛋白溶解剂和手术治疗，因为仅用胸腔引流管和抗生素治疗复杂的肺炎旁胸腔积液往往会失败，原因是积液黏稠且存在分隔。本文介绍了一例足月儿，在出生后第6天出现呼吸窘迫症状。影像学检查显示左侧大量胸腔积液，伴有分隔和占位效应。胸腔积液肉眼可见为脓性，性质为渗出液。革兰氏染色显示革兰氏阳性球菌，但培养结果为阴性。采用了经验性广谱抗生素和胸腔闭式引流治疗，患儿入院47天后出院。尽管住院时间延长，但患儿存活且无并发症。因此，对于有分隔的新生儿脓胸，非手术治疗仍是一种选择。治疗成功的关键在于立即识别积液、及时开始使用抗生素以及早期进行有效的胸腔闭式引流。
