Surgical Management of Necrotizing Pneumonia in Pediatric Patients. A Retrospective Analysis in a Third-Level Center

Introduction: Necrotizing pneumonia (NP) is a rare entity seen to occur in 0.9%–7% of cases of community-acquired pneumonia in the pediatric population. Medical management remains the cornerstone of treatment. However, the destruction of both parenchyma and blood vessels impairs blood flow, limiting antibiotic concentrations and allowing the infection to persist. Although surgical management remains debated, some authors advocate for it in cases of medical treatment failure or extensive disease. The objective of this study was to present the surgical outcomes of our experience in treating NP in the pediatric population. Methods: A retrospective and observational study was conducted on all cases of NP in children who required surgical management between January 2022 and June 2024. Results: During the study period, a total of 142 pediatric thoracic surgeries were performed, of which 25 involved patients with NP, who were included in our analysis. The median age was 3 years (2–4), with a nearly equal gender distribution (52% female, n = 13). The median duration of symptoms prior to the surgical procedure was 27 days (22–36), antibiotic therapy duration ranged from 5 to 18 days. On the basis of computed tomography findings regarding the extent of parenchymal involvement, 17 patients underwent sublobar resections, while 8 required lobar resections. While no statistically significant differences were observed in post-operative outcomes between groups, it is noteworthy that patients who underwent lobectomy experienced a higher frequency of complications. Conclusion: Surgical intervention, typically involving resection of necrotic lung tissue, may be considered in carefully selected pediatric patients who demonstrate persistent clinical deterioration despite optimized medical therapy and exhibit extensive parenchymal destruction on imaging. It is critical to tailor the treatment plan to the patient’s clinical status and disease progression.