Title : Pediatric necrotizing pneumonia: diagnostic strategies, therapeutic approaches, and clinical outcomes
Abstract:
Background and Objective: Pediatric necrotizing pneumonia (PNP) is a rare and severe complication of community-acquired pneumonia characterized by pulmonary parenchymal destruction and necrotic cavitation. This study aimed to analyze factors associated with PNP, with emphasis on diagnostic strategies, therapeutic approaches, and clinical outcomes.
Methods: A literature review was conducted using the PubMed/MEDLINE database. The search strategy combined terms related to pediatrics and necrotizing pneumonia using Boolean operators. Of 231 records identified, studies published in English between 2015 and 2025 that addressed the proposed themes were screened according to predefined inclusion and exclusion criteria. Fifteen articles were included in the final analysis.
Results: Diagnosis may be challenging because clinical and radiological manifestations overlap among different etiologic agents, including Mycoplasma pneumoniae and other causes of necrotizing pneumonia. Lung ultrasound showed potential for early detection while reducing radiation exposure, and computed tomography radiomics emerged as a promising approach for diagnostic prediction. Inflammatory markers, including the monocyte-to-lymphocyte ratio, platelet-to-lymphocyte ratio, leukocytosis, neutrophilia, and elevated D-dimer, were associated with disease severity and may contribute to risk stratification. Prolonged antibiotic therapy remains central to management. In severe or refractory cases, pleural drainage and surgical intervention may be required, although indications for invasive treatment vary according to clinical severity and complications. Pulmonary embolism and hypercoagulability may occur in selected patients, supporting individualized consideration of anticoagulation. Pneumococcal conjugate vaccination has been associated with reduced hospitalizations, while ongoing surveillance remains important because of changing serotypes and antimicrobial resistance.
Conclusion: PNP requires prompt recognition and individualized management. Early diagnostic strategies, appropriate assessment of inflammatory and coagulation markers, timely antimicrobial therapy, and selective use of invasive interventions may help reduce complications. Further research is needed to validate biomarkers and standardize diagnostic and therapeutic protocols.
Keywords: Pediatric necrotizing pneumonia; Mycoplasma pneumoniae; Pediatric infectious diseases; Diagnosis; Treatment
