Changes in the incidence and bacterial aetiology of paediatric parapneumonic pleural effusions/empyema in Germany, 2010-2017: a nationwide surveillance study.

OBJECTIVES: Parapneumonic pleural effusions/empyema (PPE/PE) are severe complications of community-acquired pneumonia. We investigated the bacterial aetiology and incidence of paediatric PPE/PE in Germany after the introduction of universal pneumococcal conjugate vaccine (PCV) immunization for infants. METHODS: Children <18 years of age hospitalized with pneumonia-associated PPE/PE necessitating pleural drainage or persisting >7 days were reported to the German Surveillance Unit for Rare Diseases in Childhood between October 2010 and June 2017. All bacteria detected in blood or pleural fluid (by culture/PCR) were included, with serotyping for Streptococcus pneumoniae. RESULTS: The median age of all 1447 PPE/PE patients was 5 years (interquartile range 3-10). In 488 of the 1447 children with PPE/PE (34%), 541 bacteria (>40 species) were detected. Aerobic gram-positive cocci accounted for 469 of 541 bacteria detected (87%); these were most frequently Streptococcus pneumoniae (41%), Streptococcus pyogenes (19%) and Staphylococcus aureus (6%). Serotype 3 accounted for 45% of 78 serotyped S. pneumoniae strains. Annual PPE/PE incidence varied between 14 (95%CI 12-16) and 18 (95%CI 16-21) PPE/PE per million children. Incidence of S. pneumoniae PPE/PE decreased from 3.5 (95%CI 2.5-4.6) per million children in 2010/11 to 1.5 (95%CI 0.9-2.4) in 2013/14 (p 0.002), followed by a re-increase to 2.2 (95%CI 1.5-3.2) by 2016/17 (p 0.205). CONCLUSIONS: In the era of widespread PCV immunization, cases of paediatric PPE/PE were still caused mainly by S. pneumoniae and, increasingly, by S. pyogenes. The re-increase in the incidence of PPE/PE overall and in S. pneumoniae-associated PPE/PE indicates ongoing changes in the bacterial aetiology and requires further surveillance.

[Lung Function in Childhood and Adolescence: Influence of Prematurity and Bronchopulmonary Dysplasia]. / Lungenfunktion in Kindheit und Adoleszentenalter: Einfluss von Frühgeburtlichkeit und bronchopulmonaler Dysplasie.

INTRODUCTION: The introduction of prenatal steroids, surfactant replacement therapy and gentle ventilation modes has reduced short term respiratory morbidity and increased survival of very preterm infants. However, there is some evidence that prenatal factors, the extend of prematurity and bronchopulmonary dysplasia (BPD) may affect pulmonary function in childhood and adolescence. METHODS: We have performed a comprehensive review on the outcome of pulmonary function after premature birth before 32 weeks of gestation in the era of surfactant replacement therapy and tried to evaluate the influence of chorioamnionitis, intrauterine growth retardation (IUGR), maternal metabolic syndrome, prematurity and BPD on long term pulmonary function. RESULTS: Some children and adolescents born very preterm may experience significant airflow reduction. The bronchial obstruction in these patients is not entirely reversible by inhalative ß2-mimetics. The degree of pulmonary function impairment is partly correlated with the degree of BPD. Abnormalities in pulmonary diffusion capacity may occur after extreme prematurity, but also in patients with moderate and severe BPD. IUGR may have a negative impact on later pulmonary function in very children. There is insufficient data to assess the preterm impact of chorioamnionitis or maternal metabolic syndrome on later lung function. CONCLUSION: Infants born before 32 weeks of gestational age in the surfactant era still carry an increased risk to suffer an impaired pulmonary function in childhood and adolescence, particularly if they survived with BPD. Long term pulmonary care for these patients should take place in specialized centers.