Analysis of clinical, demographic, and laboratory features of pediatric cases developing necrotizing pneumonia due to community-acquired pneumonia before and after the COVİD-19 pandemic

Necrotizing pneumonia is a rare but severe complication seen in 7% of community-acquired pneumonias. Studies evaluating the incidence of necrotizing pneumonia over the past 20 years have indicated a trend of increasing incidence. This study aims to investigate the clinical characteristics of children diagnosed with necrotizing pneumonia in the hospital, changes before and after COVID-19, the prognosis of cases with necrotizing pneumonia, and the parameters affecting the length of hospital stay. A retrospective analysis was conducted on children aged between 28 days and 18 years who were diagnosed with necrotizing pneumonia due to community-acquired pneumonia (CAP) in the Department of Pediatric Health and Diseases at Akdeniz University between 2015 and 2023. The sociodemographic characteristics, hospital stay duration, treatment methods, and surgical requirements of the patients before and after the COVID-19 pandemic were compared. The study included 25 patients, with a mean age of 6.2 ± 3.97 years, 52% female, and 48% male. The majority of the patients were admitted during the winter months (n=10, 40%). The most common presenting symptom was cough (n=21, 84%). It was determined that 60% of the patients had used antibiotics, with the most frequently used antibiotic being amoxicillin-clavulanate (n=9, 36%). Rales were the most common finding on physical examination (n=17, 68%). The most frequently involved lobe was the right upper lobe, occurring in 40% of the cases (n=10). During hospitalization, the most commonly initiated antibiotic combination was ceftriaxone and vancomycin (n=7, 28%). Eight patients, all aged six years or younger, required intensive care. The average hospital stay duration was 32.6 ± 12.9 days, and all patients were discharged. An analysis of the seasonal distribution of admissions before and after the pandemic revealed no significant difference in the number of admissions during the winter months in both periods. In the pre-pandemic period, summer had the second highest number of admissions, whereas in the post-pandemic period, autumn ranked second. A significant difference was observed in the seasonal distribution of admissions between the pre- and post-pandemic periods (p=0.04); however, there were no significant differences in the presenting complaints or physical examination findings. In conclusion, necrotizing pneumonia is most commonly detected with prolonged fever and cough in the winter months. Most patients receive antibiotic treatment prior to hospitalization. Rales are frequently found on physical examination, and respiratory symptoms are more pronounced in children under six years of age. Changes in the seasonal distribution of admissions were observed after the pandemic; however, no significant differences were found in the presenting symptoms or examination findings. Further research is needed to better understand the effects of the pandemic on necrotizing pneumonia.