Articles
9 October 2025
Vol. 47 No. 2 (2025)
https://doi.org/10.4081/pmc.2025.354

Management of parapneumonial pleural empyema in children: a survey of the Italian Society of Infantile Videosurgery (SIVI)

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Alberto Ratta
alberto.ratta2@auslromagna.it
Pediatric Surgery Unit, Ausl della Romagna, Italy.
Maurizio Cheli
Department of Paediatric Surgery, Papa Giovanni XXIII Hospital, Bergamo, Italy.
Giovanni Gaglione
Department of Pediatric Surgery, Santobono Pausilipon Children’s Hospital, Napoli, Italy.
Andrea Volpe
Pediatric Surgery Unit, Women’s and Children’s Health Department, University Hospital of Padua, Italy.
Gabriele Lisi
Department of Pediatric Surgery “Spirito Santo”, Hospital of Pescara “G. D’Annunzio”, University Chieti-Pescara, Italy.
Valerio Gentilino
Pediatric Surgery Unit, Woman and Child Department, Filippo del Ponte Hospital-ASST Sette Laghi, Varese, Italy.
Roberto Lo Piccolo
Department of Pediatric and Neonatal Surgery, Meyer Children’s Hospital, Florence, Italy.
Giovanni Cobellis
Pediatric Surgery Unit, Salesi Children’s Hospital, Marche Polytechnic University, Ancona, Italy.
Fawzi Shweiki
Pediatric Surgery Unit, “Annunziata” Hospital, Cosenza, Italy.
Paolo Formica
Pediatric Surgery Unit, “S. Antonio Abate” Hospital, Trapani, Italy.
Ernesto Leva
Pediatric Surgery Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy.
Paola Midrio
Department of Pediatric Surgery, Ospedale Ca' Foncello, Treviso, Italy.
Daniela Codrich
Department of Pediatric Surgery, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy.
Michele Ubertazzi
Pediatric Surgery Unit, AOU Maggiore Della Carità, Novara, Italy.
Lorenzo Nanni
Pediatric Surgery Unit, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Rome, Italy.
Vincenzo Domenichelli
Pediatric Surgery Unit, Ausl della Romagna, Italy.
Maria Nobili
Pediatric Surgery Unit, University of Foggia, Italy.
Francesco Macchini
Pediatric Surgery Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
Alfonso Papparella
Pediatric Surgery, Department of Paediatrics, Faculty of Medicine, Second University of Naples, Italy.
Enrico Ciardini
Pediatric Surgery Unit, S. Chiara Hospital, Trento, Italy.
Luigi Mascia
Pediatric Surgery Unit, ARNAS “G. Brotzu”, Cagliari, Italy.
Denis Cozzi
Pediatric Surgery Unit, Sapienza University of Rome, Italy.
Fabio Salvatore Chiarenza
Department of Pediatric Surgery and Pediatric Minimally Invasive Surgery and New Technologies, San Bortolo Hospital, Vicenza, Italy.
SIVI Executive Board
Giovanni Casadio, Fabio Beretta, Cosimo Bleve, Alessio Pini Prato, Andrea Conforti, Antonio D’Alessio, Marco Gambino, Riccardo Guanà, Antonino Morabito, Simona Gerocarni Nappo, Paolo Caione, Giulia Giannotti, Italy.

The purpose of this paper was to define the specturm of management for Parapneumonial Pleural Effusion/Pleural Empyema (PE/PPE) in children in Italy. We conducted an online survey, distributed by the SIVI committee to 54 Italian pediatric surgery centers. A total of 23/54 (43%) Italian pediatric surgery centers responded. All responders (100%) required an anteroposterior chest radiograph (CXR) as the first imaging approach to suspect PPE, and chest Ultrasound (US) was routinely used in 96% of centers. A preoperative CT scan was routinely performed in 70% of centers. An etiological diagnosis was obtained in more than 80% of patients in 13% of centers, between 40% and 80% of cases in 61% of centers and in less than 40% of patients in 26% of centers. Empirical antimicrobial therapy with 2 antibiotics is the most commonly used therapeutic scheme (78% of centers) and targeted antibiotic therapy was used in 82% of enrolled centers. The majority of centers (57%) approached advanced stage pleural empyema with pleural drain placement and fibrinolysis (PDF); 26% of centers preferred to execute upfront Video-Assisted Thoracoscopic Debridement (VATD), and in 13% of centers, both fibrinolysis and VATD were used. In all cases (100%), urokinase was the fibrinolytic agent of choice. Broncho-Pleural Fistula (BPF) was treated conservatively with prolonged Pleural Drainage (PD) and antibiotics in 82% of centers, while the remaining 18% proposed early surgical treatment. 82% of centers proposed prolonged antimicrobial therapy for the treatment of Lung Abscess (LA), while 18% of centers preferred to execute upfront ultrasound-guided or thoracoscopic positioning of a pig-tail drain. As expected, we observed a lack of homogeneity in the treatment between the different centers: most of these have a preference for fibrinolysis over the use of primary VATD, with urokinase being the only fibrinolytic agent used in all centers. It would be desirable to involve as many centers as possible for the drafting of shared national guidelines in the treatment of PPE in children in Italy.

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Management of parapneumonial pleural empyema in children: a survey of the Italian Society of Infantile Videosurgery (SIVI). (2025). La Pediatria Medica E Chirurgica, 47(2). https://doi.org/10.4081/pmc.2025.354
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