Page 392 - Abstract Book KONIKA 18

Respirology

P-RES-005
Diagnosis and Treatment of Necrotizing Pneumonia in Children

Kathrine, Wahyuni Indawati, Darmawan Budi Setyanto
Department of Child Health, Faculty of Medicine, Universitas Indonesia/Dr. Ciptomangunkusumo Hospital,
Jakarta, Indonesia
Abstract
Background Necrotizing pneumonia, as severe complication of pneumonia, is found in 0.8-7% pneumonia
cases, and has high morbidity in children. It is characterized by lung tissue destruction, resulting in multiple
small thin-walled cavities, and should be suspected in non-responding or progressive pneumonia after
72-hours antibiotic administration. Early detection may contribute to early treatment and better outcome.
Objective Describing diagnostic approach to improve early diagnosis and treatment of necrotizing pneumonia.
Case A 6-month-old boy, weighed 5 kg with incomplete vaccination history, diagnosed as pneumonia with
left pleural effusion. He did not respond to antibiotic treatment and diagnosed as clinical tuberculosis. Water
sealed drainage was done, but pleural fluid analysis and culture were not performed. No improvement shown
after 6-week antituberculosis therapy. Chest CT showed solid mass on the left lung. He was referred as
suspected malignancy and planned for biopsy. There were cough, rapid breathing, and chest retraction on
the day of admission. Oxygen saturation was 98% with 2 L/min nasal cannula oxygen. Fever was presented
on 3rd observation day. Inflammation markers were increased. No positive result shown in tuberculosis
work up. Chest X-ray showed inhomogeneous consolidation on the left lung. Repeated chest CT showed
multiple hypodense lesions with irregular shaped walls on the left lung suspected cavitating pneumonia. He
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was given 3 generation cephalosporin for 21 days. Clinical symptoms were improved. He was discharged
and continuing antibiotic treatment until 30 days in outpatient clinic. Conclusion Necrotizing pneumonia
has a good outcome with adequate antibiotic treatment.
Keywords: necrotizing pneumonia; children; antibiotic

P-RES-006
Interventional Pediatric Pulmonology Approach
in Management of Subglottic Stenosis

Dimas Dwi Saputro, Rifan Fauzie, Retno Widyaningsih
Department of Child Health, Respirology Division PKIAN RSAB Harapan Kita, Jakarta, Indonesia
Abstract
Background Prolonged endotracheal intubation can cause injury and remarkable mucosal changes starting
from edema and congestion that can develop to microscopic necrosis and fibrotic scars which lead to subglottic
stenosis (SGS). Prolonged intubation is known as the leading cause of acquired SGS which usually manifest
as serious acute airway obstruction. Objective To describes our experiences in interventional pulmonology
procedures evaluating SGS in children. Case We present 3 cases (a 5-month-old male, a 11-month-old male,
and a 3-month-old female) whom hospitalized due to severe airway obstruction. All of the cases had history
of prolonged intubation > 7 days, one case intubated due to severe pneumonia, while the other due to post
operation procedures. Each patient had been managed differently previously according to their degree of
obstruction, size and location of stenosis. All patients came with persistent stridor and had no previous history
of choking, foreign body aspiration, or sick contact. On initial assessment, all patients had tachypnea, biphasic
stridor, chest indrawing, and were able to swallow without difficulties. All cases had been discussed in our
pediatric airway management team. Initial endoscopy found 2 and 3 degree of stenosis. Balloon dilation
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were performed in all patients but in the 3rd degree patient, laser resection had been performed preceding
the balloon procedure. There were no serious complications observed during and after the procedures.
Conclusion Endoscopic assessment is mandatory in the evaluation of airway obstruction. Preparation and
team communication becomes an integral part of management to treat SGS in children.
Keywords: subglottic stenosis; stridor; pediatric flexible bronchoscopy

344 KONIKA XVIII Abstract Book