DIAGNOSTIC LUNG PUNCTURE IN THE PNEUMONIAS OF INFANTS AND CHILDREN

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Abstract
Lung punctures were performed on 32 occasions in 28 infants with pneumonia to assist in specific bacteriologic diagnosis. The aspirates yielded pure cultures of Diplococcus pneumoniae and Staphylococcus aureus each in four patients and E. coli in two patients. The procedure is performed as for a thoracentesis and requires no special instruments. Three children had pneumothoraces and one had a small hemoptysis following the procedure, but only one child exhibited even minimal respiratory distress as a result of the tap. The literature on lung aspirates was reviewed with respect to the value and potential liability of the procedure. At present, diagnostic lung punctures should be considered in three groups of children with lower respiratory disease: (1) the critically ill child in whom a specific etiologic diagnosis is of major importance to guide antimicrobial therapy, (2) the child who has deteriorated while on therapy and in whom an etiologic agent is not available from the usual upper respiratory tract cultures, and (3) the child with pneumonia complicated by underlying disease or drugs limiting normal host defense mechanisms. In these three instances, the advantages of a specific etiologic diagnosis outweighs the small risk from the lung puncture.

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