Background: Pediatric pleural empyema remains a major complication of community-acquired pneumonia despite vaccination and advances in minimally invasive treatment. This narrative review summarizes current evidence on etiology and microbiology, diagnosis and imaging, antimicrobial therapy, supportive care, pleural drainage, fibrinolysis, surgery, complications, and short- and long-term outcomes. Methods: This structured narrative review searched PubMed from inception through 30 July 2026. No formal risk-of-bias assessment was performed. Of 42 publications assessed in full, 38 were included in the narrative synthesis. Results: Streptococcus pneumoniae, particularly serotype 3, Staphylococcus aureus, and Streptococcus pyogenes remain the principal pathogens. Chest ultrasound is preferred for characterizing pleural collections and guiding intervention, whereas computed tomography is reserved for atypical disease or suspected complications. Small pediatric comparative trials report broadly similar outcomes for catheter drainage with fibrinolysis and video-assisted thoracoscopic surgery (VATS), but differences in sample size, eligibility, treatment protocols, and outcome definitions limit conclusions about comparative effectiveness. Image-guided small-bore catheter drainage with protocol-based urokinase or tissue plasminogen activator is effective for many loculated effusions. Pediatric evidence does not support routine addition of DNase. Comparative trials show broadly similar clinical outcomes for fibrinolysis and video-assisted thoracoscopic surgery, although heterogeneous protocols and limited sample sizes preclude identification of a universally superior strategy. Thoracotomy is rarely required. Conclusions: Management should integrate respiratory and septic severity, pleural anatomy, microbiology, adequacy of drainage, clinical trajectory, and local expertise rather than rely on rigid staging. Long-term recovery is excellent in most previously healthy children receiving timely treatment. Standardized definitions, pediatric outcome sets, multicenter comparative trials, validated predictors of treatment failure, and studies of antimicrobial duration remain important research priorities.

Background: Pediatric pleural empyema remains a major complication of community-acquired pneumonia despite vaccination and advances in minimally invasive treatment. This narrative review summarizes current evidence on etiology, diagnosis, antimicrobial therapy, pleural drainage, fibrinolysis, and surgery. Methods: PubMed was searched from inception through July 2026 for English-language studies involving patients aged 0–18 years. Pediatric trials, observational studies, surveillance reports, guidelines, reviews, and relevant case series were considered. Of 42 publications assessed in full, 38 were included in the narrative synthesis. Results: Streptococcus pneumoniae, particularly serotype 3, Staphylococcus aureus, and Streptococcus pyogenes remain the principal pathogens. Chest ultrasound is preferred for characterizing pleural collections and guiding intervention, whereas computed tomography is reserved for atypical disease or suspected complications. Small, uncomplicated effusions may respond to antibiotics alone; large, purulent, or clinically significant collections generally require source control. Image-guided small-bore catheter drainage with protocol-based urokinase or tissue plasminogen activator is effective for many loculated effusions. Pediatric evidence does not support routine addition of DNase. Comparative trials show broadly similar clinical outcomes for fibrinolysis and video-assisted thoracoscopic surgery, although heterogeneous protocols and limited sample sizes preclude identification of a universally superior strategy. Thoracotomy is rarely required. Conclusions: Management should integrate respiratory and septic severity, pleural anatomy, microbiology, adequacy of drainage, clinical trajectory, and local expertise rather than rely on rigid staging. Long-term recovery is excellent in most previously healthy children receiving timely treatment. Standardized definitions, pediatric outcome sets, multicenter comparative trials, validated predictors of treatment failure, and studies of antimicrobial duration remain important research priorities.

.Respiratory syncytial virus (RSV) is a primary cause of lower respiratory tract infections in infants, with severe cases potentially leading to long-term respiratory issues like asthma. Globally, RSV affects 33.1 million children annually, resulting in 3.2 million hospitalizations. Despite its signifi-cant burden, treatment remains supportive, emphasizing the importance of prevention. This re-view explores current RSV prevention strategies, focusing on advancements in maternal immun-ization and monoclonal antibodies. Maternal vaccination during pregnancy has emerged as a promising approach, with the FDA-approved RSVpreF vaccine demonstrating 81.8% efficacy in reducing severe RSV infections during the first 90 days of life. Additionally, new monoclonal an-tibodies such as Nirsevimab represent key innovations. Nirsevimab offers single-dose protection, showing significant reductions in RSV hospitalizations across various studies and gaining ap-proval for universal use in regions like USA and Europe. Successful immunization programs, as seen in several countries, highlight the potential of broad implementation. While these develop-ments mark progress, further research is essential to optimize protocols, assess long-term out-comes, and expand access, aiming to alleviate RSV’s global health impact on infants and young children.