{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T14:54:13Z","timestamp":1791298453016,"version":"4.1.0"},"reference-count":32,"publisher":"Springer Science and Business Media LLC","issue":"10","license":[{"start":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T00:00:00Z","timestamp":1783555200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.springernature.com\/gp\/researchers\/text-and-data-mining"},{"start":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T00:00:00Z","timestamp":1783555200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.springernature.com\/gp\/researchers\/text-and-data-mining"}],"funder":[{"DOI":"10.13039\/501100001411","name":"Indian Council of Medical Research","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001411","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Indian Pediatr"],"published-print":{"date-parts":[[2026,10]]},"DOI":"10.1007\/s13312-026-00377-6","type":"journal-article","created":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T07:04:10Z","timestamp":1783580650000},"page":"787-796","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Intrapleural Fibrinolytic Therapy as the Initial Modality, Compared to no Intrapleural Fibrinolytic Therapy, in Children With Empyema: A Systematic Review and Meta-analysis"],"prefix":"10.1007","volume":"63","author":[{"given":"Meenakshi","family":"Sachdeva","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kanchankumar","family":"Bhagyawant","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pawan","family":"Kalyan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Soumi","family":"Kundu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shetanshu","family":"Srivastava","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pranita","family":"Pradhan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2866-2623","authenticated-orcid":false,"given":"Joseph L.","family":"Mathew","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,7,9]]},"reference":[{"key":"377_CR1","doi-asserted-by":"crossref","first-page":"425","DOI":"10.1093\/pch\/16.7.428","volume":"16","author":"T Chibuk","year":"2011","unstructured":"Chibuk T, Cohen E, Robinson J, Mahant S, Hartfield D. Paediatric complicated pneumonia: diagnosis and management of empyema. Paediatr Child Health. 2011;16:425\u20139.","journal-title":"Paediatr Child Health"},{"key":"377_CR2","doi-asserted-by":"crossref","first-page":"394","DOI":"10.1542\/pir.2016-0183","volume":"38","author":"AI Messinger","year":"2017","unstructured":"Messinger AI, Kupfer O, Hurst A, Parker S. Management of pediatric community-acquired bacterial pneumonia. Pediatr Rev. 2017;38:394\u2013409.","journal-title":"Pediatr Rev"},{"key":"377_CR3","doi-asserted-by":"crossref","first-page":"i1","DOI":"10.1136\/thx.2004.030676","volume":"60","author":"IM Balfour-Lynn","year":"2005","unstructured":"Balfour-Lynn IM. BTS guidelines for the management of pleural infection in children. Thorax. 2005;60:i1-21.","journal-title":"Thorax"},{"key":"377_CR4","doi-asserted-by":"crossref","first-page":"786","DOI":"10.1016\/S0140-6736(20)31550-6","volume":"396","author":"FM De Benedictis","year":"2020","unstructured":"De Benedictis FM, Kerem E, Chang AB, Colin AA, Zar HJ, Bush A. Complicated pneumonia in children. Lancet. 2020;396:786\u201398.","journal-title":"Lancet"},{"key":"377_CR5","doi-asserted-by":"crossref","first-page":"651","DOI":"10.1097\/INF.0000000000004359","volume":"43","author":"J Forster","year":"2024","unstructured":"Forster J, Piazza G, Goettler D, et al. Empiric antibiotic therapy in 1402 children with parapneumonic effusion\/pleural empyema in Germany: a long-term surveillance study. Pediatr Infect Dis J. 2024;43:651\u20136.","journal-title":"Pediatr Infect Dis J"},{"key":"377_CR6","doi-asserted-by":"crossref","first-page":"401","DOI":"10.1378\/chest.11-3071","volume":"142","author":"S Janda","year":"2012","unstructured":"Janda S, Swiston J. Intrapleural fibrinolytic therapy for treatment of adult parapneumonic effusions and empyemas: a systematic review and meta-analysis. Chest. 2012;142:401\u201311.","journal-title":"Chest"},{"key":"377_CR7","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1111\/crj.12068","volume":"8","author":"W Nie","year":"2014","unstructured":"Nie W, Liu Y, Ye J, et al. Efficacy of intrapleural instillation of fibrinolytics for treating pleural empyema and parapneumonic effusion: a meta-analysis of randomized control trials. Clin Respir J. 2014;8:281\u201391.","journal-title":"Clin Respir J"},{"key":"377_CR8","doi-asserted-by":"crossref","first-page":"209","DOI":"10.4103\/lungindia.lungindia_227_17","volume":"35","author":"A Singh","year":"2018","unstructured":"Singh A, Shukla A, Sharma P, Shukla J. Surgical management of stage III pediatric empyema thoracis. Lung India. 2018;35:209.","journal-title":"Lung India"},{"key":"377_CR9","doi-asserted-by":"publisher","first-page":"136","DOI":"10.1186\/s13052-024-01701-1","volume":"50","author":"D Buonsenso","year":"2024","unstructured":"Buonsenso D, Cusenza F, Passadore L, et al. Parapneumonic empyema in children: a scoping review of the literature. Ital J Pediatr. 2024;50:136.","journal-title":"Ital J Pediatr"},{"key":"377_CR10","doi-asserted-by":"crossref","unstructured":"Altmann ES, Crossingham I, Wilson S, Davies HR. Intra-pleural fibrinolytic therapy versus placebo, or a different fibrinolytic agent, in the treatment of adult parapneumonic effusions and empyema. Cochrane Database Syst Rev. 2019;CD002312.pub4.","DOI":"10.1002\/14651858.CD002312.pub4"},{"key":"377_CR11","doi-asserted-by":"crossref","first-page":"1449","DOI":"10.1111\/j.1651-2227.2010.01863.x","volume":"99","author":"K Krenke","year":"2010","unstructured":"Krenke K, Peradzy\u0144ska J, Lange J, Ruszczy\u0144ski M, Kulus M, Szajewska H. Local treatment of empyema in children: a systematic review of randomized controlled trials. Acta Paediatr. 2010;99:1449\u201353.","journal-title":"Acta Paediatr"},{"key":"377_CR12","doi-asserted-by":"publisher","DOI":"10.1007\/s13312-026-00340-5","author":"JL Mathew","year":"2026","unstructured":"Mathew JL, Chandrasekaran V, Kumar K, Kaur S, Girish M. Clinical practices for management of empyema thoracis in children: a survey of pediatricians in India. Indian Pediatr. 2026. https:\/\/doi.org\/10.1007\/s13312-026-00340-5.","journal-title":"Indian Pediatr"},{"key":"377_CR13","doi-asserted-by":"crossref","first-page":"2101","DOI":"10.1016\/j.jpedsurg.2012.07.047","volume":"47","author":"S Islam","year":"2012","unstructured":"Islam S, Calkins CM, Goldin AB, et al. The diagnosis and management of empyema in children: a comprehensive review from the APSA Outcomes and Clinical Trials Committee. J Pediatr Surg. 2012;47:2101\u201310.","journal-title":"J Pediatr Surg"},{"key":"377_CR14","doi-asserted-by":"crossref","first-page":"642","DOI":"10.1093\/ejcts\/ezv272","volume":"48","author":"M Scarci","year":"2015","unstructured":"Scarci M, Abah U, Solli P, et al. EACTS expert consensus statement for surgical management of pleural empyema. Eur J Cardiothorac Surg. 2015;48:642\u201353.","journal-title":"Eur J Cardiothorac Surg"},{"key":"377_CR15","doi-asserted-by":"crossref","unstructured":"Bradley JS, Byington CL, Shah SS, et al. Pediatric infectious diseases society and the infectious diseases society of America. Executive summary: The management of community-acquired pneumonia in infants and children older than 3 months of age: clinical practice guidelines by the Pediatric Infectious Diseases Society and the infectious diseases society of America. Clin Infect Dis. 2011;53:617\u201330.","DOI":"10.1093\/cid\/cir625"},{"key":"377_CR16","doi-asserted-by":"publisher","DOI":"10.1007\/s13312-026-00347-y","author":"JL Mathew","year":"2026","unstructured":"Mathew JL. Methodology adopted for the development of evidence-based guideline recommendations on childhood empyema. Indian Pediatr. 2026. https:\/\/doi.org\/10.1007\/s13312-026-00347-y.","journal-title":"Indian Pediatr"},{"key":"377_CR17","doi-asserted-by":"crossref","unstructured":"Sachdeva M, Pradhan P, Srivastava S, et al. Intrapleural fibrinolytic therapy as the initial modality, compared to no intrapleural fibrinolytic therapy, in children with empyema: A systematic review and meta-analysis. PROSPERO 2024 CRD42024514609. Accessed on May 23, 2026. Available from: https:\/\/www.crd.york.ac.uk\/prospero\/display_record.php?ID=CRD4202451460","DOI":"10.1007\/s13312-026-00377-6"},{"key":"377_CR18","unstructured":"Higgins JPT, Chandler J, Cumpston M, Li T, Page MJ, Welch VA, Editors. Cochrane handbook for systematic reviews of interventions version 6.3 (updated August 2024). Cochrane, 2024. Accessed on Nov 12, 2024. Available from www.training.cochrane.org\/handbook."},{"key":"377_CR19","doi-asserted-by":"crossref","first-page":"n71","DOI":"10.1136\/bmj.n71","volume":"372","author":"MJ Page","year":"2021","unstructured":"Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71.","journal-title":"BMJ"},{"key":"377_CR20","unstructured":"Vemana AP, Haider SK. Pleurisy, pleural effusions, and empyema. In: Kleigman RM, St. Geme JW, Blum NJ, et al (Eds). Nelson Textbook of Pediatrics. 22nd Ed. Elsevier Inc.; 2025: 1505\u20139."},{"key":"377_CR21","doi-asserted-by":"crossref","first-page":"785","DOI":"10.1111\/biom.12817","volume":"74","author":"L Lin","year":"2018","unstructured":"Lin L, Chu H. Quantifying publication bias in meta-analysis. Biometrics. 2018;74:785\u201394.","journal-title":"Biometrics"},{"key":"377_CR22","doi-asserted-by":"crossref","unstructured":"Sterne JAC, Savovi\u0107 J, Page MJ, et al. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ. 2019;366:14898.","DOI":"10.1136\/bmj.l4898"},{"key":"377_CR23","doi-asserted-by":"crossref","first-page":"924","DOI":"10.1136\/bmj.39489.470347.AD","volume":"336","author":"GH Guyatt","year":"2008","unstructured":"Guyatt GH, Oxman AD, Vist GE, et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ. 2008;336:924\u20136.","journal-title":"BMJ"},{"key":"377_CR24","unstructured":"GRADEpro GDT: GRADEpro guideline development tool software. McMaster University and evidence prime; 2024. Accessed on Nov 12, 2024. Available from: https:\/\/www.gradepro.org\/."},{"key":"377_CR25","doi-asserted-by":"crossref","first-page":"343","DOI":"10.1136\/thorax.57.4.343","volume":"57","author":"AH Thomson","year":"2002","unstructured":"Thomson AH. Randomised trial of intrapleural urokinase in the treatment of childhood empyema. Thorax. 2002;57:343\u20137.","journal-title":"Thorax"},{"key":"377_CR26","doi-asserted-by":"crossref","unstructured":"Singh M, Mathew JL, Chandra S, Katariya S, Kumar L. Randomized controlled trial of intrapleural streptokinase in empyema thoracis in children. Acta Paediatr. 2004;93:1443\u20135.","DOI":"10.1111\/j.1651-2227.2004.tb02626.x"},{"key":"377_CR27","first-page":"e4373","volume":"95","author":"YA de Mola Bueno","year":"2023","unstructured":"de Mola Bueno YA, Mart\u00ednez P, Chiu F, et al. Controlled and randomized trial of the use of Heberkinase\u00ae in parapneumonic pleural effusion in children. Revista Cubana de Pediatria. 2023;95:e4373.","journal-title":"Revista Cubana de Pediatria"},{"key":"377_CR28","doi-asserted-by":"crossref","first-page":"711","DOI":"10.20344\/amp.7178","volume":"29","author":"A Coelho","year":"2016","unstructured":"Coelho A, Coelho M, Pereira J, Lavrador V, Morais L, Carvalho F. Fibrinol\u00edticos no Tratamento de Derrames Pleurais Complicados. Acta Med Port. 2016;29:711\u20135.","journal-title":"Acta Med Port"},{"key":"377_CR29","doi-asserted-by":"crossref","first-page":"549","DOI":"10.7196\/SAMJnew.7796","volume":"105","author":"M Zampoli","year":"2015","unstructured":"Zampoli M, Kappos A, Verwey C, Mamathuba R, Zar HJ. Impact of fibrinolytics on the outcome of empyema in South African children. S Afr Med J. 2015;105:549.","journal-title":"S Afr Med J"},{"key":"377_CR30","doi-asserted-by":"crossref","unstructured":"Nandan D, Agarwal S, Bidhuri N, Shrivastava K, Nanda P, Lata S. Role of intrapleural urokinase in empyema thoracis. Indian J Pediatr. 2019;86:1099\u2013104.","DOI":"10.1007\/s12098-019-03060-w"},{"key":"377_CR31","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1097\/00130478-200301000-00007","volume":"4","author":"JB Cochran","year":"2003","unstructured":"Cochran JB, Tecklenburg FW, Turner RB. Intrapleural instillation of fibrinolytic agents for treatment of pleural empyema. Pediatr Crit Care Med. 2003;4:39\u201343.","journal-title":"Pediatr Crit Care Med"},{"key":"377_CR32","doi-asserted-by":"crossref","first-page":"1125","DOI":"10.1016\/j.chest.2023.06.010","volume":"164","author":"C Fernandez Elviro","year":"2023","unstructured":"Fernandez Elviro C, Longcroft-Harris B, Allin E, et al. Conservative and surgical modalities in the management of pediatric parapneumonic effusion and Empyema: A living systematic review and network meta-analysis. Chest. 2023;164:1125\u201338.","journal-title":"Chest"}],"container-title":["Indian Pediatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s13312-026-00377-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s13312-026-00377-6","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s13312-026-00377-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T14:36:50Z","timestamp":1791297410000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s13312-026-00377-6"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,9]]},"references-count":32,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2026,10]]}},"alternative-id":["377"],"URL":"https:\/\/doi.org\/10.1007\/s13312-026-00377-6","relation":{},"ISSN":["0019-6061","0974-7559"],"issn-type":[{"value":"0019-6061","type":"print"},{"value":"0974-7559","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,9]]},"assertion":[{"value":"18 February 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"22 May 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"9 July 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"None.","order":1,"name":"Ethics","label":"Conflict of Interest","group":{"name":"EthicsHeading","label":"Ethics"}},{"value":"The protocol of the systematic review was registered in the PROSPERO database (ID: CRD42024514609).","order":2,"name":"Ethics","label":"Registry","group":{"name":"EthicsHeading","label":"Ethics"}},{"value":"No generative artificial intelligence (AI) tools were used in the writing, editing, data analysis, or figure generation for this manuscript. All content is the original work of the authors.","order":3,"name":"Ethics","label":"Use of Artificial Intelligence (AI) Tools for Scientific Writing","group":{"name":"EthicsHeading","label":"Ethics"}}]}}