Neonatal pneumonia

Dr Aditya Shetty et al.

Neonatal pneumonia refers to inflammatory changes of the respiratory system caused by neonatal infection.

It is one of the leading causes of significant morbidity and mortality in developing countries. Neonatal pneumonia accounts for 10% of global child mortality. At the time of writing is thought to account for 750,000 to 1.2 million neonates death annually 5.

Neutropaenia with temperature instability. Symptoms include tachypnea, chest recession, and cough (absent in ⅔ of the cases) 7

Occurs with a transplacental spread. Aspiration of infected amniotic fluid after prolonged rupture of membranes or during delivery.

Agents

Maternal systemic infection:

Most commonly isolated bacteria include:

  • Streptococci (group A and B)
  • Staphylococcus aureus
  • E. Coli
  • Klebsiella
  • proteus 

Exposure to these organisms occurs in the following cases:

  • rupture of membranes more than 6 hours before delivery 
  • prolonged and complicated labours
  • premature infants
  • early onset
    • occurs in the first week of life and as an intrauterine pneumonia
    • often caused by gram negative bacteria
  • late onset
    • occurs in subsequent three weeks
    • often caused by gram positive bacteria

Broad and wide spectrum of abnormalities varying from a normal chest, localised or diffuse alveolar densities, interstitial lung disease and features similar to hyaline membrane disease. 

The most frequent and characteristic alveolar pattern is dense bilateral air space filling process with numerous air bronchograms

Complications of respiratory therapy like interstitial emphysema, pneumomediastinum and pneumothorax may also be identified. 

Management usually comprises of a similar strategy to neonatal sepsis with antimicrobial therapy. The risk of mortality is heavily reliant on birth weight and age of onset; low birth weight 8 and early onset 6,7 being associated with more fatality.

  • hyaline membrane disease
    • granular densities with air bronchograms
    • usually does not have associated pleural effusion
  • transient tachypnea of the newborn (TTN) 
    • serial radiographs help differentiate TTN from pneumonia as pneumonia would persist beyond 1-2 days which is the usual duration of TTN
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Article information

rID: 28613
Systems: Chest, Paediatrics
Tag: shetty
Synonyms or Alternate Spellings:
  • Neonatal pneumonias
  • Neonatal lung infection

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