Neonatal pneumonia

Last revised by Ashesh Ishwarlal Ranchod on 5 Feb 2024

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 it is thought to account for 750,000 to 1.2 million neonatal deaths annually 5.

There are several recognized risk factors:

  • rupture of membranes more than 6 hours before delivery 

  • prolonged and complicated labor

  • premature infants

  • immune disorders

Neutropenia with temperature instability.

Signs and symptoms include:

  • tachypnea

  • chest recession

  • apnea

  • respiratory distress

  • cough (absent in two-thirds of the cases) 7

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

Maternal systemic infection:

Most commonly isolated bacteria include:

  • Streptococci (group A and B)

  • Staphylococcus aureus

  • E. coli

  • Klebsiella

  • Proteus spp.

  • early onset

    • occurs in the first week of life and as an intrauterine pneumonia

    • often caused by group B streptococcus or 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, localized or diffuse alveolar densities, reticular opacities and features similar to respiratory distress syndrome.

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

Complications of respiratory therapy like interstitial emphysemapneumomediastinum and pneumothorax may also be identified. 

Management usually comprises 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.

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