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.
Exposure to these organisms occurs in the following cases:
- rupture of membranes more than 6 hours before delivery
- prolonged and complicated labours
- premature infants
Neutropenia with temperature instability. Symptoms include tachypnoea, chest recession, and cough (absent in ⅔ 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
- Proteus spp.
- occurs in the first week of life and as an intrauterine pneumonia
- often caused by group B streptococcus or gram negative bacteria
- 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, reticular opacities and features similar to hyaline membrane disease.
Treatment and prognosis
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 tachypnoea 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
- 1. Haney PJ, Bohlman M, Sun CC. Radiographic findings in neonatal pneumonia. AJR Am J Roentgenol. 1984;143 (1): 23-6. doi:10.2214/ajr.143.1.23 - Pubmed citation
- 2. Avery ME, Fletcher BD, Williams RG. The lung and its disorders in the newborn infant. Major Probl Clin Pediatr. 1981;1 4th Edition: 1-367. Pubmed citation
- 3. Benirschke K. Routes and types of infection in the fetus and the newborn. AMA J Dis Child. 1998;99: 714-21. Pubmed citation
- 4. Naeye RL, Dellinger WS, Blanc WA. Fetal and maternal features of antenatal bacterial infections. J. Pediatr. 1972;79 (5): 733-9. Pubmed citation
- 5. Bale, Judith R., Barbara J. Stoll, and Adetokunbo O. Lucas. "Reducing Neonatal Mortality and Morbidity." (2003). Pubmed citation
- 6. Shakunthala, S. K., Rao G. Mallikarjuna, and S. Urmila. "" Diagnostic lung puncture aspiration in acute pneumonia of newborn"." Indian pediatrics15.1 (1978): 39-44.
- 7. Webber, S., et al. "Neonatal pneumonia." Archives of disease in childhood 65.2 (1990): 207-211. Pubmed citation
- 8. Lehmann, D. and P. Heywood. "Effect of birthweight on pneumonia-specific and total mortality among infants in the highlands of Papua New Guinea." Papua New Guinea Medical Journal 39 (1996): 274-283. Pubmed citation
- neonatal lines and tubes
- neonatal respiratory distress (causes)
- neonatal chest x-ray (an approach)
- neonatal chest pathology