last authored: April 2012, David LaPierre
Neonatal pneumonia is one of the most significant causes of neonatal mortality worldwide, with 264,000-545,000 neonatal deaths annually (Nissen, 2007).
This topic will describe the pathogens, risk factors, diagnosis, and treatment of this important disease.
Courtesy of Global Health Media Project
Baby Stephen is a 7 day-old boy who comes back to the hospital because he is feeding poorly and having difficulty 'catching his breath'. A quick glance shows he is in respiratory distress.
The respiratory tract can be infected in utero, during labour and delivery through the birth canal, or thereafter. During prolonged or difficult deliveries, decreased oxygen supply can lead to respiratory efforts and aspiration of vernix, meconium, or vaginal canal tissues may occur. Bacteria may accompany aspirate.
Infections of infants no more than a few days old are usually related to respiratory infection.
Early symptoms can be nonspecific, and include:
Maternal factors to assess include:
Exam may reveal:
Changes in breath sounds, dullness on percussion, and rales or ronchi can be very difficult to appreciate.
A complete bood count should be ordered.
Blood cultures are indicated.
Fluid from effusions, if deemed clinically significant, should be sent for gram stain.
A chest X-ray can reveal consolidation or effusion.
The differential for respiratory distress in neonates includes:
Infants should be kept warm and dry.
Oxygen should be provided to maintain saturation. Positive pressure ventilation and/or intubation should be provided if necessary.
Intravenous access should be established, with IV fluids provided to maintain hydration.
Ampicillin (for GBS and Listeria) AND gentamycin OR cefotaxime for gram-negative coverage.
As gentamycin is oto- and nephrotoxic, levels need to be closely monitored to prevent complications.
Treatment should be provided for 10-21 days.
If C. trachomatis is suspected, erythromycin may be used.
Progression depends on the pathogen.
GBS can occur within the first hours to days of extrauterine life and result in rapid respiratory failure and hemodynamic collapse.
Community-acquired organisms typically cause a slower progression of symptoms.
authors: April 2012, David LaPierre