Neonatal Pneumonia
last authored: April 2012, David LaPierre
last reviewed:
Introduction
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
The Case of Baby Stephen
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.
- What questions do you ask his mother?
- What do you look for on physical exam?
- How do you begin treatment?
Causes and Risk Factors
Bacteria |
Viruses |
Other
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Pathophysiology
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.
Signs and Symptoms
- history
- physical exam
History
Early symptoms can be nonspecific, and include:
- poor feeding
- lethargy
- irritability
- general sense that the infant is unwell
Maternal factors to assess include:
- GBS status
- fever or other signs of infection preceding or during labour
- prolonged rupture of membranes
- HIV status
Physical Exam
Exam may reveal:
- tachypnea
- tachycardia
- fever, or hypothermia
- grunting
- chest retractions
- nasal flaring
- cyanosis
- increased need for ventilator support, if already receiving
Changes in breath sounds, dullness on percussion, and rales or ronchi can be very difficult to appreciate.
Investigations
- lab investigations
- diagnostic imaging
Lab Investigations
A complete bood count should be ordered.
Blood cultures are indicated.
Fluid from effusions, if deemed clinically significant, should be sent for gram stain.
Diagnostic Imaging
A chest X-ray can reveal consolidation or effusion.
Differential Diagnosis
The differential for respiratory distress in neonates includes:
- respiratory distress syndrome
- meconium aspiration
- persistent pulmonary hypertension
- transient tachypnea of the newborn
- pneumothorax
- diaphragmatic hernia
- pulmonary hypoplasia
- choanal atresia
- meningitis
- cyanotic heart disease
- sepsis
- shock
- hypoglycemia
Treatments
Supportive Care
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.
Antibiotics
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.
Consequences and Course
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.
Resources and References
Black RE et al. 2010. Global, regional, and national causes of child mortality in 2008: a systematic analysis. Lancet. 375(9730): 1969-1987.
Nissen MD. 2007. Congenital and neonatal pneumonia. Paediatr Respir Rev. 8(3):195-203.
Topic Development
authors: April 2012, David LaPierre
reviewers:
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