Neonatal Pneumonia

Neonatal Pneumonia

Illustration Etiology risk factors for neonatal

infection

Symptoms, Signs, and Diagnosis Treatment

Illustration Neonatal pneumonia is lung infection in a neonate. Onset may be within hours of birth and part of a generalized sepsis syndrome, or after 7 days and confined to the lungs. The incidence of pneumonia in the newborn is relatively high – 1~2‰. The pneumonia in a neonate is usually of bacterial origin.

Illustration  Early-onset

pneumonia is part of generalized sepsis that presents at or within hours of birth.  Late-onset pneumonia usually occurs after 7 days of age, most commonly in neonatal ICUs in infants who require prolonged endotracheal intubation because of lung disease.

Etiology  Bacterial • • • • •

organisms :

group B streptococci gram-negative bacilli including E. coli, Klebsiella, and Pseudomonas listeria Staphylococcus species other rarer bacterial pathogens include anaerobiotic bacilli and Chlamydia

Etiology  Nonbacterial • • • •

pathogens

mycoplasma pneumonia candida albicans cytomegalovirus pneumocystis carinii

Symptoms, Signs, and Diagnosis  Early • • • • •

symptoms include: Lethargy Apnoea Bradycardia Poor feeding - there may be temperature instability on examination, there may be diminished air entry over areas of consolidation or effusion.

Symptoms, Signs, and Diagnosis  Late-onset

hospital-acquired pneumonia may begin gradually, with more secretions being suctioned from the endotracheal tube and higher ventilator settings.

Symptoms, Signs, and Diagnosis  Features

which are used to define respiratory distress include:

    

respiratory rate of greater than 60/min for more than an hour grunting expiration subcostal or sternal recession on inspiration flaring of the nasal alae with or without cyanosis in air - increased oxygen requirement

Investigations  septic     

screen in neonates full blood count urea and electrolytes, with glucose estimation blood culture chest radiology lumbar puncture

Chest X-ray Spot laminated shape

Figure 1. Note asymmetric coarse patchy infiltrates.

Figure 2. Note diffuse fine granular infiltrates. .

Treatment  Antibiotics:  In

early-onset sepsis, initial therapy should include ampicillinor penicillin G plus an aminoglycoside.

 In

late-onset hospital-acquired sepsis, initial therapy should include vancomycin plus an aminoglycoside.

 Ceftazidime

,ceftriaxone

Erythromycin; mycoplasma pneumonia Chlamydia pneumonia Antifungusagent: candida albicans Flaconazole Ketoconazole

Treatment  The • • • •

other treatment:

Keep warm Feeding Oxygen Fliud