- Overview of Neonatal Infections
- Neonatal Sepsis
- Neonatal Hospital-Acquired Infection
- Neonatal Pneumonia
- Neonatal Bacterial Meningitis
- Neonatal Listeriosis
- Neonatal Conjunctivitis
- Neonatal Herpes Simplex Virus (HSV) Infection
- Neonatal Hepatitis B Virus (HBV) Infection
- Congenital and Perinatal Cytomegalovirus Infection (CMV)
- Congenital Rubella
- Congenital Syphilis
- Congenital Toxoplasmosis
- Perinatal Tuberculosis (TB)
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. Signs may be limited to respiratory distress or progress to shock and death. Diagnosis is by clinical and laboratory evaluation for sepsis. Treatment is initial broad-spectrum antibiotics changed to organism-specific medications as soon as possible.
(See also Overview of Pneumonia in adults and Overview of Neonatal Infections.)
Pneumonia is the most common invasive bacterial infection in neonates after primary sepsis. Early-onset pneumonia is part of generalized sepsis that first manifests at or within hours of birth (see Neonatal Sepsis). Late-onset pneumonia usually occurs after 7 days of age, most commonly in neonatal intensive care units among infants who require prolonged endotracheal intubation because of lung disease (called ventilator-associated pneumonia).
Etiology of Neonatal Pneumonia
Organisms are acquired from the maternal genital tract or the hospital nursery or neonatal intensive care unit. These organisms include gram-positive cocci (eg, groups A and B streptococci, both methicillin-sensitive and methicillin-resistant Staphylococcus aureus) and gram-negative bacilli (eg, Escherichia coli, Klebsiella species, Proteus species).
In infants who have received broad-spectrum antibiotics, many other pathogens may be found, including Pseudomonas, Citrobacter, Bacillus, and Serratia.
Viruses, such as cytomegalovirus and herpes simplex virus, or fungi, such as Candida and Aspergillus, cause some cases of neonatal pneumonia (1).
Etiology references
1. Nissen MD. Congenital and neonatal pneumonia. Paediatr Respir Rev. 2007;8(3):195-203. doi:10.1016/j.prrv.2007.07.001
Symptoms and Signs of Neonatal Pneumonia
Early-onset symptoms are typically nonspecific as in other forms of early-onset neonatal sepsis.
Late-onset hospital-acquired pneumonia manifests with unexplained worsening of the patient's respiratory status and increased quantities and a change in the quality of the respiratory secretions (eg, thick and brown). Infants may be acutely ill, with temperature instability and neutropenia.
Diagnosis of Neonatal Pneumonia
Chest radiograph
Evaluation includes chest radiograph, pulse oximetry, blood cultures, and Gram stain and culture of tracheal aspirate.
New, persistent infiltrates should be visible on chest radiograph but may be difficult to recognize if the infant has severe bronchopulmonary dysplasia.
If Gram stain of tracheal aspirate shows a significant number of polymorphonuclear leukocytes and a single organism that is consistent with the one that grows from culture of the tracheal aspirate, the likelihood increases that this organism is the cause of the pneumonia. Because bacterial pneumonia in neonates may disseminate, a full evaluation for sepsis, including a lumbar puncture, should also be performed. However, blood cultures are positive in only a small percentage of cases of hospital-acquired pneumonia. In neonates who require prolonged intubation, tracheal aspirate cultures may show endotracheal tube colonization and should be interpreted in the context of the clinical presentation.
Treatment of Neonatal Pneumonia
Usually vancomycin and a broad-spectrum beta-lactam antibioticUsually vancomycin and a broad-spectrum beta-lactam antibiotic
Antimicrobial therapy in early-onset disease is similar to that for neonatal sepsis. Vancomycin and a broad-spectrum beta-lactam antibiotic such as meropenem, piperacillin/tazobactam, or cefepime are the initial treatment of choice for most late-onset hospital-acquired pneumonia. This regimen treats sepsis as well as pneumonia with typical hospital-acquired pathogens including Antimicrobial therapy in early-onset disease is similar to that for neonatal sepsis. Vancomycin and a broad-spectrum beta-lactam antibiotic such as meropenem, piperacillin/tazobactam, or cefepime are the initial treatment of choice for most late-onset hospital-acquired pneumonia. This regimen treats sepsis as well as pneumonia with typical hospital-acquired pathogens includingP. aeruginosa.
Local patterns of infection and bacterial resistance should always be used to help guide empiric choices of antimicrobials. More specific antibiotics are substituted after sensitivity results are available. General treatment is the same as that for neonatal sepsis.
Chlamydial Pneumonia
Exposure to chlamydial organisms during delivery may result in development of chlamydial pneumonia at 2 to 18 weeks of life.
Infants are tachypneic but usually not critically ill and may also have a history of conjunctivitis caused by the same organism.
Eosinophilia may be present, and radiographs show bilateral interstitial infiltrates with hyperinflation.
Treatment of Chlamydial Pneumonia
Erythromycin or azithromycinErythromycin or azithromycin
Treatment with erythromycin for 14 days or azithromycin for 3 days typically resolves the pneumonia. Occasionally, however, a second course may be necessary. Because erythromycins in neonates may cause Treatment with erythromycin for 14 days or azithromycin for 3 days typically resolves the pneumonia. Occasionally, however, a second course may be necessary. Because erythromycins in neonates may causehypertrophic pyloric stenosis (HPS), all neonates treated with erythromycin or azithromycin should be monitored for symptoms and signs of HPS, and their parents should be counseled regarding potential risks.
The diagnosis of pneumonia secondary to Chlamydia trachomatis should prompt an evaluation of the mother and her partner because untreated maternal chlamydial infection may have complications such as pelvic inflammatory disease and sterility.
