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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 drugs as soon as possible.
Pneumonia is the most common invasive bacterial infection after primary sepsis. Early-onset pneumonia is part of generalized sepsis that first manifests at or within hours of birth. Late-onset pneumonia usually occurs after 7 days of age, most commonly in neonatal ICUs among infants who require prolonged endotracheal intubation because of lung disease.
Etiology
Organisms are acquired from the maternal genital tract or the nursery. These organisms include gram-positive cocci (eg, groups A and B streptococci, Staphylococcus aureus) and gram-negative bacilli (eg, Escherichia coli, Klebsiella sp, Proteus sp). Methicillin-resistant S. aureus is common in late-onset hospital-acquired pneumonia. In infants who have received broad-spectrum antibiotics, many other pathogens may be found, including Pseudomonas, Citrobacter, Bacillus, and Serratia. Viruses or fungi cause some cases.
Symptoms and Signs
Late-onset hospital-acquired pneumonia may begin gradually, with more secretions being suctioned from the endotracheal tube and higher ventilator settings. Other infants may be acutely ill, with temperature instability and neutropenia. New infiltrates may be visible on chest x-ray but may be difficult to recognize if the infant has severe bronchopulmonary dysplasia.
Diagnosis
Evaluation includes cultures of blood and tracheal aspirate, chest x-ray, and pulse oximetry. Because bacterial pneumonia in neonates may disseminate, a full evaluation for sepsis, including a lumbar puncture, should also be done.
Treatment
Antimicrobial therapy in early-onset disease is similar to that for neonatal sepsis. Vancomycin and cefotaxime are the initial treatment of choice for most late-onset hospital-acquired pneumonia. This regimen treats sepsis as well as pneumonia. More specific antibiotics are substituted after sensitivity results are available. General treatment is the same as that for neonatal sepsis (see Infections in Neonates: Treatment).
Chlamydial Pneumonia
Contamination with chlamydial organisms during delivery may result in development of chlamydial pneumonia at 2 to 12 wk. 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 x-rays show bilateral interstitial infiltrates. Treatment with erythromycin leads to rapid resolution. 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.
Last full review/revision October 2009 by Mary T. Caserta, MD
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