| ID | 364 |
|---|---|
| Name | NEONATAL PNEUMONIA |
| Cause | Peumonia due to infection- may be acquired- 1. Transplacentally- as one component of a generalized intrauterine infection caused by - - Cytomegalovirus - Rubella virus - Toxoplasma gondii - Listeria - T. pallidum - Coliform - Pneumococci. 2. Perinatally- by aspiration of amniotic fluid or birth canal secretions associated with - - Streptococcus group B. - Gram-ve enteric bacilli (e. coli, klebsiella, proteus, pseudomonas etc.) - Chlamydia - Herpes simplex virus. 3. Postnatally (after birth i.e. newborn period)- caused by- - staphylococcus aureus (mostly) - streptococcus group B. - E. coli - Klebsiella - Pseudomonas - Respiratory virus. |
| Signs Symptoms | Sudden onset of respiratory distress or other signs of illness, such as apnea, lethargy, poor feeding, tachycardia, abdominal distention |
| Diagnosis | Diagnosis: 1. Clinical history including birth history 2. Physical examinations - (as above) 3. Investigations- a X-ray chest- consolidation or confluent patchy opacities are usual finding. In staphylococcal pneumonia- initially there may be homogenous opacity (may be extensive), subsequently emphysematous bulle (pneumatocoele) can be seen (is the most diagnostic for staph. pneumonia). b. Tracheal aspirate- gram stain & culture. c. Blood culture-if necessary |
| Investigations | Chest x-ray Evaluation includes chest x-ray pulse oximetry blood cultures Gram stain and culture of tracheal aspirate. Ultrasonography of chest |
| Management | Management: A. General- 1. Incubator care (if available) with 40% oxygen & humidity between 50-60%). Or, 2. O2 inhalation 3. Oropharyngeal suction (if necessary). 4. Body temperature should be maintained optimum 98.6°F) (room temp. 85-90°F) 5. Nutrition- parenteral fluid with 10% dextrose atleast in the first 24 hours them nasogastric tube (N.G tube) feeding (if possible) 6. Regular monitoring of vital signs. B. Antibiotic therapy- Selection of appropriate antibiotic therapy needs gram’s staining & culture of sputum or tracheobronchial secretions and radiographic findings. For initial coverage with an unknown pathogen, a combination of 1. penicillins or cephalosporins or both to cover gram positive organisms & 2. an aminoglycoside e.g gentamicin to cover gram negative enteric organisms is usually given. Such as- 1. Inj. ampicillin 50-100mg/kg/day in 6-hourly divided doses for 7-10 days. And/Or, Inj. cefotaximel00mg/kg/day i.v or i.m b.d in first wk. of life; & 150mg/kg/day i.v or i.m t.d.s after first wk. of age. Or, Inj. ceftriaxone20-50mg/kg/day (max. 50mg/kg/day) by i.v infusion onece daily in 1st week of life (neonate); or, 20-50mg/kg/day (max. 80mg/kg/day in severe infection) by i.v or by deep i.m injection onece daily after 1st week of life (infant) for 7-10 days. 2. Inj. gentamicin 5-7.5mg/kg/day in 2 divided doses for 7-10 days. Staphylococcal pneumonia- same as for neonatal septicemia (see above). Since the etiologic agents of bacterial pneumonia are the same as for sepsis (& meningitis), similar antibiotic regimens can be used in either cases. C. Additional therapy - (particularly in low birth weight cases). 1. Inj. vitamin-K Img i.v/i.m stat for once. |
| Introduction | Pneumonia is a pulmonary inflammatory disease. It is the most common cause of morbidity & mortality in the newborn infant. |
| History | |
| Etiology | |
| Clinical Features | Clinical feature: Infants with congenital or postnatal pneumonia initially exhibits nonspecific s/s of illness such as - Nonspecific s/s- 1 Poor feeding or reluctant to feed. 2 Lethergy 3 Irritability 4 Pale or poor colour 5. A rise or sudden fall of temperature (i.e. temperature instability) 6. General impression- baby is not doing well. 7. Hypotension. 8. Acidosis. Respiratory s/s- Respiratory distress with - - Grunting. - Tachypnoea/apnoea or cyanosis. - Flaring of the ale nasi. - Tachycardia. - Substernal, sternal, intercostal &/or subcostal retractions (or recessions). On respiratory exam- 1. Dullness to percussion- difficult to elicite, but if present suggests extensive consolidation or effusion. 2. On auscultation- poor air entry; may reveal fine crackling rales in any portion of lungs or decreased breath sounds, but often these may not be found. Areas of hyperresonance may indicate compensatory emphysema. |
| Preventions | M aternal [group B streptococcus (GBS)] screening, intrapartum antibiotic prophylaxis, and appropriate follow-up of newborns at high risk after delivery |
| Treatment | Usually vancomycin and a broad-spectrum beta-lactam drug Chlamydial Pneumonia Erythromycin or azithromycin Treatment with erythromycin 12.5 mg/kg orally every 6 hours for 14 days or azithromycin 20 mg/kg orally/IV once a day for 3 days typically resolves the pneumonia |
| Complications | Respiratory failure meningitis, pneumothorax blood infection weakened immune system |
| Prognosis | |
| Types | Types of neonatal pneumonia: A. Early onset pneumonia: Presents within 6 hours of life. A term or preterm baby having delivered after prolonged rupture of membrane or difficult labor, developed respiratory distress usually within 4-6 hours of after birth. B. Late onset pneumonia: Presents after 24 hours of life This is usually associated with aspiration, bacteremia or mechanical ventilation, and occurs after 24 hours of life. |
| Classification | |
| Observation | |
| Pathology |
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