VILLAREAL, Kied L.

| BSN 2F October 17, 2023

3rd Rotation – Pedia (10th Week) CI: Ma’am Josephine Gales

Neonatal Pneumonia
A Case Analysis
I. Introduction
Pneumonia is an important cause of neonatal infection and accounts for significant
morbidity and mortality, especially in still developing country like the Philippines. It is the top
cause of death in children under the age of five, and the greatest risk of mortality from
pneumonia in childhood is in the neonatal period.
Diagnosis of pneumonia in newborns is proven to be difficult. Compared to older
children, neonates show fewer localizing signs of pulmonary infection; pneumonia frequently
manifests as a systemic deterioration involving multiple organ systems. Therefore, any newborn
infant with sudden onset of respiratory distress or other signs of illness should be assessed for
pneumonia and sepsis.

II. Definition
Neonatal pneumonia is an infection of the lungs in newborn babies that occurs within the
first four weeks of life. In this case, there is an excess fluid in the lungs resulting from an
inflammatory process. The inflammation is triggered by many infectious organisms and by
inhalation of irritating agents.
The infection is classified depending on the time of manifestation:
1. Congenital Pneumonia - established during fetal life.
2. Early-onset neonatal pneumonia - mostly acquired from the mother during labor or
delivery, and commonly presents with respiratory distress beginning at, or soon after
birth.
3. Late-onset neonatal 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).

III. Etiology
Neonatal pneumonia is caused by infectious agents that can be acquired intrauterine,
during birth (intrapartum), or soon after birth.
The most common cause is Group B Streptococci, which is present in the birth canal
along with the other pathogens which are Klebsiella, Escherichia coli, and Listeria
monocytogenes. In late-onset neonatal pneumonia, the most identified pathogen acquired from
the postnatal environment are Streptococcus pneumonia, Streptococcus
pyogenes, and Staphylococcus aureus.

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IV. Disease Process
Neonatal pneumonia typically starts with the infiltration of microorganisms into the lung
tissues, through the mouth or nose from the postnatal environment, or it can be transferred from
an infected mother during childbirth. Once they are in the lungs, they begin to multiply rapidly,
producing toxins and other substances that cause inflammation and damage to the lung tissues.
As the inflammation progresses, the tiny air sacs/alveoli become blocked and filled with
fluid, resulting in respiratory distress. The affected lungs are unable to exchange oxygen and
carbon dioxide properly, leading to low oxygen levels in the body (a condition called hypoxia).
This can lead to fatigue, irritability, and other symptoms such as fever and fast breathing.
In severe cases, the inflammation caused by neonatal pneumonia can spread to other
parts of the body, leading to complications such as sepsis, meningitis, and septic shock. In rare
cases, this can result in death.

V. Predisposing/Risk Factors
1. Immature innate & adaptive 5. Prolonged (>18h) or premature
immunity rupture of membranes.
2. Premature birth 6. Galactosemia
3. Male gender 7. Chorioamnionitis
4. Low birth weight

VI. Manifestations/Signs and Symptoms

The clinical signs of neonatal pneumonia are unspecific and present as:

• Respiratory Distress • Copious Secretion (Thick & Brown)

• Wheezing • Lethargic
• Coughing • Irritable
• Fever • Abdominal Distention
• Fast Breathing • Cyanosis
• Refusal to Feed • Neutropenia

VII. Diagnostic Procedures

1. Physical Examination: Check signs for Respiratory Distress
2. Chest X-ray
3. Pulse Oximetry to detect Hypoxemia.
4. Blood Cultures
5. Sputum Test
6. Lumbar Puncture/Spinal Tap to detect Sepsis.

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VII. Management
It is important to act quickly and seek prompt medical attention once it is suspected that
the newborn has neonatal pneumonia. One should also be alert to the warning signs (e.g.,
fever, respiratory distress, wheezing, coughing, etc.) that the newborn exhibit and act quickly to
diagnose and treat the condition appropriately.

VIII. Treatment
Antimicrobial therapy in early-onset disease is similar to that for neonatal sepsis.
Vancomycin and a broad-spectrum beta-lactam drug such as meropenem,
piperacillin/tazobactam, or cefepime are the initial treatment of choice for most late-onset
hospital-acquired pneumonia. In severe cases, oxygen therapy and ventilator support may be
necessary.

IX. Prevention

• For Congenital and Early-onset Neonatal Pneumonia:

o Maternal GBS (Group B Streptococcus) vaccination/immunization and screening.
• For Late-onset Neonatal Pneumonia
o Limiting the amount of time newborns have a breathing tube.
o Handwashing, using gloves, and decontaminating surfaces.

References:
Hooven, T., & Polin R. (2017). Pneumonia. Semin Fetal Neonatal Med. 2017. Retrieved October
16, 2023 from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7270051/#:~:text=Supportive%20care%2
0and%20rationally%20selected,identification%20of%20a%20causative%20organism.
Rodriguez, T. (2019). Expert Q&A: Neonatal Pneumonia. Retrieved October 16, 2023 from
https://www.infectiousdiseaseadvisor.com/home/resources/lungs-bugs/important-
aspects-of-screening-and-management-of-neonatal-pneumonia/
Tesini, B. (2022). Neonatal Pneumonia. Retrieved October 16, 2023 from
https://www.msdmanuals.com/professional/pediatrics/infections-in-neonates/neonatal-
pneumonia