Case Study

Neonatal Pneumonia
I.Introduction
I. Introduction
Pneumonia is an important cause of neonatal infection and accounts for significant morbidity and mor
tality, especially in still developing country like the Philippines. Pneumonia is the leading killer of child
ren younger than 5 years, and the greatest risk of mortality from pneumonia in childhood is in the neo
natal period.Substantial reductions in childhood pneumonia deaths have been hindered by a lack of p
rogress in addressing neonatal mortality. Deaths in the neonatal period constitute 41·6% of the 6·3 m
illion children who die annually before their fifth birthday. In 2010, there were an estimated 1·7 million
cases of neonatal sepsis and 510 000 cases of neonatal pneumonia. On Nov 12, World Pneumonia
Day, we focus on prevention of pneumonia in these youngest and most susceptible victims. Accordin
g to the Philippine Statistics Authority in 2016, some of the leading causes of death in Infants are Pne
umonia and Bacterial sepsis. With Pneumonia having mortality rate of 2,885 and Bacterial sepsis hav
ing the rate of 2,135 from the year 2016.
Early-onset neonatal pneumonia is mostly acquired from the mother during labour or deli
very, and commonly presents with respiratory distress beginning at, or soon after, birth.
Because signs of pneumonia are non-specific in neonates, any newborn infant with sudd
en onset of respiratory distress or other signs of illness should be assessed for pneumo
nia and sepsis. Successful treatment depends on the pathogen, early recognition of the i
nfection, and prompt therapy before the development of irreversible injury. In resource-li
mited settings, however, timely diagnosis and treatment is often not possible and mortali
ty is high.
Efforts to prevent neonatal pneumonia and sepsis have been few, despite being essenti
al for reduction of this high mortality. Active immunisation is not always possible in neon
ates because of the immaturity of the neonatal immune system and the several weeks n
ecessary for protective immunity to develop.
Beyond herd protection of neonates through immunisation of older children with
Streptococcus pneumoniae and Haemophilus influenzae type b (Hib) conjugate v
accines, existing vaccine interventions during infancy have so far not substantiall
y reduced neonatal mortality. Maternal immunisation is a viable approach for prot
ection of young infants from the most common infectious causes of mortality, bot
h by allowing sufficient protection through the passive placental transfer of mater
nal antibodies to the fetus and by enabling reduced mother-to-child transmission
of infection. Safe and effective, maternal antenatal immunisation allows the neon
ate to acquire necessary pathogen-specific antibody concentrations to fight infect
ions during a discrete but heightened period of susceptibility.
I. Introduction
Pneumonia is an important cause of neonatal infection and accounts for significant morbidity and mor
tality, especially in still developing country like the Philippines. Pneumonia is the leading killer of child
ren younger than 5 years, and the greatest risk of mortality from pneumonia in childhood is in the neo
natal period.Substantial reductions in childhood pneumonia deaths have been hindered by a lack of p
rogress in addressing neonatal mortality. Deaths in the neonatal period constitute 41·6% of the 6·3 m
illion children who die annually before their fifth birthday. In 2010, there were an estimated 1·7 million
cases of neonatal sepsis and 510 000 cases of neonatal pneumonia. On Nov 12, World Pneumonia
Day, we focus on prevention of pneumonia in these youngest and most susceptible victims. Accordin
g to the Philippine Statistics Authority in 2016, some of the leading causes of death in Infants are Pne
umonia and Bacterial sepsis. With Pneumonia having mortality rate of 2,885 and Bacterial sepsis hav
ing the rate of 2,135 from the year 2016.
II. Objectives
II. Objectives
General Objectives:
The students will able to utilize skills, knowledge and attitude cultivated
in the making of this case presentation and to understand what is the n
ecessary nursing care for a client who have neonatal pneumonia.
Specific Objectives:

Skills
• To demonstrate adept observation skills by being able to identify the signs and
symptoms manifested in neonatal pneumonia.
• To demonstrate good performances of health assessment.

• To provide health teachings to the family of the client.

Knowledge
• Acquire adequate knowledge about neonatal pneumonia.
• Obtain information on the underlying causes and factors that affects the client.
• Be sufficiently informed on the body organs affected.
• Be informed in the different laboratory and diagnostic procedures.
• Be familiar with the client’s medication with their therapeutic and adverse effects.
• Be able to formulate the appropriate nursing care plan that will help improve the

client’s condition.
Attitude

• Being able to recognize the client’s discomfort and empathize with her.
• Encourage interaction to the family of the patient to establish rapport.
• Recognize the emotional impact of the client illnesses on the family.
• Applying the Vincentian core values in planning nursing care.
III. Anatomy &
Physiology
III. Anatomy & Physiology
 
THE RESPIRATORY SYSTEMS ARE CONSIST OF:
 Nose
 Mouth
 Throat(pharynx)
 Voice box ( larynx)
 Windpipe (trachea)
 Airways (bronchi)
 Lungs
III. Anatomy & Physiology
 
UPPER RESPIRATORY TRACT INCLUDES:
 Nose
 Air filled space above and behind the
nose (nasal cavity)
 Sinuses
III. Anatomy & Physiology
 
LOWER RESPIRATORY TRACT INCLUDES:
 Voice box ( Larynx)
 Windpipe ( Trachea)
 Lungs
 Airways ( bronchi and bronchioles)
 Air sacs ( alveoli)
III. Anatomy & Physiology
What do lungs do?
The lungs take oxygen. The body cells need oxygen to live and carry out their normal functions. T
hey also get rid of carbon dioxide, which is the waste product of the cells.
The right lung has 3 lobes. The left lung has 2 lobes. When you breathe, the air:
 Enters the body through the nose and mouth
 Travels down the throat through the voice box and windpipe.
 Goes into the lungs through tubes (mainstem bronchi).
 One of these tubes goes to the right lung and one goes to the left lung
 In the lungs, these tubes divide into smaller bronchi
 Then into smaller tubes called bronchioles
 Bronchioles end in tiny air sacs called alveoli.
IV. Textbook and
Discussion
IV. Textbook and Discussion
NEONATAL PNEUMONIA

 
Definition:
Neonatal pneumonia is a serious respiratory infectious disease caused by a variety
of microorganisms, mainly bacteria, with the potential of high mortality and morbidit
y. It´s impact may be increased in the case of early onset, prematurity or an underlyi
ng pulmonary condition like RDS, meconium aspiration or CLD/bronchopulmonary d
ysplasia (BPD), when the pulmonary capacity is already limited.
Cause:

Pneumonia may be acquired by intrauterine (e.g. transplacental hematogeno

us, ascending from birth canal), intrapartum (e.g aspiration) or postnatal rout
es (e.g. hematogenous, environmental). The pathogens include mainly bacte
ria, followed by viruses and fungi which induce an inflammatory pulmonary c
ondition. This may cause epithelial injury to the airways, leakage of proteina
ceous fluid into the alveoli and interstitium, leading to surfactant deficiency
or dysfunction. Important predisposing factors in the evolution of pneumoni
a are immaturity, low birth weight, premature rupture of membranes, chorioa
mnionitis and factors associated with prolonged neonatal intensive care.
Clinical Manifestation:

Depending on the time of manifestation of infection neonatal pneumonia may be clas

sified as early onset pneumonia (within the first 3 or 7 days of life, mostly within 48 h
ours), or late onset pneumonia (within 4 and 28 days of life). Congenital or intrauterin
e pneumonia can be considered a variant of early onset pneumonia (2). Other classifi
cations refer to the underlying pathogen, like bacterial or viral pneumonia or the patt
ern of lung infiltrates (e.g. interstitial pneumonia) on chest radiographs.
Clinical Manifestation:

Clinical signs are unspecific and present as respiratory distress of various degree, s
uspicious appearing tracheal aspirates, cough, apnea, high or low temperature, poor
feeding, abdominal distension, and lethargy. Tachypnea is a predominant clinical sig
n. Persistent fever is rather unusual, but has been reported in neonates with viral pn
eumonia.
Clinical Manifestation:
From the textbook Manifested by the Patient Rationale
Cough Present Caused by an infection in the
respiratory due to the air sacs filled
with
phelgm
Apnea None Cessation of breathing
Fever Present Occurrence of the inflammation
process which stimulates the
hypothalamus causing temperature to
rise above the normal range.

Poor feeding None The neonate has a little interest in

feeding.
Abdominal distension None Occurs when substances, such as air
(gas) or fluid accumulate in the
abdomen causing its expansion.

Lethargy None A pathological state of sleepiness or

deep unresponsiveness.
Clinical Manifestation:

Diagnostic Procedures:
In the clinical routine pneumonia is diagnosed based on a combination of perinatal

risk factors, signs of neonatal respiratory distress, positive laboratory studies,

radiological signs and a typical clinical course.

Treatment:
The WHO recommends as first line treatment ampicillin plus gentamycin. In cases

where we detect pathogens in blood, or in endotracheal aspirates we treat according

to susceptibility from antibiogram results.
V. Vital information
V. Vital Information:

Vital Info:

Name of the Patient: J, ALC.

Age: 19 days old
Sex: Female

Citizenship: Filipino
Religion: Roman Catholic

Date of Birth: January 2, 2020

Chief Complaint: Cough, fever

Date Admitted: January 16, 2020

V. Vital Information:

Admitting Diagnosis: Neonatal Pneumonia

Attending Physician: Dr. Constantino

Final Diagnosis: Neonatal Sepsis, Late onset and Neonatal Pneumonia

Clinical Assessment:

Past Medical History: None.

Present Medical History: 1 day PTA, pt. experienced nasal congestion associated with cough and with
yellowish phlegm and with fever around 38.2 C. The pt. was medicated with paracetamol with unrecalled
dosage and noted temporary relief with fever.

Pt. was born to a G1P1 mother term via NSVD at a local birthing clinic by a midwife.
Family history: The father has a history of drug allergy (Bioflu) and has a history of Bronchial asthma
Social History: Breastfeeding
VI. Clinical Assessment
VI. Clinical Assessment

Clinical Assessment:
A. Past Medical History: None.

B. Present Medical History: 1 day PTA, pt. experienced nasal congestion associated
with cough and with yellowish phlegm and with fever around 38.2 C. The pt. was medicated

with paracetamol with unrecalled dosage and noted temporary relief with fever. Pt. was born to a G1
P1 mother term via NSVD at a local birthing clinic by a midwife.

C.Family history: The father has a history of drug allergy (Bioflu) and has a history of

Bronchial asthma.
D.Social History: Breastfeeding
VII. Milestone and
Development
VII. Milestone and Development
First few days: Gross Fine Language Social Feeding
motor Motor
Neonate +HeadLag +Grasping Cry Prefer Root, suck,
Reflex Human swallows
face

Week one
At week one the baby is still becoming acclimatised to his/her
brand new environment - with sounds, sights and smells completely foreign,
and at times, utterly overwhelming. He/she might not sleep for large chunks
of time, those tiny eyes tend to flutter closed more than they're open.
VII. Milestone and Development

At first week of the baby:

• Focus on objects only within 15-30cm of his face
• Be able to move both arms and legs equally
• Briefly lift his head during supervised tummy time.

Two-week-old babies can:

• Be expected to sleep a large portion of the day – about 16 - 20 hours.
• Raise their heads slightly.
• Focus and begin to make eye contact with you.
• Blink in reaction to bright light.
• Respond to sound and recognize your voice
VII. Milestone and Development

Weeks 3-4
As the baby wraps up this first month, he/ she is more alert than back in week one –
possibly even flashing that first real smile. The baby will probably:
 Continue to focus on objects within 15-30cm of his face
 Be able to move both arms and legs equally
 Lift head a little further during supervised tummy time
 He also might start cooing (not just crying) and holding his or her head steady
when upright.
VIII. Physical
Assessment
 VIII. Physical Assessment
Body Parts Methods of Findings Interpretation
Assessment

Skin Inspection Skin appears Normal

warm to touch,
pinkish in color
and there is no
presence of
rashes
Head Inspection The anterior Normal
fontanelle is intact,
not sunken and is
pulsating.
 Body Parts Methods of Findings Interpretation
Assessment
Face Inspection The eyes are in good Normal
alignment, both
ears are
symmetrical and no
discharge in the
opening of the ear
canal, and the nose
appears pinkish in
color
Mouth Inspection The hard and soft Normal
palate are intact, and
there is no presence
of rashes in the
mouth
 Body Parts Methods of Findings Interpretation
Assessment
Abdomen Inspection The cord is already Normal
healed
Lungs Auscultation There is no presence Normal
of abnormal breath
sounds upon
auscultation
Arms and Legs Inspection The baby can well Normal
flex her arms and
legs and the moro
reflex is still present
IX. Pathophysiology
PATHOPHYSIOLOGY OF NEONATAL PNEUMONIA

Due to the etiological factors

Defenses are limited in neonates

Dissemination and illnesses may result

Pneumonia will be established.

X. Laboratory and
Diagnoses
X. Laboratory and
Diagnoses

Radiology Unit
o Chest: APL
o Impression:
 Neonatal pneumonia, both bases
prominent thymus in the right.
 X. Laboratory and
Diagnoses

Hematology
Complete Blood Count:

Examination Results Reference Values Signicance of the

Result

Hematocrit: L 0.36 vol/fr 0.39-0.63 Anemia

Hemoglobin L 121 gms/L 125-205 Anemia

 X. Laboratory and
Diagnoses

Differential Count:
Examination Results Reference Values Significance of the Result

Eosinophil : H 8% 0-2 Eosinophilia

Lymphocyte
H 51 36-45 Lymphocytosis

Monocyte
H 13% 6-10 Monocytosis

Platelet count H 526 150-450 Thrombocytosis

XI. Drug Tabulation
 XI. Drug Tabulation
Name of Drug Action
Gentamycin 15 mg Inhibits protein synthesis by
binding directly to the 30S
ribosomal unit; bactericidal
Side effects/ Adverse
Reactions
Adverse Reactions:
CNS: fever, head ache, lethargy,
encephalopathy, confusion,
dizziness, seizures, numbness.
CV: hypotension
EENT: ototoxicity, blurred vision,
tinnitus.
GI: vomiting, nausea
Hematologic: anemia,
eosinophilia, leukopenia
Musculoskeletal: muscle
twitching
Respiratory: apnea
Skin: rash, urticaria
Indication/ Nursing
Contraindication Responsibilities
Indications:  Watch out for signs and
 Serious infections caused symptoms of super
by sensitive strains of infection (especially of
Pseudomonas aeruginosa, upper respiratory tract),
E. coli, Proteus and such as continued fever,
Staphylococcus. chills and increased pulse
Contraindications: rate.
 Contraindicated in  Therapy usually continues
patients hypersensitive to for 7-10 days. If no
drugs or other amino response occurs in 3 to 5
glycosides. days, stop therapy and
 Use cautiously in obtain new specimens for
neonates, infants, elderly culture and sensitivity
patients, and patients with testing.
impaired renal function or  Remember the 12 rights
neuromuscular disorders. in medication
administration.
 XI. Drug Tabulation
Name of Drug Action Side effects/ Adverse Indication/
Reactions Contraindication
Ampicillin Sulbactam Inhibits cell wall Adverse Reactions: Indication:
(Silgram) 150 mg synthesis during CV: thrombophlebitis,  Intra-abdominal,
bacterial multiplication. vein irritation  gynecologic, and
GI: nausea, vomting infections caused by
susceptible strains.
Hematologic: anemia
Skin: pain at injection
Contraindication:
site  Contraindicated to
patients hypersensitivity to
drugs or other
penicillins.
 Use cautiously in
patients with other drug
Allergies
( especially to
cephalosporins )
because of possible cross
sensitivity, and in those
with mononucleosis
because of high risk of
maculopapular rash.
Nursing
Responsibilities
 Decreased dosage
in
 patients with
impaired renal
function.
 Don’t use IM route
in children.
 Monitor liver
function test results
during therapy,
especially in patients with
impaired liver function.
 If large doses are
given or if therapy is
prolonged, bacterial
or fungal
superenfection may
occur, especially in
elderly or
immunosuppressed
patients.

 XI. Drug Tabulation
Name of Drug Action Side effects/ Adverse Indication/ Nursing
Reactions Contraindication Responsibilities
Disudrin drops Nasal decongestant, Adverse Reactions: Indication: • Before taking this
0.3 ml clears obstructed air • Tremors,  Used for relief of medication, tell the
TID passages and nasal • nervousness, clogged nose, runny doctor if patient has:
sinuses • dizziness, nose, itchy, watery high blood pressure or
due to congestion eyes and sneezing
• increased blood any heart problems,
making breathing easier associated with
pressure, glaucoma, thyroid
common cold, upper
• palpitation, problems, diabetes,
airway cough
• arrhythmia, pallor syndrome, allergic bladder problems and
• and respiratory rhinitis, and other difficulty in urinating.
distress. minor respiratory
tract infections.  Remember the 10
Contraindication: rights in
 If patient has medication
allergic to any administration.
ingredient in the
product.
 If patient has high
blood pressure or
severe heart disease
unless
recommended by
X. Nursing Care Plan
(hyperlink)