1. PNEUMONIA
BY: NICOLE STEVENS

2. Objectives Definition Discuss the pathophysiology of pneumonia
Identify the risk factors for pneumonia
Describe the clinical signs of pneumonia
Discuss the medical and nursing management of pneumonia

3. Definition Infection of the fetal or newborn lung
Inflammatory condition, especially affecting the alveoli; typically caused by an infection (agents can include bacteria, viruses, fungi and parasites)
May originate in the lung or may be a focal complication of a contagious or systemic inflammatory process
May be intrauterine:
Transplacental or aspiration of infected amniotic fluid
May be acquired in the neonatal period:
Increased risk for babies who have prolonged hospital admissions

4. Etiology of pneumonia Age-dependent
The incidence in newborns is relatively high (1-2 per 1000); in neonates is usually of bacterial origin
Neonatal period– GBS colonizes the genital area of 15-30% of pregnant women
1% of infants born to untreated GBS- postive women will develop early onset disease
Other bacteria: gram negative bacilli (E. coli, Klebsiella, pseudomonas), listeria, and the staphylococcus species; rarer bacterial pathogens include anaerobic bacilli & chlamydia.
Non-bacterial pathogens: mycoplasma pneumonia, candida albicans, CMV & pneumocystis carinii

5. Etiology
Beyond the neonatal period viruses are the main cause of pneumonia, fore example: RSV, parainfluenza, influenza, adenovirus, Rhinovirus, coronavirus, human metapneumovirus

6. Risk Factors (for neonates)
Premature labour
Low birth weight
Maternal history of chorioamnionitis
Excessive obstetric manipulations
Prolonged labour with intact membranes
Maternal urinary tract infection
Prolonged rupture of membranes (> 24 hrs)
NICU admission

8. Signs and Symptoms (in neonates)
Tachypnoea > 60 breaths/min
Grunting
Retractions
Cyanosis
Recurrent apnoea
Diminished breath sounds/wheezing
Lethargy
Bradycardia
Temperature instability
Cardiovascular collapse
Persistent pulmonary hypertension

9. Signs & Symptoms (in paeds)
Febrile
Tachypnoea
Increased WOB
Cough
Vomitting
Irritability or tiredness
Pain in the chest, especially with coughing
Abdominal pains
Poor appetite

10. Pneumonia
There is coarse opacity of one or more regions of the lung parenchyma
This image is of a baby with Listeria septicaemia and pneumonia

11. Pneumonia
Group B Streptococcus can have a similar appearance to HMD, however the granulation is typically more coarse with pneumonia

12. Investigations Bloods: blood culture, FBE, CRP
Chest xrays (will present as consolidation in one lobe or all the lung)
Blood gases
Nasopharyngeal aspirates
Endotracheal tube aspirates (if intubated)

13. Treatment
Is multifaceted and includes both antimicrobial therapy (if bacterial in nature) and respiratory support
Depending on age and severity antibiotics might be given orally or intravenously
Usual antibiotcs penicillin or flucloxicillin and gentamycin
The goals are treatment are to eradicate infection and provide adequate support of gas exchange to ensure the survival and eventual well being of the infant
Nasal prong oxygen, CPAP, ventilation – level of support required is dependent on symptoms
Fluids, pain relief

14. References
Medscape, congenital pneumonia