Neonatal pneumonia is pneumonia that occurs in very young infants. This lung disease can develop in infants as young as 24 hours old and often occurs partially because of abnormalities in the airways and lungs. Neonatal pneumonia is a significant cause of death in newborns; in deaths that occur in the first 30 days of life, pneumonia is a contributing factor in as much as 25 percent of cases. Infants with pneumonia complicated by blood-borne infection have a mortality risk of 10 percent, and this risk triples if the infant had a low birth weight.
There are several risk factors for neonatal pneumonia that can be present before birth. These include maternal fever, tenderness or pain in the uterine area, urinary tract infection and tachycardia of the fetus. Signs that can be noted at or shortly after birth include preterm labor, cloudy or foul-smelling amniotic fluid and rupture of uterine membranes before labor begins. An additional risk factor is gestational maternal illness with an infectious organism known to be capable of crossing the placental barrier.
Neonates with pneumonia can have a number of different symptoms. These include abnormally high respiratory rate, grunting when exhaling, yellow or green airway secretions, aspiration of blood, oxygen deprivation in certain tissues and discolored skin, hair and nails. Newborns might also have fluctuating temperature, skin rash, jaundice, irregular heartbeat and a distended abdomen.
Prompt diagnosis and treatment of neonatal pneumonia is crucial because of the high mortality risk associated with this disease. Pneumonia can significantly alter gas exchange in the lungs of neonates, potentially resulting in oxygen deprivation and compromise of metabolism of all cell types in the body. Structural and immunological defense mechanisms are not fully formed in neonates, which makes it all but impossible for the newborn to fight the infection effectively. In addition, there is an increased risk that the infection might spread from the lungs to other parts of the body.
The goals of treatment for neonatal pneumonia are to eradicate the infectious agent and at the same time to protect the infant by providing respiratory support. There are some risks involved in treatment, however, that must be minimized to ensure the infant’s lungs are not permanently damaged. The main risk of antimicrobial treatment is that antimicrobial medications can temporarily worsen lung inflammation, which might increase the risk of permanent lung damage. To reduce this risk, antimicrobial medications are chosen carefully to minimize the dose required to combat the infection.
Antimicrobial medications are the key to successfully treating this disease, but medication alone cannot provide the infant with adequate support. In addition to antimicrobial medication, the infant is provided with a source of oxygen to ensure that he or she is not oxygen-deprived because of reduced lung function. Neonates might also receive blood transfusions and intravenous fluids to ensure adequate nutrition and blood-oxygen capacity.