Neonatal pneumonia is a lung infection that occurs in a newborn within the first 28 days of life and requires prompt medical attention. The infection causes inflammation in the small air sacs of the lungs, known as alveoli, which can fill with fluid and make breathing difficult for the infant. While the diagnosis can be frightening for parents, the condition is treatable. The outlook for newborns who receive timely and appropriate medical care is positive.
Causes and Risk Factors of Neonatal Pneumonia
The causes of neonatal pneumonia are categorized based on when the infection begins. Early-onset pneumonia appears within the first few hours or days after birth and is acquired from the mother. The infant can be exposed to infectious agents in the birth canal during delivery. One of the most common bacteria for early-onset cases is Group B streptococcus, which may be present in the mother without causing her any symptoms.
Late-onset pneumonia develops more than seven days after birth and is acquired from the environment, such as in the hospital or at home. Newborns in the neonatal intensive care unit (NICU) who require breathing tubes are at an increased risk because the tube can allow germs to enter the lungs. The specific pathogens for late-onset pneumonia can vary depending on the hospital and community.
Several risk factors can make a newborn more susceptible to developing pneumonia.
- Prematurity, as infants born before 37 weeks have underdeveloped immune systems and lungs.
- Low birth weight, which is often linked to prematurity.
- Maternal infections during pregnancy, such as chorioamnionitis (an infection of the amniotic fluid and membranes).
- A prolonged period between the rupture of the amniotic sac and delivery.
Symptoms in a Newborn
The signs of neonatal pneumonia can be subtle and may resemble other newborn health issues. One category of symptoms relates to breathing difficulties. Parents might notice their baby is breathing much faster than usual (tachypnea), making grunting noises with each breath, flaring of the nostrils, or showing retractions, where the skin in the chest and neck area sinks in.
General signs of illness are also common. The baby may develop a fever or have a low body temperature (hypothermia). A change in behavior, such as excessive sleepiness, lethargy, or unusual irritability, can be a symptom. Poor feeding is another warning sign, as an infant with pneumonia may refuse to eat.
A bluish tint to the skin, lips, or nail beds, known as cyanosis, indicates that the baby is not getting enough oxygen. This is a serious sign that requires immediate medical evaluation. Any combination of these symptoms should prompt parents to contact a healthcare provider without delay.
The Diagnostic Process
When neonatal pneumonia is suspected, a physical examination is the first step. A doctor will observe the infant’s breathing patterns for rapid breathing, grunting, or retractions. Using a stethoscope, the provider will listen to the baby’s lungs to detect abnormal sounds, such as crackles, that could indicate fluid in the air sacs.
A chest X-ray is a standard diagnostic tool to get a clearer picture of the lungs. This imaging test allows the medical team to see areas of inflammation or fluid buildup consistent with pneumonia. The X-ray helps determine the extent and location of the infection, which guides treatment decisions.
Laboratory tests are also performed to gather more information. A blood test is used to check for signs of infection, such as an elevated white blood cell count. To identify the specific pathogen, a blood culture may be ordered, and if the newborn requires a breathing tube, a sample of fluid from the trachea may be collected and analyzed.
Treatment and Hospital Care
Newborns diagnosed with pneumonia require hospitalization, often in a NICU. The primary medical treatment for bacterial pneumonia is antibiotics, given directly into a vein through an intravenous (IV) line for quick effect. Doctors often start with a broad-spectrum antibiotic while awaiting culture results, and may adjust the medication once the specific organism is identified.
Respiratory support is a central component of care. The level of support depends on the severity of the illness and may include supplemental oxygen through a nasal cannula. Others might require continuous positive airway pressure (CPAP) to keep air sacs open, and in the most severe cases, a mechanical ventilator may be needed to breathe for the baby.
Supportive care is also administered to help the baby recover. This includes providing IV fluids to maintain hydration and deliver nutrients if the baby is too weak to feed. The medical team continuously monitors the infant’s vital signs, including heart rate, breathing rate, and oxygen levels. Most newborns with pneumonia recover completely with this care.
Preventive Measures
Preventing neonatal pneumonia starts with comprehensive prenatal care. Regular check-ups allow healthcare providers to monitor the mother’s health and screen for infections. A preventive step is screening for Group B streptococcus (GBS) late in pregnancy. If a mother tests positive, she can be given antibiotics during labor to reduce the risk of transmitting the bacteria.
Simple hygiene practices are effective in preventing late-onset pneumonia. Meticulous hand-washing with soap and water is important for anyone handling the newborn. Keeping surfaces clean and sanitized can also help reduce the spread of germs in the baby’s environment.
Protecting the newborn from exposure to illnesses is another important measure. It is advisable to limit the baby’s contact with individuals who have colds, the flu, or other respiratory infections. Parents and caregivers should ensure they are current on their vaccinations, such as the flu shot and the Tdap vaccine, to create a protective circle of health.