Buy the Book PDA Download

Update Me E-mail alerts The Merck Manual Minute

Print This Topic Email This Topic

Neonatal pneumonia is lung infection in a neonate. Onset may be within hours of birth and part of a generalized sepsis syndrome, or after 7 days and confined to the lungs. Signs may be limited to respiratory distress or progress to shock and death. Diagnosis is by clinical and laboratory evaluation for sepsis. Treatment is initial broad-spectrum antibiotics changed to organism-specific drugs as soon as possible.

Early-onset pneumonia is part of generalized sepsis that presents at or within hours of birth. Late-onset pneumonia usually occurs after 7 days of age, most commonly in neonatal ICUs in infants who require prolonged endotracheal intubation because of lung disease.

Etiology

Organisms are acquired from the maternal genital tract or the nursery. These include gram-positive cocci (eg, groups A and B streptococci, Staphylococcus aureus) and gram-negative bacilli (eg, Escherichia coli , Klebsiella sp, and Proteus sp). In infants who have received broad-spectrum antibiotics, many other pathogens may be found, including Pseudomonas, Citrobacter, Bacillus, and Serratia.

Symptoms, Signs, and Diagnosis

Late-onset hospital-acquired pneumonia may begin gradually, with more secretions being suctioned from the endotracheal tube and higher ventilator settings. Other infants may be acutely ill, with temperature instability and neutropenia. New infiltrates may be visible on chest x-ray but may be difficult to recognize if the infant has severe bronchopulmonary dysplasia.

Evaluation includes cultures of blood and tracheal aspirate, chest x-ray, and pulse oximetry.

Treatment

Vancomycin Some Trade Names
VANCOCIN
Click for Drug Monograph
and cefotaxime Some Trade Names
CLAFORAN
Click for Drug Monograph
are the initial treatment of choice if methicillin-resistant S. aureus is suspected. Ceftazidime Some Trade Names
FORTAZ
TAZICEF
Click for Drug Monograph
may be substituted for cefotaxime Some Trade Names
CLAFORAN
Click for Drug Monograph
if Pseudomonas is a concern. More specific antibiotics are substituted after sensitivity results are available. General treatment is the same as that for neonatal sepsis (see Infections in Neonates: Treatment).

Chlamydial Pneumonia

Contamination with chlamydial organisms during delivery may result in development of chlamydial pneumonia at 2 to 12 wk. Infants are tachypneic but usually not critically ill and may also have conjunctivitis caused by the same organism. Eosinophilia may be present, and x-rays show bilateral interstitial infiltrates. Treatment with erythromycin Some Trade Names
ERY-TAB
ERYTHROCIN
Click for Drug Monograph
leads to rapid resolution.

Last full review/revision November 2005

Content last modified November 2005