Download Congenital Pneumonia

BY: NICOLE STEVENS
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
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
Etiology of pneumonia
 Age-dependent
 The incidence in newborns is relatively high (1-2 per 1000);
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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
Etiology
 Beyond the neonatal period viruses are the main
cause of pneumonia, fore example: RSV,
parainfluenza, influenza, adenovirus, Rhinovirus,
coronavirus, human metapneumovirus
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
Signs and Symptoms (in neonates)
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Tachypnoea > 60 breaths/min
Grunting
Retractions
Cyanosis
Recurrent apnoea
Diminished breath sounds/wheezing
Lethargy
Bradycardia
Temperature instability
Cardiovascular collapse
Persistent pulmonary hypertension
Signs & Symptoms (in paeds)
 Febrile
 Tachypnoea
 Increased WOB
 Cough
 Vomitting
 Irritability or tiredness
 Pain in the chest, especially with coughing
 Abdominal pains
 Poor appetite
Pneumonia
 There is coarse opacity
of one or more regions
of the lung
parenchyma
Pneumonia
 Group B
Streptococcus can
have a similar
appearance to HMD,
however the
granulation is
typically more coarse
with pneumonia
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)
Treatment
 Is multifaceted and includes both antimicrobial therapy (if
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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
References
 Medscape, congenital pneumonia
http://emedicine.medscape.com