Pneumonia is an inflammatory process involving lungs resulting in derangement in gas exchange at the levels of the lung. Pneumonia manifesting within 3 days of birth is known as congenital pneumonia and source of infection is the mother. Pneumonia is an important cause of hospital admissions and mortality in newborns. It is contributing to 10-25% of deaths occurring within 30 days. In congenital pneumonia newborn catches infection while in utero (true congenital pneumonia), during delivery (intrapartum) or after delivery (postnatal) within 24 hours. In true congenital pneumonia, the infection can spread through maternal blood or be ascending infection from mother’s birth canal or aspiration of infected amniotic fluid. Mother usually has symptoms of infection like fever, rupture of a bag of membrane etc but at times mother may not have any symptoms of infection. As this infection is established well before birth, newborn usually have systemic involvement rather than lungs only. Intrapartum and postnatal congenital cases of pneumonia may also of systemic spread of infection from lungs.
How is congenital pneumonia caused?
Congenital pneumonia can be caused by bacteria, viruses, fungi, protozoa. Bacterial infection is the most common cause and usually present within 3 days of birth and if treated appropriately, newborn responds well to treatment. But few agents can cause chronic congenital infection such as CMV, Syphilis, Tuberculosis, Toxoplasma, rubella. It also usually manifests within 24 hrs, but also has features suggestive of the simultaneous involvement of other organs. Infections caused by Chlamydia usually present after 2 weeks.
Signs and symptoms associated with congenital pneumonia:
In true congenital pneumonia, the baby is symptomatic at birth and condition progresses fast. Infants infected during delivery usually develop symptoms after few hours. Postnatal pneumonia usually present after 24 hrs. Newborns present with low temperature (hypothermia), fast breathing, difficulty in feeding, abnormal sound while breathing (grunting) and blue discolouration (Cyanosis). Fever and cough are an infrequent presentation of congenital pneumonia. In severe disease newborn may have low sugar, blood pressure, decreased urine output and even seizures.
How is congenital pneumonia treated?
Treatment of newborns with pneumonia needs special care in well equipped NICU. Treatment involves both supportive and targeted treatment. Supportive care includes support to a respiratory system in the form of oxygen and ventilator support. Affected newborn also needs IV Fluids and management of other complications like low BP, low sugar etc. Targeted treatment includes treatment with antibiotics to eradicate the infection. Antimicrobial agents are chosen depending on the microorganism suspected in that particular situation and susceptibility pattern of microorganism.