Pneumonia is an inflammatory process involving lungs resulting in derangement in gas exchange at the levels of 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 infection can spread through maternal blood or ascending infection from mother’s birth canal or aspiration of infected amniotic fluid. Mother usually has symptoms of infection like fever, rupture of 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 has systemic involvement rather than lungs only. Intrapartum and postnatal congenital pneumonias may also of systemic spread of infection from lungs.
Causes of Congenital Pneumonia:
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 with in 24 hrs, but also has features suggestive of simultaneous involvement of other organs. Infections caused by Chlamydia usually presents after 2 weeks.
In true congenital pneumonia, baby is symptomatic at birth and condition progresses fast. Infants infected during delivery usually develop symptoms after few hours. Postnatal pneumonias usually present after 24 hrs. Newborns present with low temperature (hypothermia), fast breathing, difficulty in feeding, abnormal sound while breathing (grunting) and blue discoloration (Cyanosis). Fever and cough are infrequent presentation of congenital pneumonia. In severe disease newborn may have low sugar, blood pressure, decreased urine output and even seizures.
Treatment and Management Recommended for Pneumonia:
Treatment of newborns with pneumonia needs special care in well equipped NICU. Treatment involves both supportive and targeted treatment. Supportive care includes support to respiratory system in the form of oxygen and ventilator support. Affected newborn also need IV Fluids and management of other complications like low BP, low sugar etc. Targeted treatment includes treatment with antibiotics to eradicate infection. Antimicrobial agents are chosen depending on the microorganism suspected in that particular situation and susceptibility pattern of microorganism.