Dr Amita Pandey

Professor, Deptt of Obs & Gyn,

K G Medical University, Lucknow

Statistics
Pneumonia & diarrhoea are the greatest killers of

children under 5 globally accounting for one in four

deaths
Incidence of pneumonia in children under five is
estimated to be about 156 million new episodes each
year worldwide, of which 151 million are in the
developing countries
With 2,97,114 deaths, India tops of the list of these
countries
WHO estimates that death due to pneumonia
occurs in 1 in 3 cases

Mortality due to childhood

pneumonia
Strongly linked to

- malnutrition
- poverty
- inadequate access to health care
In India disease more frequently seen in rural and
urban poor

Types of Neonatal Pneumonia

Infective

- GBS
- Hemophilus influenzae
- Enterococci
- Other Gram negative cocci
- Staph aureous
Non-infective
- Diffuse alveolar damage
- Non-specific interstitial pneumonia
- Aspiration

Source of Infection in Neonates

Trans-placental

Acquired during pregnancy from overt or subclinical maternal

infection
Intra-partum/ Ascending
Acquired during delivery by passage through an infected birth
canal or by ascending infection if delivery is delayed after
rupture of membranes
Post-partum
Acquired after delivery from contact with an infected mother
directly (eg, TB ) or through breastfeeding (eg, HIV, CMV) or
from contact with health care practitioners & hospital
environment

Risk factors for Neonatal Pneumonia

Preterm labor

PROM > 18 hrs

Chorio-amnionitis in mother
Maternal genito-urinary infection

Recurrent maternal urinary tract infection

Antenatal infections in mother known to transmit

transplacentally

Other contributing factors

Malnutrition

Vitamin deficiency
Illiteracy of mothers resulting in unhygienic & unhealthy

practices
Unhygienic living spaces
Bad health planning
Low budgetary allocation for health

Neonatal Pneumonia- Pathophysiology

Limited defense in fetus leads to early dissemination of

infection
Infection causes infiltration & destruction of
bronchopulmonary tissue
Fibrinous exudation into alveoli leads to inhibition of
pulmonary surfactant function & respiratory failure
Presentation very similar to respiratory distress syndrome
(RDS) & differentiating the two in a premature baby can
be very difficult

Types of Neonatal Pneumonia

Early onset (<3 days)
First manifests at or within
hours of birth
Results from organisms
acquired antenatal or
intra-partum
Symptoms may appear
within 6 h of birth

Late onset (>3 days)

Usually acquired from the
environment
More likely in preterm
infants, particularly those
with prolonged
hospitalization & use of IV
catheters

Signs & Symptoms

Elevated respiratory rate

Retraction
Grunting
Nasal flaring

Poor feeding
Abdominal distention
Increased secretion in airways
Central cyanosis

Investigations
CBC

Chest X-ray
Blood culture
Inflammation markers- CRP, cytokines

Arterial blood gases

Goals of Therapy
Eradicate infection

Provide adequate support of gaseous exchange to ensure

survival and well being of infant

Decrease long lasting lung changes that adversely affect
lung function, quality of life & susceptibility to future
infections
Parenteral nutritional support

Morbidity following Neonatal

Pneumonia
Chronic lung disease

Prolonged need for respiratory support

Childhood otitis media

Reactive airway disease

Severity of subsequent childhood respiratory infections

Mortality following Neonatal Pneumonia

Mortality rate of early-onset sepsis is 3 to 40%

Mortality of late-onset sepsis is 2 to 20% (that of late-

onset GBS is about 2%)

Fatality rate is 2 to 4 times higher in LBW infants than in
full-term infants
Extremely LBW infants who develop sepsis have a
significantly greater risk of poor outcome

Prevention and Control of Pneumonia

Vaccination (Streptococcus pneumoniae & HIB)
Access to care & use of antibiotics- appropriate facility for

case management in CHC

Exclusive breastfeeding for first 6 months of life
Control of indoor air pollution and provision of a healthy
environment
Prevention of exposure to tobacco smoke
Educate parents about hand washing & prevention of
future exposure
Longitudinal surveillance with future problems

Prevention and Control of Pneumonia

(contd.)
Improvement in maternal nutrition & prevention of low

birth weight
Aggressive management of preterm labor
Consider intrapartum chemoprophylaxis in mothers at
risk for GBS infection
Antepartum & intrapartum antibiotics in mothers with
PROM & chorioamnionitis
Prevention and management of HIV infection
In case of meconium aspiration, suction of trachea
immediately after birth

Prevention and Control of Pneumonia

(contd.)
Proper care of infant

Pneumococcal & infuenza immunization

Immunoglobulins

Thank you