congenital pneumonia

1. PRESENTED BY
RN III VIOLET ISRAVEL
SCBU, AHMADI HOSPITAL

2.  Pneumonia
is an inflammatory pulmonary process
that may originate in the lung or be a focal
complication of a contiguous or systemic
inflammatory process.
 Abnormalities of airway patency as well as alveolar
ventilation and perfusion occur frequently due to
various mechanisms.
 These derangements often significantly alter gas
exchange and dependent cellular metabolism in
the many tissues and organs that determine
survival and contribute to quality of life.

3. Congenital Pneumonia is an inflammatory condition of
the lung—affecting primarily the microscopic air sacs
known as alveoli at birth.

It is usually caused by infection with viruses or bacteria
and less commonly other microorganisms, certain drugs
and other conditions such as autoimmune diseases.

Such pathologic problems, superimposed on the
underlying difficulties associated with the transition
from intrauterine to extrauterine life, pose critical
challenges to the immature human organism.

4.  In
2008, pneumonia occurred in approximately 156
million children (151 million in the developing
world and 5 million in the developed world)
 Many of these deaths occur in the newborn period.
 The World Health Organization estimates that one
in three newborn infant deaths is due to
pneumonia.
 Neonatal pneumonia ranges from 20 to 32 percent
of live-born and from 15 to 38 percent of stillborn
infants.
 congenital pneumonia accounted for 30 of these 56
infections, caused by maternal enteric organisms
frequently accompanies chorioamnionitis and/or
funisitis in these congenital infections.

5. o
o
o
o
o
o
o
o
o
o
Morphology
Lobar pneumonia
Bronchopneumonia
Interstitial pneumonia
Onset
True congenital pneumonia
Intrapartum pneumonia
Postnatal pneumonia
Etiology
viral
Bacterial
Mycoplasmal
Aspiration

6. Unexplained preterm labor
 Rupture of membranes before the onset of labor
 Membrane rupture more than 18 hours before delivery
 Maternal fever (>38°C/100.4°F)
 Uterine tenderness
 Foul-smelling amniotic fluid
 Infection of the maternal genitourinary tract
 Previous infant with neonatal infection
 Nonreassuring fetal well-being test results
 Fetal tachycardia
 Meconium in the amniotic fluid
 Recurrent maternal urinary tract infection
 Gestational history of illness consistent with an
organism known to have transplacental pathogenic
potential


7.  Congenital
pneumonia may be infectious or
noninfectious
 Group B Streptococcus (GBS)
 Nontypable Haemophilus influenzae
 Other gram-negative bacilli
 Listeria monocytogenes
 Enterococci
 Staphylococcus aureus
 noninfectious pneumonia are a class of diffuse lung
diseases. They include: diffuse alveolar
damage, organizing pneumonia, nonspecific
interstitial pneumonia, lymphocytic interstitial
pneumonia, desquamative interstitial
pneumonia, Aspiration

8. Transmission of congenital pneumonia usually occurs
via 1 of 3 routes:
 Haematogenous
Mom with bacterial or viral(micro organisms)
accumulation in blood.
 Ascending
Ascending infection from the birth canal
 Aspiration
Aspiration of infected or inflamed amniotic fluid

9. Due to the etiological factors
If the mother has a bloodstream infection
defenses are limited in fetuses
can readily cross the placental barrier
dissemination and illness may result
before birth or relatively shortly before birth
pneumonia is already established at birth

10. Elevated respiratory rate
 Retractions
 Grunting when exhaling
 Nasal flaring
 Increase of mucous and other fluid substances in the
airways (White, yellow, green, or hemorrhagic colors
and creamy or chunky textures)
 Unstable body temperature
 Poor feeding, Abdominal distention
 Jaundice at birth
 Glucose intolerance
 Hypoperfusion
 Oliguria
 Cyanosis of central tissues, such as the trunk.


11. Physical exam
 Observe for signs of respiratory distress
 Examination of the chest may be normal, but may show
decreased chest expansion on the affected side.
 Harsh breath sounds from the larger airways that are
transmitted through the inflamed lung are termed
bronchial breathing, and are heard on auscultation with
a stethoscope.
 Crackles (rales) may be heard over the affected area
during inspiration.
 Percussion may be dulled over the affected lung, and
increased, rather than decreased, vocal resonance
distinguishes pneumonia from a pleural effusion.

12. When considering pneumonia, devote particular attention to the
following:
 Costophrenic angles

Pleural spaces and surfaces

Diaphragmatic margins

Cardiothymic silhouette

Pulmonary vasculature

Right major fissure

Air bronchograms overlying the cardiac shadow

Lung expansion

Patterns of aeration

13. X-ray examination of the chest may reveal certain abnormal changes
associated with pneumonia. Localized shadows obscuring areas of the lung
may indicate a bacterial pneumonia, while streaky or patchy appearing
changes in the x-ray picture may indicate viral or mycoplasma
pneumonia.

14.  Complete
Blood Count
White Blood Cell Count (5000-25000)
 Inflammation markers
CRP, Procalcitonin, cytokines
 Culture
The most useful laboratory tests for congenital
pneumonia facilitate the identification of an
infecting microorganism. Results can be used for
therapeutic decisions as well as prognostic and
infection control considerations.
 Arterial Blood Gas
Indicated for S/S of Hypoxia

15.  Therapy
in infants with neonatal pneumonia is
multifaceted.
 The goals of therapy are to eradicate infection and
provide adequate support of gas exchange to
ensure the survival and eventual well being of the
infant.
 This is not to imply that eradication of invasive
microbes should not be a goal;
 Drainage of a restrictive or infected effusion or
empyema may enhance clearance of the infection
and will improve lung mechanics
 Even if the infection is eradicated, many hosts
develop long-lasting or permanent pulmonary
changes that adversely affect lung function, quality
of life, and susceptibility to later infections

16. Adequate gas exchange depends not only on alveolar
ventilation, but also on perfusion and gas transport
capacity of the alveolar perfusate (ie, blood).
Airway patency
• Gentle vibration and percussion is used in some
centers to mobilize the secretions.
• Deep suctioning should be avoided because it can
cause airway trauma and swelling, which, in turn,
may cause large airway obstruction.
• Use of mucolytic agents
Ventilatory support
may be rendered unusually challenging by alveoli
with variable degrees of inflation from the
unpredictable distribution of surfactant inactivation,
partial airway obstruction, and fluid exudation.

17.  Red
blood cells should be administered to achieve
a hemoglobin concentration of 13-16 g/dL in the
acutely ill infant, to ensure optimal oxygen
delivery to the tissues.
 Delivery of adequate amounts of glucose and
maintenance of thermoregulation, electrolyte
balance, and other elements of neonatal
supportive care are also essential.
 Nutrition: Attempts at enteral feeding often are
withheld in favor of parenteral nutritional support
until respiratory and hemodynamic status is
sufficiently stable. Transfer
 (If no facilities)stabilize the neonate and transfer
to a tertiary care neonatal intensive care unit.

18. ANTIBIOTICS & ANTVIRALS
Primary Antibiotic Protocol
 Ampicillin 50 mg/kg/dose IV or IM q12 hours
 Cefotaxime 50mg/kg IV or IM q12h
 Erythromycin 30-50 mg/kg/d PO divided Q8H
 Gentamicin 2.5 mg/kg/dose IV/IM Q24H
Antiviral agents
acyclovir (Zovirax)
Acyclovir treatment should be considered when a
diagnosis of herpes simplex virus is suspected and
when the infant is not responding to antibiotic
therapy.

19.  Restrictive
pleural effusion
 Infected pleural effusion
 Empyema
 Systemic infection with metastatic foci
 Persistent pulmonary hypertension of the newborn
 Air leak syndrome, including pneumothorax,
pneumomediastinum, pneumopericardium, and
pulmonary interstitial emphysema
 Airway injury
 Obstructive airway secretions
 Hypoperfusion
 Chronic lung disease
 Hypoxic-ischemic and cytokine-mediated end-organ
injury

20. 















Consider intrapartum antibiotic chemoprophylaxis with penicillin or another
appropriate antimicrobial agent in mothers at risk for early-onset group B
streptococcal disease.
Risk factors are as follows:
Known colonization of birth canal by group B Streptococcus
Premature delivery
Membrane rupture more than 18 hours before delivery
Intrapartum fever
Group B streptococcal bacteriuria
History of previous infant with early-onset neonatal group B streptococcal infection
Consult the Red Book for the most current recommendations for infants at risk for
group B streptococcal sepsis/pneumonia.[38]
Prevention strategies may include antepartum and intrapartum broad-spectrum
antibiotic treatment in mothers with preterm rupture of membranes or in whom
chorioamnionitis is suspected.
In the presence of particulate amniotic fluid meconium, suction the trachea
immediately after birth if the infant is not vigorous.[39]
Currently, there is little evidence demonstrating the potential efficacy of the
following interventions in neonates:
Elevating the head
Use of antireflux medications
Differential policies for oral care and changes of suction and ventilator tubing
Other potential interventions

21. Continued growth and development of pulmonary and other
tissues offers good prospects for long-term survival and
progressive improvement in most infants who survive
congenital pneumonia. Nevertheless, although quantitation of
risk is difficult and is strongly influenced by gestational
age, congenital anomalies, and coexisting cardiovascular
disease, there is a consensus that congenital pneumonia
increases the following:
 Chronic lung disease

Prolonged need for respiratory support

Childhood otitis media

Reactive airway disease

Severity of subsequent early childhood respiratory infections

Complications attendant to these conditions

22. Education of parents whose infant has had congenital
pneumonia is principally directed toward subsequent
care.
 Counsel parents regarding the need to prevent
exposure of infants to tobacco smoke.
 Educate parents regarding the benefit infants may
receive from pneumococcal immunization and annual
influenza immunization.
 Discuss potential benefits and costs of respiratory
syncytial virus immune globulin.
 Educate parents regarding later infectious exposures in
daycare centers, schools, and similar settings and the
importance of hand washing.
 Emphasize careful longitudinal surveillance for longterm problems with
growth, development, otitis, reactive airway
disease, and other complications.


24. 1.Impaired Gas Exchange (cyanosis ,irritability, nasal
flaring,tachycardia)
2.Ineffective Breathing Pattern (nasal flaring)
 Monitor
ventilator settings hourly.(if on ventilator)
 Elevate head of bed.
 Provide chest physiotherapy and postural draining
 Monitor blood gases and act accordingly
 Admin nebulizer and respiratory stimulant

25. 3.Altered body Temperature [Fever, cold and clammy
skin]
 Monitor neonate’s condition.
 Monitor Vital signs
 Provide neutral environment
 Ensure that all equipment used for infant is
sterile, scrupulously clean. Do not share
equipment with other infants
 Ensure optimal hydration status.
 Administer Anti-pyretics as ordered

26. 4.Decreased Cardiac Output (tachycardia, cyanosis,pallor,
mottling)
5.Ineffective Tissue Perfusion, peripheral (hypotension,
skin color changes in limbs cyanosis, pallor, mottling)
Assess respiratory rate, depth, and quality
 Assess skin for changes in color, temperature
 Monitor neonate’s condition.
 Monitor Vital signs Q1H
 Note quality & strength of peripheral pulses
 Elevate Head of bed
 Elevate affected extremities with edema
 Provide a quiet, restful atmosphere
 Administer oxygen as ordered
 Maintain fluid & electrolyte balance


27. 6.RISK FOR INFECTION
 Thorough hand washing by care givers
 Wear gloves
 Use disposable IV cannula
 Thorough skin preparation
 All IV ports should be wiped with alcohol
 Early identification of extravasation
 Avoid unnecessary IV infusion
 Keep cord dry
 Hygiene of Baby
 No unnecessary intervention
 Better management of IV Lines
 Disinfection of Equipments

28.  7.Altered
Nutrition: less than body requirements
(decreased oral intake)
 8.Fluid
Volume deficit (hypotension, fever)
Assess for S/S of dehydration
 Avoid enteral feed, if sick
 Check weight twice a day
 Maintain strict intake and output
 Start IV Fluid, Infuse 10% D 2ml/Kg stat to
 Maintain normoglycaemia
 Maintain fluid & electrolyte balance and tissue
perfusion
 If CRT > 3 sec infuse 10 ml / Kg NS


29. 9.Altered parenting
Interview parents, noting their perception of
situation and individual concerns
 Educate regarding child growth & deve
lopment, addressing parental perceptions
 Involve parents in activities with the baby that
they can accomplish successfully
 Recognize & provide positive feedback for
protective parenting behaviors
 Provide NICU Tel.No & encourage visiting
 Provide baby’s picture
