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.
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. Recognition, prevention, and treatment of these problems are major factors in the care of high-risk newborn infants.
This article focuses on pneumonia that presents within the first 24 hours after birth. Although pneumonia is an important cause of morbidity and mortality among ne wborn infants, it remains a difficult disease to identify promptly and treat.
(See Treatment and Management, as well as Medication.)
Clinical manifestations are often nonspecific (see Clinical Presentation).
Neonatal pneumonia shares respiratory and hemodynamic signs with a host of noninflammatory processes.
Radiographic and laboratory findings have limited predictive value. (See Workup.)
Therapy in infants with neonatal pneumonia is multifaceted and includes both antimicrobial therapy and respiratory support. 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 (see Treatment and Management).