1. Caserta, Mary. " Neonatal Pneumonia: Infections in Neonates: Merck Manual Professional ." THE MERCK MANUALS - Trusted Medical and Scientific Information. The Merck Manual, n.d. Web. 23 Sept. 2011. Retrieved from http://www.merckmanuals.com/professional/pediatrics/infections_in_neonates/neonatal_pneumonia.html
2. Patient status
3. Media
4. Causes
   1. Aspiration or hematogenous matter spreading to the lungs
   2. S. pneumoniae is most common
      1. community-acquired pneumonia
   3. group A streptococci
   4. M. catarrhalis
   5. organism unidentified as of 9/24/11
5. Pathophysiology
   1. onset is abrupt
   2. generally follows a viral infection
      1. disturbs natural defense mechanisms of upper respiratory tract
   3. Early-onset pneumonia
      1. generalized sepsis that first manifests at or within hours of birth
   4. Late-onset pneumonia
      1. occurs after 7 days of age, most commonly in NICUs among infants who require prolonged endotracheal intubation because of lung disease
6. Clinical Manifestations
   1. respiratory distress may or may not be present
      1. some cases, only finding is tachypnea
   2. cyanosis
   3. apnea
   4. activity and eating pattern decreased for a few days
   5. abrupt fever
   6. vomiting
   7. diarrhea
   8. abdominal distention
   9. pneumonia in newborns carries a high morbidity and mortality rate
      1. suspect bacterial infection in all neonates with respiratory symptoms
   10. decreased eating pattern, fever, tachypnea and tachycardia present upon admission
7. Diagnostics
   1. pulmonary infiltrates on radiographic exam
      1. lobar consolidation and in severe cases, pleural effusion
         1. PneumNeonat01Day01CXRPA.jpg
   2. blood cultures
   3. nasopharyngeal specimens
   4. lung aspiration
   5. biopsy
   6. Elevated WBC count
      1. may be normal for infants with staphylococcal disease
   7. recurrent pneumonia
      1. evaluate for cystic fibrosis or immunodeficiency disease
   8. rule out aspiration pneumonia as potential cause
   9. urine culture, chest x-ray, blood culture completed
8. Therapeutic Management
   1. antimicrobial therapy
   2. oral Amoxicillin
      1. outpatient use for infants and children <5years
   3. amoxicillin-clavulanate or second generation cephalosporin (cefuroxime, cefedroxil)
      1. used for patients incompletely immunized against H. influenzae
   4. in hospital, medications given parenterally for rapid action and maximum effect
   5. IV cefuroxime,cefotaxime and ceftriaxone
      1. primary antibacterial agents in hospitalized child
   6. chest physiotherapy with postural drainage may be helpful
      1. clearing secretions in some cases
   7. oxygen may be required if infant is in respiratory distress
   8. Patient medications include Ceftriaxone antibiotic infusion q6h and acetaminophen PRN for fever
9. Prognosis
   1. generally good
   2. rapid recovery
      1. recognized and treated early
   3. course of staphylococcal pneumonia generally prolonged
10. Nursing Care Management
    1. thorough assessment
       1. respiratory rate and status
       2. oxygenation
       3. general disposition
       4. level of activity
    2. administration of supplemental oxygen and antibiotics
    3. oral fluids given cautiously
       1. avoid aspiration
       2. decrease possibility of aggravating a fatiguing cough
    4. control fever
       1. cooling environment
       2. administer antipyretics as prescribed
    5. bulb suction syringe
       1. clear nares and nasopharynx
    6. encourage questions from family
       1. involve entire family in care
       2. facilitate effective communication