Pneumonia is the most common serious bacterial infection in newborns after sepsis. Pneumonia that begins at or within hours of birth is called early-onset pneumonia. Pneumonia that begins after 7 days of age is called late-onset pneumonia. Late-onset pneumonia most commonly occurs in newborns in neonatal intensive care units (NICUs) who need a breathing tube (endotracheal intubation—see Mechanical Ventilation) for lung problems. Having a breathing tube increases the risk of pneumonia.
Pneumonia may be caused by various organisms, such as bacteria, viruses, or fungi, that get into the lungs. Newborns become infected after passing through the mother's birth canal or after coming into contact with organisms in the NICU or nursery.
Symptoms of bacterial pneumonia vary depending on when the child is infected.
Newborns who have early-onset pneumonia have symptoms similar to symptoms of sepsis in newborns.
Newborns who have late-onset pneumonia develop unexplained breathing problems and may need extra oxygen or more breathing support. The amount of sputum (thick or discolored mucus) increases and changes (for example, becomes thicker and brown). Infants may be very ill and have an unstable temperature.
To diagnose pneumonia, doctors do a chest x-ray. They do blood tests to look for bacteria in the blood. Because infants who have pneumonia may have low levels of oxygen in their blood, doctors measure levels of oxygen in the blood by placing a sensor on a finger or an earlobe. This test is called pulse oximetry. Doctors may also obtain a sample of sputum and test it to look for bacteria.
Because pneumonia caused by bacteria may spread, doctors may test newborns for sepsis, which includes a spinal tap (see diagnosis of sepsis).
To treat pneumonia in newborns, doctors give intravenous antibiotics. Once they identify the specific organism, they may adjust the type of antibiotic.
In addition to antibiotic therapy, other treatments may be needed, such as use of a machine that helps air get in and out of the lungs (ventilator), intravenous fluids, blood and plasma transfusions, and drugs that support blood pressure and circulation.