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© Borgis - New Medicine 1/2003, s. 26-28
Marlena Banaś, Monika Dominiak, Monika Badowska
Pneumonia diagnostics in neonates
Students´ Scientific Association, 2nd Clinic of Neonatal Pathology, The Medical University of Warsaw
Protector of Students´ Association: Zofia Rajtar-Leontiew MD, PhD
Summary
Introduction: Pneumonia seems to be one of the most important problems among neonates. According to the literature, itaffects 1.2% of neonates in the first 72 hours, and 3.8% after this period.
Objectives: The purpose of our research is: 1.Assertion of the frequency of neonate hospitalization due to pneumonia, depending on the day of life, and including premature babies (noting their birth weight); 2.Assessing criteria for diagnosis; 3. Assertion the frequency of coexistence of pneumonia and congenital heart failure; 4. Assess the duration of hospitalization.
Methods: Retrospective research was based on case histories from 01.01.1999. to 10.31.2002. in Clinic of Neonatal Pathology in the Medical School of the University of Warsaw. We examined 102 case histories with a diagnosis of pneumonia.
Results: The frequency of neonate hospitalization due to pneumonia with reference to all neonates hospitalization – 12.75%.
I. The frequency of hospitalizations with pneumonia based on the day of life:
 To 15th dayAfter 15th day
In general42,2%57.8%
% prematures18.6%22%
Birth weight of prematuresl/ 3.8%2/13
> 2501 g6/89/13
< 1500 g1/81/13
< 1000 g-1/13

II. The diagnosis of pneumonia was based on:
A. physical examination and radiology.
Only changes on auscultation25.5%
Radiological changes12.7%
Radiological changes and changes on auscultation58.8%
Admitted from another health centre3%

B. accesory investigations-confirmation of inflamation.
Leukocytosis > 20 thousands3,9%
CRP > 0.5338.2%
Positive bacteriological culture:
S. Epidermidis
Enterobacteriacae
S. aureus&Klebsiella
Pseudomonas&Acinetobacter
12.9%
9
2
1
2

C. Interviews: typical symptoms of pneumonia – 3.1%.
III. Coexistance of congenital heart defects – 31.4%.
IV. Duration of hospitalization:
< 14 days56,8%
> 15-2127,4%
> 2115,7%
Key words: pneumonia, neonates.
Introduction
Pneumonia has been identified as a specific condition since the times of Hippocrates, in the fourth century BC. There are many ways of describing the inflammatory processes taking place in the lungs. According to one of these, pneumonia is a disease of the mesenchyme and/or the interstitial tissue, with characteristic clinical and radiological symptoms.
Despite the introduction of auscultation by Laveneca in 1819, and the significant development of diagnosis and treatment in the past century, this disease remains as one of the main causes of death in children throughout the world.
Pneumonia is especially important in the neonatal period, because this is a period in which the immuno-logical processes are not fully developed, and the child is not completely adapted to extrauteral life. As a result, pneumonia can have a fulminant course, and an atypical clinical presentation.
Objectives
Symptoms of neonatal pneumonia can be minimal, and our research therefore aimed at:
Establishing the frequency of neonate hospital admissions due to pneumonia, together with the day of life, and including premature babies (noting their birth weight);
Assessing the criteria for diagnosis;
Establishing the frequency of coexistance of pneumonia and congenital heart failure;
Establishing the typical duration of hospitalization.
Methods
Retrospective research was based on case histories from 01.01.1999 to 31.10.2002 (40 months) in the Second Clinic of Neonatal Pathology in The Medical University of Warsaw. We considered 102 case histories with a diagnosis of pneumonia.
The table 1 shows the number of admissions and the number of neonatal cases of pneumonia, including prematures with this diagnosis, in the studied period (table 1).

Table 1. Number of admissions showing the number of neonatal cases of pneumonia.
YearsNumber of admissionsNumber of neonatal cases of pneumoniaNumber of premature babies with pneumonia
1999193317
2000200294
2001226278
2002189152
The number of neonatal cases of pneumonia per year oscillates between 7.9 and 16% (Fig. 1).

Fig. 1. The cases of pneumonia per year.
From the above data, we can see that 12.75% of neonate admissions were cases of pneumonia. Premature babies with the above-mentioned diagnosis represent 2.6% of all admissions in the same period.
Of the total number of neonates studied, 42.2% were in hospital up to or including day 15. of these, 18.6% were prematures (Fig. 2).

Fig. 2. The number of neonate admissions due to pneumonia, depending on the day of life.
Six out of the eight prematures had LBW, one with VLBW, and one had normal birth weight.
After day 15. 57.8% remained in admission, of these, 22% were prematures.
Nine out of the thirteen premature babies had LBW, 1-VLBW, 1-ELBW and two had the normal birth weight.
The diagnosis
The diagnosis was based on physical and radiological examinations.
25.5% were confirmed only by signs 12.7% didn´t show any auscultatory changes. Diagnosis was based on characteristic changes in the radiological picture of the lungs.
3% of the neonates admitted had already been diagnosed by another health centre. The diagnosis was based on:

Extra tests were carried out to confirm the inflammatory process. Among these were tests for inflammatory markers, such as leucocytosis, ESR, and CRP. A blood culture was also carried out. From our analyses we observed that a leukocytosis count of above 20 thousand (above the diagnostic value in this age group) occurred in 3.5% of the neonatal cases with pneumonia. About 20% of the patients had an ESR indicating inflammation, CRP as the most specific indicator being positive (above 0.53 mg% according to the lab.) in 38.2% of the cases. A blood culture was done in 74.6% of admitted subjects with pneumonia. It was positive in 12.95% of cases. Among the pathogens were S. epidermidis, Enterobacteriacae, S. aureus, and Klebsiella. Pseudomonans aeruginosa, and Acineto-bacter were also found.
Symptoms
Data collected from careproviders was helpful in making the diagnoses. Typical symptoms of pneumonia like dyspnoea with retraction of the intercostal space and apnoea were present in 93.1% of cases. Atypical symptoms like fever, vomiting, distress, anorexia, jaundice, prurient skin disorders and loose stool were present in 6.9%.
We discovered that a relationship between pneu-monia and congenital heart failure existed in 31.4% of the neonates.
Pneumonia and CNS haemorrhages
In 9 cases CNS haemorrhages were noted. Six of these were premature babies.
Duration of hospital admission
The duration of hospitalization of 56.8% of the neonates was less than 14 days. Between 15 and 21 days 27.9% were hospitalised, and 15.7% were hospitalized for longer than 21 days.

Fig. 3. The pneumonia and congenital defect.
Conclusion
Pneumonia is one of the most important problems in the neonatal period. Our analysis shows that it affects 12.75% of all neonatal admissions to hospital in patient care.
Special attention should be paid to prematures (especially these with low birth weight) because they account for 20% of the total admitted cases of neonatal pneumonia.
It is important to note that auscultatory changes do not always compare with the radiological image of the lungs.
In order to confirm infection, it is important to carry out extra tests (the most specific of which is CRP), as well as a blood culture.
Although the clinical symptoms may be minimal, a history of symptoms should also be obtained while taking the case history.
Summarising, vital elements in the diagnosis of pneumonia in neonates are:
- good case history,
- thorough physical examination,
- radiological examination of the chest,
- extra tests (Leukocytosis, CRP, ESR, blood culture).
New Medicine 1/2003
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