© 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
SummaryIntroduction: 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 day | After 15th day |
| In general | 42,2% | 57.8% |
| % prematures | 18.6% | 22% |
| Birth weight of prematures | l/ 3.8% | 2/13 |
| > 2501 g | 6/8 | 9/13 |
| < 1500 g | 1/8 | 1/13 |
| < 1000 g | - | 1/13 |
II. The diagnosis of pneumonia was based on:A. physical examination and radiology.
| Only changes on auscultation | 25.5% |
| Radiological changes | 12.7% |
| Radiological changes and changes on auscultation | 58.8% |
| Admitted from another health centre | 3% |
B. accesory investigations-confirmation of inflamation.
| Leukocytosis > 20 thousands | 3,9% |
| CRP > 0.53 | 38.2% |
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 days | 56,8% |
| > 15-21 | 27,4% |
| > 21 | 15,7% |
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.
| Years | Number
of admissions | Number
of neonatal cases of pneumonia | Number of premature babies with pneumonia |
| 1999 | 193 | 31 | 7 |
| 2000 | 200 | 29 | 4 |
| 2001 | 226 | 27 | 8 |
| 2002 | 189 | 15 | 2 |
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:
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