Jurnal 6
Jurnal 6
Jurnal 6
Abstract
Background: Pneumonia is one of the causes of neonatal infection and responsible
for significant morbidity and mortality, especially in developing countries. The study
was aimed to reveal frequency and outcome of pneumonia among hospitalized sick
newborn of neonatal intensive care unit.
Methodology: This observational study was carried out in the NICU of Bangabandhu
Sheikh Mujib Medical University (BSMMU) on 94 neonates with the diagnosis of
pneumonia admitted from July 2012 to June 2014. All studied neonates were
subjected to history taking, clinical examination, routine investigations, chest
radiography and blood culture and sensitivity.
Results: Incidence of neonatal pneumonia was 43% among admitted neonates
with respiratory distress. Mean birth weight and gestational age were 2392±854
and 33±3.9 weeks respectively. Of enrolled infants with pneumonia, 38 (40.4%)
were early onset, 24 (25%) were hospital acquired pneumonia and community
acquired pneumonia was documented in 14 (14.8 %) and the rest 18 (19%) were
ventilator associated pneumonia. Blood culture was positive in 18 (19%) of cases
with neonatal pneumonia; most common pathogen isolated was acinetobacter.
Mean duration of hospital stay was 19±8 days. Most of the neonatal pneumonia
were cured 72 (76%) with therapy, whereas 17 (18%) died during their hospital
course.
Conclusion: Overall incidence among admitted sick neonates was 8.4% which
constituted 34% of distressed neonate.
Keywords: Neonatal pneumonia, Ventilator associated pneumonia
Introduction
bacteria, followed by viruses and fungi which induce Transient episodes of consolidation lasting less than
an inflammatory pulmonary condition6, causing 48 hours due to pulmonary edema were excluded
epithelial injury to the airways. 5 Early onset from the diagnosis of neonatal pneumonia.
pneumonia is mostly caused by ascending infection Respiratory distress is characterized by any of the
from maternal genital tract across the membranes, following: (i) noisy or difficult breathing; (ii) respiratory
and the baby is often septicemic at birth. Pneumonia rate >60/min; (iii) chest retraction; (iv) cyanosis and
of late onset is usually caused by nosocomial (v) grunting. All radiographs suggestive of pneumonia
infection 7 especially in mechanically ventilated were reviewed by a radiologist who was blinded of
patients after 48 hours of mechanical ventilation.8 clinical findings of enrolled newborns. Then
Although pneumonia is an important cause of pneumonia was categorized into early onset
morbidity and mortality among newborn infants, its pneumonia, nosocomial pneumonia, community
prompt identification and treatment remain difficult acquired pneumonia and ventilator associated
because radiographic changes may be due to pneumonia. Pneumonia that became clinically
atelectasis or noninfectious diseases such as evident within 48 hours of birth was defined as early
bronchopulmonary dysplasia rather than infection, onset pneumonia. Nosocomial pneumonia was
and infants rarely undergo invasive diagnostic defined as sign symptoms of pneumonia appeared
procedures such as bronchoscopy.6 There is scarcity 48 hours after hospital admission. Ventilator
of published data regarding burden, clinical features, associated pneumonia was defined as a nosocomial
etiology and outcome of neonatal pneumonia in infection diagnosed in patients undergoing
Bangladesh. The present study was aimed (i)to find mechanical ventilator for at least 48 hours.
the proportion of pneumonia in neonates admitted Community Acquired pneumonia (CAP) was defined
to a neonatal intensive care unit (ii) evaluate common clinically as the presence of signs and symptoms of
clinical signs of neonatal pneumonia other than pneumonia in a previously healthy neonate due to
respiratory distress; (iii) determine bacterial etiology an acute infection (of less than 14 days’ duration)
of neonatal pneumonia; and (iv) determine outcome which had been acquired in the community outside
of neonatal pneumonia. hospital.
After enrollment all neonates were subjected to
Patients and Methods
clinical assessment by: 1. History taking, including:
This prospective observational study was carried out
patient data, antenatal and perinatal history 2. Clinical
over a period of two year from July 2012 to June
examination 3. Laboratory investigations including
2014 in the neonatal intensive care unit of
complete blood count, C-reactive protein (CRP),
Bangabandhu Sheikh Mujib Medical University
blood culture, chest radiography on admission and
(BSMMU), Dhaka, Bangladesh. Ninety four neonates
repeated as required, and arterial blood gases. The
with the diagnosis of pneumonia during their hospital
babies were followed up till discharge from the
stay were enrolled consecutively. Newborn with
hospital or death. Total duration of respiratory therapy
postnatal age more than 28 days, surgical problem
and hospital stay were also documented. Data
related to the respiratory system and doubtful cases
analysis was performed using SPSS version 20
where diagnosis of pneumonia could not be
established were excluded. (SPSS, Chicago, IL). The analysis of patient
demographics and baseline outcome variables were
The baby was evaluated in between feeds and in summarized using descriptive summary measures:
quiet state. Respiratory rate was recorded for full 1 expressed as mean for numerical variables and
minute with the help of stop watch in another hand.
percent for categorical variables.
Pneumonia was diagnosed in the presence of
respiratory distress with: (a) Radiologic features Results
suggestive of pneumonia (Presence of any of the During the study period total number of admissions
following: nodular or coarse patchy infiltrates, diffuse was 1108; respiratory distress was the presenting
haziness or granularity and lobar or sub-lobar feature in 271 (24%) cases. Of the 271 cases of
consolidation) with or without Positive blood culture. respiratory distress, pneumonia was the underlying
BANGLADESH J CHILD HEALTH 2018; VOL 42 (2) : 114 Neonatal Pneumonia in NICU of a Tertiary Care Center
Table-I
Demographic variables of enrolled infants
Most common radiologic change was localized/ Mean duration of hospital stay was 13±8 and 19±8
diffuse alveolar infiltrates in more than half 58% (55/ days. Majority 76.5% (72/94) of the neonatal
94) of the newborn with pneumonia. Other findings pneumonia were cured while 5% (5/94) left against
were uni and or bilateral haziness and sublobar, lobar medical advice and 18% (17/94) died during their
consolidation in 23% (22/94) and 18% (17/94) and hospital course (Figure 2).
respectively (Figure 2 and 3).
Discussion
In this study, a total of 94 neonatal pneumonia cases
were included over two year’s duration, mean birth
weight and gestational age was 2392±854 grams and
33±3.9 weeks respectively. In this study, the mean
birth weight of pneumonia cases was lower which
was similar to the result obtained by Khattab et al.11
Also lower mean gestational age of infants with
pneumonia were documented which was in
agreement with other studies enrolled ventilator
associated pneumonia cases only.11
Overall incidence of pneumonia among admitted
neonate was 8.4%. Of infants with respiratory
distress, incidence of pneumonia was 34%. The
variable incidences were demonstrated by the earlier
studies ranging from 18.7% to 68.7%. 12-16 A study
from India showed higher incidence (68.7%) in
comparison to other reports.17
While earlier studies12-16 exclusively enrolled inborn
with respiratory distress, we aimed to figure out the
Fig.-2: Bilateral diffuse alveolar infiltration in an overall incidence among both inborn and outborn. In
enrolled preterm newborn presenting early onset
this study, the distribution of pneumonia was slightly
pneumonia
higher among outborn delivery (55% vs 45%).
The overall mortality rate in the present study was
18% which is lower than that reported from other
studies.12, 13, 17,18 Wide range of mortality rate from
8% up to 48% was reported in a review of relevant
studies done in developing countries2. Eight percent
death was reported in a study done in the emergency
department of a referral centre of India19.
In this study, near about half (40.4%) of the enrolled
neonates were having early onset pneumonia. It is
important to recognize, however, that risk factors are
often absent in babies who develop pneumonia of
early onset and prolonged rupture of membrane
(>18hours) were documented in most of the cases
(85%) of early onset pneumonia which was
comparable with the study done by Webber S et al.7
We have not been able to show clearly the etiological
agent in those babies who we thought had pneumonia
but who had negative blood cultures. Our findings
Fig.-3: Inhomogenous opacity in an enrolled preterm support the practice of many units that all neonates
newborn presenting early onset pneumonia with respiratory distress should be given antibiotics
BANGLADESH J CHILD HEALTH 2018; VOL 42 (2) : 116 Neonatal Pneumonia in NICU of a Tertiary Care Center
intravenously for at least 48 to 72 hours until the 4. Bang AT, Bang R A, Morankar V P, Sontakke P
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