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Dr Amita Pandey
Professor, Deptt of Obs & Gyn,
K G Medical University, Lucknow
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Statistics
Pneumonia & diarrhoea are the greatest killers ofchildren under 5 globally accounting for one in fourdeaths
Incidence of pneumonia in children under five isestimated to be about 156 million new episodes eachyear worldwide, of which 151 million are in thedeveloping countries
With 2,97,114 deaths, India tops of the list of thesecountries
WHO estimates that death due to pneumoniaoccurs in 1 in 3 cases
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Mortality due to childhood
pneumonia
Strongly linked to
- malnutrition- poverty
- inadequate access to health care
In India disease more frequently seen in rural andurban poor
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Types of Neonatal Pneumonia
Infective
- GBS
- Hemophilus influenzae- Enterococci
- Other Gram negative cocci
- Staph aureous
Non-infective- Diffuse alveolar damage
- Non-specific interstitial pneumonia
- Aspiration
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Source of Infection in Neonates
Trans-placental
Acquired during pregnancy from overt or subclinical maternalinfection
Intra-partum/ AscendingAcquired during delivery by passage through an infected birthcanal or by ascending infection if delivery is delayed afterrupture of membranes
Post-partum
Acquired after delivery from contact with an infected motherdirectly (eg, TB ) or through breastfeeding (eg, HIV, CMV) orfrom contact with health care practitioners & hospitalenvironment
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Risk factors for Neonatal Pneumonia Preterm labor
PROM > 18 hrs
Chorio-amnionitis in mother Maternal genito-urinary infection
Recurrent maternal urinary tract infection
Antenatal infections in mother known to transmittransplacentally
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Other contributing factors Malnutrition
Vitamin deficiency
Illiteracy of mothers resulting in unhygienic & unhealthypractices
Unhygienic living spaces
Bad health planning
Low budgetary allocation for health
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Neonatal Pneumonia- Pathophysiology
Limited defense in fetus leads to early dissemination of
infection
Infection causes infiltration & destruction ofbronchopulmonary tissue
Fibrinous exudation into alveoli leads to inhibition of
pulmonary surfactant function & respiratory failure
Presentation very similar to respiratory distress syndrome(RDS) & differentiating the two in a premature baby can
be very difficult
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Types of Neonatal Pneumonia
Early onset (3 days)
Usually acquired from the
environment
More likely in preterm
infants, particularly those
with prolonged
hospitalization & use of IVcatheters
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Signs & Symptoms
Elevated respiratory rate
Retraction
Grunting
Nasal flaring
Poor feeding
Abdominal distention
Increased secretion in airways
Central cyanosis
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Investigations
CBC
Chest X-ray
Blood culture
Inflammation markers- CRP, cytokines
Arterial blood gases
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Goals of Therapy Eradicate infection
Provide adequate support of gaseous exchange to ensure
survival and well being of infant
Decrease long lasting lung changes that adversely affect
lung function, quality of life & susceptibility to future
infections
Parenteral nutritional support
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Morbidity following Neonatal
Pneumonia Chronic lung disease
Prolonged need for respiratory support
Childhood otitis media
Reactive airway disease
Severity of subsequent childhood respiratory infections
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Mortality following Neonatal Pneumonia Mortality rate of early-onset sepsis is 3 to 40%
Mortality of late-onset sepsis is 2 to 20% (that of late-
onset GBS is about 2%)
Fatality rate is 2 to 4 times higher in LBW infants than in
full-term infants
Extremely LBW infants who develop sepsis have a
significantly greater risk of poor
outcome
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Prevention and Control of Pneumonia
Vaccination (Streptococcus pneumoniae & HIB)
Access to care & use of antibiotics- appropriate facility for
case management in CHC
Exclusive breastfeeding for first 6 months of life
Control of indoor air pollution and provision of a healthy
environment
Prevention of exposure to tobacco smoke
Educate parents about hand washing & prevention of
future exposure
Longitudinal surveillance with future problems
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Prevention and Control of Pneumonia
(contd.)
Improvement in maternal nutrition & prevention of lowbirth weight
Aggressive management of preterm labor Consider intrapartum chemoprophylaxis in mothers at
risk for GBS infection
Antepartum & intrapartum antibiotics in mothers with
PROM & chorioamnionitis Prevention and management of HIV infection
In case of meconium aspiration, suction of tracheaimmediately after birth
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Prevention and Control of Pneumonia
(contd.) Proper care of infant
Pneumococcal & infuenza immunization
Immunoglobulins
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Thank you