Which physical findings are characteristic of intrapartum infection-caused neonatal sepsis?

Updated: Jun 13, 2019
  • Author: Nathan S Gollehon, MD, FAAP; Chief Editor: Muhammad Aslam, MD  more...
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Answer

Neonates who are infected during the birth process may acquire pneumonia through aspiration of microorganisms from the maternal genitourinary tract during delivery. Klebsiella species and S aureus are especially likely to generate severe lung damage, producing microabscesses and empyema. Early-onset group B streptococcal (GBS) pneumonia has a particularly fulminant course, with significant mortality in the first 48 hours of life.

Intrapartum aspiration may lead to infection with pulmonary changes, infiltration, and destruction of bronchopulmonary tissue. This damage is partly due to the release of prostaglandins and leukotrienes from granulocytes. Fibrinous exudation into the alveoli leads to inhibition of pulmonary surfactant function and respiratory failure, with a presentation similar to that of RDS. Vascular congestion, hemorrhage, and necrosis may occur. Infectious pneumonia is also characterized by pneumatoceles within the pulmonary tissue.

Coughing, grunting, retractions, nasal flaring, tachypnea or irregular respiration, rales, decreased breath sounds, and cyanosis may be observed.  Infants who aspirate meconium, blood, or other proinflammatory material during labor may be symptomatic at birth, whereas infants primarily impacted by an infectious process may not show symptoms in the first hours after birth. Radiographic evaluation may demonstrate segmental or lobar atelectasis or a diffuse reticulogranular pattern, much like what is observed in RDS. Pleural effusions may be observed in advanced disease.


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