Current Understanding of Congenital Pneumonia

Nem-Yun Boo

Disclosures

Pediatr Health. 2008;2(5):563-569. 

In This Article

Abstract and Introduction

Abstract

Currently there is no consistent definition of congenital pneumonia. The actual incidence of this condition is unknown. Autopsy studies on preterm infants suggest that this condition is grossly under-diagnosed and a common cause of death. Bacteria, virus and fungi have been reported to be the causative organisms, with Staphylococcus epidermidis, Group B Streptococcus, Escherichia coli and Ureaplasma urealyticum being the most common. Examination of the gastric aspirate or nasopharyngeal aspirates shortly after birth, or tracheal aspirates obtained within 8 h of birth, may identify the causative organisms. Except for Gram staining and routine microbiological culture, most of the diagnostic tests are expensive. This review presents the diagnostic problems, treatment, prevention and future perspective of this condition.

Introduction

The Oxford Medical Dictionary defines the word 'congenital' as an adjective 'describing a condition that is recognized at birth or that is believed to have been present since birth'.[1] Based on this definition, congenital pneumonia is pneumonia with clinical and radiological evidence present at birth. Some authors defined it as pneumonia that is present at birth with a positive tracheal aspirate culture obtained within 4 h of delivery,[2] based on a study of Sherman et al.[3] Barton et al. found that congenital infection (presented at ≤48 h of age) was the most common (50.5%) primary cause of death in 111 extremely low birthweight infants (<1000g) on whom they carried out autopsy and examination of their placental and laboratory findings.[4] They observed that congenital infection was significantly under-diagnosed clinically, with most deaths attributed to immaturity or respiratory distress syndrome. Furthermore, they found that congenital pneumonia was the predominant type of congenital infection, affecting 53.6% of this series of extremely low birthweight infants, and that infection of the amniotic fluid leading to pneumonia was the major cause of death.

Review of the literature showed that no large population studies have been reported on the incidence of congenital pneumonia based on explicitly defined diagnostic criteria. Barnett and Klein estimated that congenital pneumonia accounted for 10-38% of stillbirths and 20-63% of liveborns who subsequently died.[5] Duke estimated that neonatal pneumonia, including congenital pneumonia, contributed globally to 750,000-1.2 million neonatal deaths annually.[6]

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