Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Congenital Pneumonia Differential Diagnoses

  • Author: Muhammad Aslam, MD; Chief Editor: Ted Rosenkrantz, MD  more...
 
Updated: Mar 02, 2016
 
 

Diagnostic Considerations

Although many cases of pneumonia diagnosed in the first 24 hours of life are infectious and benefit from targeted antimicrobial therapy, some are noninfectious.

A number of conditions may present as respiratory dysfunction in the first 24 hours of life. However, consider that a newborn with any of these conditions may have superimposed pneumonia as well. Such conditions include the following:

  • Alveolar-capillary dysplasia
  • Arrhythmia
  • Asphyxia
  • Bronchial duplication
  • Chest wall injury or anomaly
  • Choanal atresia
  • Chylothorax
  • Diaphragmatic eventration
  • Heart block
  • Intracranial hemorrhage
  • Laryngeal cleft
  • Laryngeal nerve injury
  • Mutation of ABCA3 gene (for surfactant phospholipid transport)
  • Neuromuscular disorders
  • Phrenic nerve injury
  • Pulmonary hemorrhage
  • Pulmonary hypoplasia
  • Pulmonary lymphangiectasia
  • Spinal injury
  • Surfactant-related protein B deficiency
  • Tachycardia syndromes
  • Tracheoesophageal fistula[25]
  • Transplacental medications
  • Vascular catheter accident
  • Other causes of airway obstruction
  • Other congenital heart diseases
  • Other inborn errors of metabolism
  • Other neuromuscular diseases

Differential Diagnoses

 
 
Contributor Information and Disclosures
Author

Muhammad Aslam, MD Associate Professor of Pediatrics, University of California, Irvine, School of Medicine; Neonatologist, Division of Newborn Medicine, Department of Pediatrics, UC Irvine Medical Center

Muhammad Aslam, MD is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.

Coauthor(s)

Mariam L Abdul-Latif, MD Neonatal-Perinatal Medicine Fellow, Department of Pediatrics, University of California, Irvine, School of Medicine

Mariam L Abdul-Latif, MD is a member of the following medical societies: American Academy of Pediatrics, Texas Medical Association, Texas Pediatric Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Brian S Carter, MD, FAAP Professor of Pediatrics, University of Missouri-Kansas City School of Medicine; Attending Physician, Division of Neonatology, Children's Mercy Hospital and Clinics; Faculty, Children's Mercy Bioethics Center

Brian S Carter, MD, FAAP is a member of the following medical societies: Alpha Omega Alpha, American Academy of Hospice and Palliative Medicine, American Academy of Pediatrics, American Pediatric Society, American Society for Bioethics and Humanities, American Society of Law, Medicine & Ethics, Society for Pediatric Research, National Hospice and Palliative Care Organization

Disclosure: Nothing to disclose.

Chief Editor

Ted Rosenkrantz, MD Professor, Departments of Pediatrics and Obstetrics/Gynecology, Division of Neonatal-Perinatal Medicine, University of Connecticut School of Medicine

Ted Rosenkrantz, MD is a member of the following medical societies: American Academy of Pediatrics, American Pediatric Society, Eastern Society for Pediatric Research, American Medical Association, Connecticut State Medical Society, Society for Pediatric Research

Disclosure: Nothing to disclose.

Acknowledgements

Roger G Faix, MD Professor, Department of Pediatrics (Neonatology), University of Utah School of Medicine

Roger G Faix, MD is a member of the following medical societies: American Academy of Pediatrics, American Pediatric Society, American Society for Microbiology, National Perinatal Association, Society for Pediatric Research, and Utah Medical Association

Disclosure: Nothing to disclose.

References
  1. Barton L, Hodgman JE, Pavlova Z. Causes of death in the extremely low birth weight infant. Pediatrics. 1999 Feb. 103(2):446-51. [Medline].

  2. Duke T. Neonatal pneumonia in developing countries. Arch Dis Child Fetal Neonatal Ed. 2005 May. 90(3):F211-9. [Medline].

  3. Heron MP, Smith BL. Deaths: leading causes for 2003. Natl Vital Stat Rep. 2007 Mar 15. 55(10):1-92. [Medline].

  4. Nissen MD. Congenital and neonatal pneumonia. Paediatr Respir Rev. 2007 Sep. 8(3):195-203. [Medline].

  5. Feria-Kaiser C, Furuya ME, Vargas MH, Rodriguez A, Cantu MA,. Main diagnosis and cause of death in a neonatal intensive care unit: do clinicians and pathologists agree?. Acta Paediatr. 2002. 91(4):453-8. [Medline].

  6. Barnett ED, Klein JO. Bacterial infections of the respiratory tract. Remington JS, Klein JO, eds. Infectious Diseases of the Fetus and Newborn Infant. 6th ed. Philadelphia, Pa: Elsevier Saunders Co; 2006. 297-317.

  7. Bone RC, Grodzin CJ, Balk RA. Sepsis: a new hypothesis for pathogenesis of the disease process. Chest. 1997 Jul. 112(1):235-43. [Medline].

  8. Stoll BJ, Hansen NI, Higgins RD, et al. Very low birth weight preterm infants with early onset neonatal sepsis: the predominance of gram-negative infections continues in the National Institute of Child Health and Human Development Neonatal Research Network, 2002-2003. Pediatr Infect Dis J. 2005 Jul. 24(7):635-9. [Medline].

  9. Srinivasjois RM, Kohan R, Keil AD, Smith NM. Congenital Mycoplasma pneumoniae pneumonia in a neonate. Pediatr Infect Dis J. 2008 May. 27(5):474-5. [Medline].

  10. Kotecha S, Hodge R, Schaber JA, et al. Pulmonary Ureaplasma urealyticum is associated with the development of acute lung inflammation and chronic lung disease in preterm infants. Pediatr Res. 2004 Jan. 55(1):61-8. [Medline].

  11. Katz B, Patel P, Duffy L, Schelonka RL, Dimmitt RA, Waites KB. Characterization of ureaplasmas isolated from preterm infants with and without bronchopulmonary dysplasia. J Clin Microbiol. 2005 Sep. 43(9):4852-4. [Medline].

  12. Heggie AD, Bar-Shain D, Boxerbaum B, Fanaroff AA, O'Riordan MA, Robertson JA. Identification and quantification of ureaplasmas colonizing the respiratory tract and assessment of their role in the development of chronic lung disease in preterm infants. Pediatr Infect Dis J. 2001 Sep. 20(9):854-9. [Medline].

  13. Ballard HO, Bernard P, Whitehead V, et al. Determining the incidence of Ureaplasma spp. and its role in development of bronchopulmonary dysplasia. [Abstract 3858.111]. Pediatric Academic Societies Meeting 2009. Baltimore, MD. May 3, 2009. aps-spr.org. Available at www.abstracts2view.com/pas/view.php?nu=PAS09L1_3037. Accessed: June 11, 2009.

  14. Morioka I, Fujibayashi H, Enoki E, Yokoyama N, Yokozaki H, Matsuo M. Congenital pneumonia with sepsis caused by intrauterine infection of Ureaplasma parvum in a term newborn: a first case report. J Perinatol. 2010 May. 30(5):359-62. [Medline].

  15. Fischer C, Meylan P, Bickle Graz M, et al. Severe postnatally acquired cytomegalovirus infection presenting with colitis, pneumonitis and sepsis-like syndrome in an extremely low birthweight infant. Neonatology. 2010 Jun. 97(4):339-45. [Medline].

  16. Sanchez MO, Chang AB. Congenital rubella pneumonitis complicated by Pneumocystis jiroveci infection with positive long term respiratory outcome: a case report and literature review. Pediatr Pulmonol. 2009 Dec. 44(12):1235-9. [Medline].

  17. Chang JH, Huang YL, Chen CC, Li SY. Vertical transmission of Neisseria gonorrhoeae to a female premature neonate with congenital pneumonia. J Formos Med Assoc. 2013 Oct. 112(10):648-9. [Medline].

  18. Hermoso Torregrosa C, Carrasco Zalvide M, Ferrer Castillo MT. Streptococcus pneumoniae: an unusual pathogen in neonatal sepsis of vertical transmission. Arch Bronconeumol. 2012 Nov. 48(11):425-6. [Medline].

  19. Patel S, DeSantis ER. Treatment of congenital tuberculosis. Am J Health Syst Pharm. 2008 Nov 1. 65(21):2027-31. [Medline].

  20. Varik RS, Shubha AM, Lewin M, Alexander B, Kini U, Das K. Infantile pulmonary tuberculosis: the great mimic. Pediatr Surg Int. 2012 Jun. 28(6):627-33. [Medline].

  21. Wang SM, Hsu CH, Chang JH. Congenital candidiasis. Pediatr Neonatol. 2008 Jun. 49(3):94-6. [Medline].

  22. Iqbal Q, Younus MM, Ahmed A, et al. Neonatal mechanical ventilation: Indications and outcome. Indian J Crit Care Med. 2015 Sep. 19 (9):523-7. [Medline].

  23. Chen CH, Wen HJ, Chen PC, Lin SJ, Chiang TL, Hsieh IC. Prenatal and postnatal risk factors for infantile pneumonia in a representative birth cohort. Epidemiol Infect. 2012 Jul. 140(7):1277-85. [Medline].

  24. Boo NY, Cheah IG. Risk factors associated with necrotising enterocolitis in very low birth weight infants in Malaysian neonatal intensive care units. Singapore Med J. 2012 Dec. 53(12):826-31. [Medline].

  25. Puri A, Yadav PS, Saha U, Singh R, Chadha R, Choudhary SR. A case series study of therapeutic implications of Type IIIb4: A rare variant of esophageal atresia and distal tracheoesophageal fistula. J Pediatr Surg. 2013 Jul. 48(7):1463-9. [Medline].

  26. Haney PJ, Bohlman M, Sun CC. Radiographic findings in neonatal pneumonia. AJR Am J Roentgenol. 1984 Jul. 143(1):23-6. [Medline].

  27. Wiswell TE, Baumgart S, Gannon CM, Spitzer AR. No lumbar puncture in the evaluation for early neonatal sepsis: will meningitis be missed?. Pediatrics. 1995 Jun. 95(6):803-6. [Medline].

  28. Sherman MP, Goetzman BW, Ahlfors CE, Wennberg RP. Tracheal aspiration and its clinical correlates in the diagnosis of congenital pneumonia. Pediatrics. 1980 Feb. 65(2):258-63. [Medline].

  29. Giacoia GP, Neter E, Ogra P. Respiratory infections in infants on mechanical ventilation: the immune response as a diagnostic aid. J Pediatr. 1981 May. 98(5):691-5. [Medline].

  30. Chaaban H, Singh K, Huang J, Siryaporn E, Lim YP, Padbury JF. The role of inter-alpha inhibitor proteins in the diagnosis of neonatal sepsis. J Pediatr. 2009 Apr. 154(4):620-622.e1. [Medline].

  31. Gokdemir Y, Cakir E, Kut A, Erdem E, Karadag B, Ersu R, et al. Bronchoscopic evaluation of unexplained recurrent and persistent pneumonia in children. J Paediatr Child Health. 2013 Mar. 49(3):E204-7. [Medline].

  32. Gauvin F, Dassa C, Chaibou M, et al. Ventilator-associated pneumonia in intubated children: comparison of different diagnostic methods. Pediatr Crit Care Med. 2003 Oct. 4(4):437-43. [Medline].

  33. Gauvin F, Lacroix J, Guertin MC, et al. Reproducibility of blind protected bronchoalveolar lavage in mechanically ventilated children. Am J Respir Crit Care Med. 2002 Jun 15. 165(12):1618-23. [Medline].

  34. Labenne M, Poyart C, Rambaud C, et al. Blind protected specimen brush and bronchoalveolar lavage in ventilated children. Crit Care Med. 1999 Nov. 27(11):2537-43. [Medline].

  35. Klein JO. Diagnostic lung puncture in the pneumonias of infants and children. Pediatrics. 1969 Oct. 44(4):486-92. [Medline].

  36. Wigglesworth JS. Perinatal Pathology. 2nd ed. Philadelphia, Pa: WB Saunders Co; 1996. 131-57, 184-7.

  37. Wynn JL, Neu J, Moldawer LL, Levy O. Potential of immunomodulatory agents for prevention and treatment of neonatal sepsis. J Perinatol. 2009 Feb. 29(2):79-88. [Medline].

  38. Ballard HO, Bernard P, Hayes D, et al. Use of azithromycin for the prevention of bronchopulmonary dysplasia: a randomized, double-blind, placebo controlled trial. [Abstract 4515.2]. Pediatric Academic Societies Meeting 2009. Baltimore, MD. May 4, 2009. aps-spr.org. Available at www.abstracts2view.com/pas/view.php?nu=PAS09L1_3053. Accessed: June 11, 2009.

  39. Ballard HO, Bernard P, Whitehead V, et al. Use of azithromycin for the early treatment of Ureaplasma spp. in preterm infants: a randomized, double-blind, placebo controlled trial. [Abstract 4515.3]. Pediatric Academic Societies Meeting 2009. Baltimore, MD. May 4, 2009. aps-spr.org. Available at www.abstracts2view.com/pas/view.php?nu=PAS09L1_3037. Accessed: June 11, 2009.

  40. Clark RH, Bloom BT, Spitzer AR, Gerstmann DR. Empiric use of ampicillin and cefotaxime, compared with ampicillin and gentamicin, for neonates at risk for sepsis is associated with an increased risk of neonatal death. Pediatrics. 2006 Jan. 117(1):67-74. [Medline].

  41. de Man P, Verhoeven BA, Verbrugh HA, Vos MC, van den Anker JN. An antibiotic policy to prevent emergence of resistant bacilli. Lancet. 2000 Mar 18. 355(9208):973-8. [Medline].

  42. Braude AC, Hornstein A, Klein M, Vas S, Rebuck AS. Pulmonary disposition of tobramycin. Am Rev Respir Dis. 1983 May. 127(5):563-5. [Medline].

  43. Pennington JE. Penetration of antibiotics into respiratory secretions. Rev Infect Dis. 1981 Jan-Feb. 3(1):67-73. [Medline].

  44. Harding JE, Miles FK, Becroft DM, et al. Chest physiotherapy may be associated with brain damage in extremely premature infants. J Pediatr. 1998 Mar. 132(3 Pt 1):440-4. [Medline].

  45. van Kaam AH, Lachmann RA, Herting E, et al. Reducing atelectasis attenuates bacterial growth and translocation in experimental pneumonia. Am J Respir Crit Care Med. 2004 May 1. 169(9):1046-53. [Medline].

  46. Chowdhury O, Wedderburn CJ, Lee S, Hannam S, Greenough A. Respiratory support practices in infants born at term in the United Kingdom. Eur J Pediatr. 2012 Nov. 171(11):1633-8. [Medline].

  47. Carnielli VP, Zimmermann LJ, Hamvas A, Cogo PE. Pulmonary surfactant kinetics of the newborn infant: novel insights from studies with stable isotopes. J Perinatol. 2009 May. 29 Suppl 2:S29-37. [Medline].

  48. Keiser A, Bhandari V. The role of surfactant therapy in nonrespiratory distress syndrome conditions in neonates. Am J Perinatol. 2016 Jan. 33 (1):1-8. [Medline].

  49. Herting E, Gefeller O, Land M, et al. Surfactant treatment of neonates with respiratory failure and group B streptococcal infection. Members of the Collaborative European Multicenter Study Group. Pediatrics. 2000 Nov. 106(5):957-64; discussion 1135. [Medline].

  50. Herting E, Sun B, Jarstrand C, et al. Surfactant improves lung function and mitigates bacterial growth in immature ventilated rabbits with experimentally induced neonatal group B streptococcal pneumonia. Arch Dis Child Fetal Neonatal Ed. 1997 Jan. 76(1):F3-8. [Medline].

  51. [Guideline] Engle WA. Surfactant-replacement therapy for respiratory distress in the preterm and term neonate. Pediatrics. 2008 Feb. 121(2):419-32. [Medline]. [Full Text].

  52. NINOSG. Inhaled nitric oxide in full-term and nearly full-term infants with hypoxic respiratory failure. The Neonatal Inhaled Nitric Oxide Study Group. N Engl J Med. 1997 Feb 27. 336(9):597-604. [Medline].

  53. ECMO. UK collaborative randomised trial of neonatal extracorporeal membrane oxygenation. UK Collaborative ECMO Trail Group. Lancet. 1996 Jul 13. 348(9020):75-82. [Medline].

  54. IELSO. 1999 Summary Report of the Registry for International Extracorporeal Life Support Organization. 1999. 1-10.

  55. AAP. Red Book. Available at http://aapredbook.aappublications.org/. Accessed: November 18, 2010.

  56. Wiswell TE, Gannon CM, Jacob J, Goldsmith L, Szyld E, Weiss K, et al. Delivery room management of the apparently vigorous meconium-stained neonate: results of the multicenter, international collaborative trial. Pediatrics. 2000 Jan. 105(1 Pt 1):1-7. [Medline].

  57. Guzoglu N, Demirkol FN, Aliefendioglu D. Haemorrhagic pneumonia caused by Stenotrophomonas maltophilia in two newborns. J Infect Dev Ctries. 2015 May 18. 9(5):533-5. [Medline].

  58. Hermansen CL, Mahajan A. Newborn respiratory distress. Am Fam Physician. 2015 Dec 1. 92 (11):994-1002. [Medline].

Previous
Next
 
Anteroposterior chest radiograph in an infant born at 28 weeks' gestation was performed following apnea and profound birth depression. Subtle reticulogranularity and prominent distal air bronchograms were consistent with respiratory distress syndrome, prompting exogenous surfactant and antimicrobial therapy. Initial smear of endotracheal aspirate revealed few neutrophils but numerous, small, gram-negative coccobacilli. Culture of blood and tracheal aspirate yielded florid growth of nontypeable Haemophilus influenzae.
Full-term infant (note ossified proximal humeral epiphyses, consistent with full term) with progressive respiratory distress from birth following delivery to a febrile mother through thick, particulate, meconium-containing fluid and recovery of copious meconium from the trachea. Right clavicle is fractured without displacement. Note the coarse dense infiltrates obscuring the cardiothymic silhouette bilaterally with superimposed prominent air bronchograms. Listeria monocytogeneswas recovered from the initial blood culture.
Patchy infiltrates most prominent along left cardiothymic margin in a full-term infant (note proximal humeral ossific nuclei) born to an afebrile woman 18 hours after membranes ruptured. The infant was initially vigorous but developed gradual onset of progressive respiratory distress beginning at 2 hours and prompting endotracheal intubation and transfer to a tertiary center at age 10 hours. Note blunting of the right costophrenic angle, a thin radiodense rim along the lateral right hemithorax, and a fluid line in the right major fissure, all consistent with pleural effusion. Gram staining of pleural fluid recovered at thoracentesis indicated occasional gram-negative bacilli. Tracheal aspirate, pleural fluid, and blood all yielded Escherichia coliupon culture. The dense right upper lobe may appear to suggest lobar infiltrate, but upward bowing of the fissure is more suggestive of volume loss, as in atelectasis, than the bulging picture expected with dense pneumonic change. This lobe appeared normal and appropriately inflated on a subsequent film 2 hours later, also suggestive of atelectasis. Umbilical venous catheter and endotracheal tube were positioned properly on the follow-up film.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.