Congenital Pneumonia Differential Diagnoses

  • Author: Roger G Faix, MD; Chief Editor: Ted Rosenkrantz, MD   more...
 
Updated: Mar 29, 2011
 
 

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
  • Transplacental medications
  • Vascular catheter accident
  • Other causes of airway obstruction
  • Other congenital heart diseases
  • Other inborn errors of metabolism
  • Other neuromuscular diseases

Differential Diagnoses

Proceed to Workup
 
 
Contributor Information and Disclosures
Author

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: Ikaria Consulting fee Consulting; Biosynexus Consulting fee Review panel membership

Specialty Editor Board

Steven M Donn, MD  Professor of Pediatrics, University of Michigan Medical School; Director, Division of Neonatal-Perinatal Medicine, Department of Pediatrics, CS Mott Children's Hospital, University of Michigan Health System

Steven M Donn, MD is a member of the following medical societies: American Pediatric Society

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Pharmacy Editor, eMedicine

Disclosure: Nothing to disclose.

Brian S Carter, MD, FAAP  Professor of Pediatrics (Neonatology), Vanderbilt University School of Medicine; Director, Neonatal Follow-up Program, Monroe Carell Jr Children's Hospital at Vanderbilt

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 Society for Bioethics and Humanities, American Society of Law, Medicine & Ethics, National Hospice and Palliative Care Organization, Society for Pediatric Research, and Southern Society for Pediatric Research

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 Medical Association, American Pediatric Society, Connecticut State Medical Society, Eastern Society for Pediatric Research, and Society for Pediatric Research

Disclosure: Nothing to disclose.

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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.
 
 
 
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