RESPIRATORY CONDITIONS
Congenital Pneumonia
A practical guide for paediatric registrars · Early-onset (congenital) pneumonia in the newborn
COVER FOR SEPSIS
WHEN IN DOUBT
Ascending / intrapartum infection
Organisms reach the lung in utero (ascending from the genital tract) or during passage through the birth canal. The core event.
Inflammatory lung injury
Infection triggers inflammation, alveolar exudate and surfactant dysfunction.
Impaired gas exchange
Consolidation and oedema cause hypoxaemia, hypercapnia and increased work of breathing.
Systemic sepsis
The same infection causes bacteraemia and sepsis - shock, poor perfusion and multi-organ effects.
PPHN risk
Severe pneumonia, especially GBS, can trigger persistent pulmonary hypertension.
🩺CLINICAL FINDINGS
- Respiratory distress: tachypnoea, grunting, flaring, recession, cyanosis - often indistinguishable from RDS/TTN
- Temperature instability, lethargy, poor feeding
- Tachycardia, poor perfusion, hypotension if septic
- Apnoea (especially preterm)
- Maternal risk factors in the history (PROM, GBS, chorioamnionitis)
- A term infant with an "RDS-like" picture is pneumonia until proven otherwise
🔬INVESTIGATIONS
- CXR: variable - may mimic RDS or TTN, be patchy/asymmetric, or normal
- Sepsis screen: FBC, CRP (serial), blood culture before antibiotics
- ABG: hypoxaemia ± acidosis
- Pre/post-ductal SpO₂ (assess for PPHN)
- Consider LP if sepsis is confirmed or strongly suspected
- Maternal history and GBS status; surface/placental swabs
🚩COMPLICATIONS & RED FLAGS
- Septic shock and DIC
- PPHN; air leak if ventilated
- Meningitis (especially GBS)
- Red flags: a "term RDS" picture, septic features or GBS risk factors - start antibiotics promptly
Add a de-identified CXR here
The film is variable: it may mimic RDS (diffuse granular/ground-glass), resemble TTN (perihilar streaking, effusions), show patchy asymmetric infiltrates, or be normal. Correlate with the clinical picture and risk factors - a term infant with an "RDS-like" film should be treated as pneumonia.
MANAGEMENT
Treat first, confirm later - antibiotics and supportive care, then de-escalate once cultures and the clinical course allow.
Antibiotics First
- Take a blood culture, then start empiric IV antibiotics promptly - typically benzylpenicillin (or ampicillin) + gentamicin per local protocol
- Don't delay antibiotics for imaging if sepsis is suspected
- Review at 36-48h: stop if cultures are negative and the baby is well; complete a course if confirmed or strongly suspected
- Broaden/adjust cover for meningitis or specific organisms as indicated
Respiratory & Supportive
- Oxygen to target SpO₂; escalate CPAP → ventilation; HFOV/surfactant in severe disease
- Maintain perfusion and BP - fluids, inotropes for shock
- Thermoregulation, glucose, minimal handling
- Watch for and treat PPHN (gentle ventilation, iNO if needed)
Prevent & Screen
- Antenatal GBS screening and intrapartum prophylaxis reduce early-onset GBS disease
- Use a structured early-onset sepsis risk assessment (risk factors + exam ± EOS calculator) to guide screening
- Document and hand over maternal risk factors
How do you distinguish congenital pneumonia from RDS and TTN in the first hours - and why does it matter less than you'd think for initial management?
What is your empiric antibiotic choice, and when do you stop?
How do GBS screening and intrapartum prophylaxis change early-onset disease?
When would you perform a lumbar puncture?
Take-home message: Congenital (early-onset) pneumonia is a lung infection acquired before or during birth - most often GBS - that looks just like RDS or TTN. Because you can't reliably tell them apart and it sits within the early-onset sepsis spectrum, take a sepsis screen and start empiric antibiotics promptly, then stop at 36-48h if cultures are negative and the baby is well. Support breathing and perfusion, watch for PPHN, and prevent disease through GBS screening and intrapartum prophylaxis.
For educational purposes only. Always align management to current ANZCOR/NRP guidelines and your local SCN/NICU or NETS protocols.