Neonatal Pneumonia: Causes, Symptoms, Treatment

If your newborn is suffering from neonatal pneumonia, check out below its causes, symptoms and treatment.


Neonatal pneumonia occurs when germs (bacteria, viruses, fungi or parasites) enter the neonate from the nursery or the maternal genital tract. Such bacteria include gram-positive cocci like Staphylococcus aureus, and gram-negative bacilli like Escherichia coli, Proteus sp., Klebsiella sp.

Other bacteria like Pseudomonas, Bacillus, Citrobacter and Serratia may enter infants through broad-spectrum antibiotics. 

Responsible viruses include influenza virus (flu), adenoviruses, respiratory syncytial virus (RSV), rhinovirus and parainfluenza virus.


Very fast breathing (with wheezing or grunting sounds) and breathing difficulties are sometimes, the only symptom.

  • Neonates with pneumonia caused by bacteria commonly fall sick rapidly, beginning with a sudden high fever and extremely fast breathing.
  • Neonates with pneumonia caused by viruses develop the symptoms more slowly with less severity but wheezing may be more common.  

Other possible symptoms include:

  • Stuffy nose
  • Cough
  • Fever
  • Shaking chills
  • Chest pain
  • Vomiting
  • Abdominal pain (due to coughing and breathing difficulties)
  • Poor feeding that may cause dehydration
  • Less activity
  • In severe cases, greyish or bluish colour of the fingernails and lips

Late-onset hospital-acquired pneumonia leads to unusual worsening of the neonate’s respiratory condition and, more quantities with changed quality of respiratory secretions (such as thick and brown). Newborns may fall severely ill, with neutropenia and unstable temperature.

Pneumonia because of chlamydia can cause ‘pink-eye’ (conjunctivitis) with no fever and mild weakness.

Pneumonia because of whooping cough (pertussis) may cause long coughing spells, blueness due to lack of air, or ‘whoop’ sounds on trying to breathe.


Neonatal pneumonia usually requires hospital treatment if it causes breathing problems and a long-lasting high fever, or if the neonates:

  • Require oxygen therapy
  • Get a lung infection which might have spread to the bloodstream
  • Vomit too much to take medicine by mouth
  • Suffer a chronic disease which affects the immune system
  • Develop whooping cough
  • Keep getting pneumonia

Hospital treatment may include:

  • Intravenous (IV) antibiotics (administered into the vein through a needle)
  • Respiratory therapy (breathing treatments)
  • Treatment in the Intensive Care Unit (ICU) in more critical cases

Neonatal pneumonia caused by viruses

Here, antibiotics are not required. Antiviral medicines are now available but are reserved for the flu in early-onset pneumonia.

 Neonatal pneumonia caused by bacteria

Its treatment includes:

  • In early-onset pneumonia, antibiotics are given orally at home. This antimicrobial therapy is similar to that for neonatal sepsis.
  • For most hospital-acquired late-onset pneumonia, the primary treatment of choice includes Vancomycin along with a broad-spectrum beta-lactam drug, like tazobactam/piperacillin, meropenem, or cefepime. This regimen treats pneumonia (and sepsis too) with the typical hospital-acquired pathogens like P. aeruginosa.

Local patterns of bacterial resistance and infection must always be employed to help conduct empiric choices of antimicrobials. After receiving the sensitivity results, more definite antibiotics are substituted.

Chlamydial pneumonia

It’s treated with either of the following:

  • Erythromycin (for 14 days)
  • Azithromycin (for 3 days)

A newborn treated with erythromycin or azithromycin must be monitored for signs of Hypertrophic Pyloric Stenosis (HPS).

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