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Neumonía Neonatal
R2 Zapata López Arturo
ManuelINSN
13/02/2013
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Generalidades
• 00 000 muertes neonatales de!idasa in"e##iones respiratorias$
• Mas del %0& de las muertesneonatales o#urren en países en'(ías de desarrollo)$
• *na serie de autopsias de 1+00muertes neonatales , +-rs. 203&tu(ieron Neumonía$
Neonatal pneumonia in developing countries, Arch. Dis. Child. FetalNeonatal Ed. 2008;90;2!29
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eni#ión
• No -a #onsenso$
• MS. In"e##ión pulmonar#onsiderada dentro del espe#tro deSepsis Neonatal4 #on si5nos #líni#osinespe#í#os 6superpuestos a otrotipo de in"e##iones74 8ue se presenta
en los primeros 2 dias de (ida$
Neonatal pneumonia in developing countries, Arch. Dis. Child. FetalNeonatal Ed. 2008;90;2!29
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9lasi#a#ión
Temprana/Precoz
• 9ontro(ersial. +:2-rs :dias$
• Mas GRAM ;
• Men#ión espe#ial .Neumonia Intrauterina
Tardia/Nosocomial
• 9ontro(ersial. <:2-rs < :dias$
• Mas GRAM =6+>:>&7
Neonatal pneumonia in developing countries, Arch. Dis. Child. FetalNeonatal Ed. 2008;90;2!29
Antimicrobial Therapy and Late Onset Sepsis, Neoreviews202!"!e#$
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Neumonía Intrauterina
• Su!5rupo dentro de Neumonía ?re#oz$
• Al na#er. Ap5ar @ao4 SR modse($BCepatoesplenome5alia4 Drom!o#itopenia4I#teri#iaB$
• Ante#edente. 9orioamnionitis$ R?M <
1-rs4 Madre DR9C4 Listeria4 D@94 CIE$
• Eia Dranspla#entaria o Aspirati(a$
Neonatal pneumonia in developing countries, Arch. Dis. Child. FetalNeonatal Ed. 2008;90;2!29
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?ato5enia. Me#anismos de In"e##ión
• Dranspla#entario. 5eneralmente(iremias maternas4 raro !a#terias$
• In-alatoria/ Aspirati(a . Li8uidoamnioti#o4 prenatal o intraparto$
• Cemató5ena. a partir de otro "o#o$
Neumonía neonatal4 A#ta ?ediatr Fsp$ 200 HH6107. +1+H
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a#tores de Ries5o. Neumonía?re#oz
• Ries5o MAJR de Sepsis ?re#oz.
• R?M< 1-rs$
• 9oriamnionitis$• ?arto ?retKrmino$
Mana5ement o" Neonates it- Suspe#ted or ?ro(en Farlnset @a#terialSepsis4 Pediatrics 2012;129;1006
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Ftiolo5ía ?re#oz
• Strepto#o#o A5ala#tiae
• F$ 9oli
•
le!siella• Listeria Mono#ito5enes
• B9-lamdia D$B6presenta#ión Dardía7
•
B*reaplasma *$B6aso#iado a en"ermedadpulmonar #róni#a$7
• M#oplasma C$
Neumonía neonatal4 A#ta ?ediatr Fsp$ 200 HH6107. +1+H
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Ftiolo5ia Dardía
• ?seudomona A$
• 9andida
•
Serratia• ?roteus
• Stalo#o#o Aureus
•
Caemop-ilus• 9-lamdia D$
Neumonía neonatal4 A#ta ?ediatr Fsp$ 200 HH6107. +1+H
%espiratory &istress in the Term and Near'term (n)ant, Neoreviews
2005;6;e289
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Antimicrobial Therapy and Late Onset Sepsis, Neoreviews202!"!e#$
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Ftiolo5ía. EIR*S
• Cerpes
• 9ME
• Ru!eola
•
Eari#ela• Grupo F9C
• ESR
• Inuenza
• Adeno(irus
• Metapneumo(irus
• CIE
Neumonía neonatal4 A#ta ?ediatr Fsp$ 200 HH6107. +1+H
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9líni#a
• i#ultad respiratoria de Grado(aria!le$
• Si5nos 9líni#os de Sepsis Neonatal
• Lesiones de piel6pustulas4 on"alitis7
•
Cepatoesplenome5alia• lin"adenopatias
• 9onunti(itis Dardia
Neumonía neonatal4 A#ta ?ediatr Fsp$ 200 HH6107. +1+H
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Sensi!ilidad & de si5nos paraNeumonia #on #am!io Radio5rO#o$
Neonatal pneumonia in developing countries, Arch. Dis. Child. FetalNeonatal Ed. 2008;90;2!29
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ia5nósti#o
• Cistoria perinatal #ompleta$
• FPamen "ísi#o
• Ima5en
• La!oratorio. Cemo#ulti(o4Cemo5rama4 ?9R$
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Radio5raa
•
9am!ios a + :2 -rs$6 Su normalidad no eP#lueel dia5nósti#o4 se interpreta #on la #lini#a7$
• B?atrones S*GFSDIESB.
• Eidrio deslustrado !ron#o5rama. Strepto#o#o
• Intersti#ial di"uso !ilateral. 9-lamdia D$
• Neumato#eles4 A!s#esos4 empiema. Stalo#o#o
A$
Neumonía neonatal4 A#ta ?ediatr Fsp$ 200 HH6107. +1+H
%espiratory &istress in the Term and Near'term (n)ant, Neoreviews
2005;6;e289
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%espiratory &istress in the Term and Near'term (n)ant, Neoreviews
??ADRNFS RAIGRAI9S J ?SI@LF?ADLGIA
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Cemo5rama• ?o!re E?? para Sepsis Demprana$
• Indi#es 6I/D7. *tiles para FP#luir In"e##ión$
• I/D,0$22 en RN?D4 ,0$2: RND4 E?? 2>&4 E?N%%&$
• Neutropenia es mas espe#í#a 8ue Neutrolia$6 RND, 100 mm3 al na#er4 RND, :00mm3 a 121+-rs7$
• ?la8uetas. ?o#o espe#i#as4 po#o sensi!les4tardías4 demoran en re#uperarse$
Mana5ement o" Neonates it- Suspe#ted or ?ro(en Farlnset @a#terialSepsis4 Pediatrics 2012;129;1006
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Cemo#ulti(o• %20& ?ositi(os$
•
23& ?a#ientes #on @a#teremia tienen MF9$• Cemo#ulti(o67 3& de ?a#ientes #on MF9$
• Indi#a#iones$
• Cemo#ulti(o =• eterioro 9lini#o / La!oratorial
• Mala e(olu#ion a pesar de #o!ertura AD@$
Mana5ement o" Neonates it- Suspe#ted or ?ro(en Farlnset @a#terialSepsis4 Pediatrics 2012;129;1006
?un#ión Lum!ar
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i lt d R i t i ? i!l
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i#ultad Respiratoria. ?osi!les9ausas$
%espiratory &istress in the Term and Near'term (n)ant, Neoreviews
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Dratamiento
•
Fmpíri#o INI9IAL ante la sospe#-a$
• ?auta de Sepsis ?re#oz. ?eni#ilina =
Amino5li#osido$6se5Qn F$G4 Coras de(ida7
•
?auta de Sepsis Dardía. Se5Qn el perlmi#ro!ioló5i#o sensi!ilidad$6 Ean#omi#ina = Amino5li#osido7
Neumonía neonatal4 A#ta ?ediatr Fsp$ 200 HH6107. +1+H
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uture ire#tions in t-e F(aluation and Mana5ement o" Neonatal Sepsis,Neoreviews 202! 13e103
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?ronósti#o
• Fn "un#ión a la edad 5esta#ional4peso al na#er4 #omor!ilidades45ermenes4 maneo ini#ial4 tiempo de
apari#ión6pre#oz4 tardía74 ausen#iade ta8uipnea$
• Strepto#o#o del 5rupo @ mortalidad0& en las primeras + -rs$
Neumonía neonatal4 A#ta ?ediatr Fsp$ 200 HH6107. +1+H
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?ronosti#o a #orto plazo en un#ión alA5ente Ftioló5i#o
"ate!onset #epsis$ Epidemiolog%, Evaluation, and &utcome,
Neorevie's 200;;e(2)
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?rolaPis
• ?ara e(itar Sepsis Neonatal ?re#ozSG@$
• Ampi#ilina4 ?eni#ilina + -rs antes delparto$
Neumonía neonatal A#ta ?ediatr Fsp 200 HH6107. +1 +H