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Pneumonia in the newbown: a study of the pathology and bacteriology of 177 cases

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Date
1938
Author
MacGregor, Agnes Rose
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Abstract
 
 
An extensive review of the literature showed that a considerable amount of study has been devoted to pneumonia in the earliest days of life, but that no unanimity of opinion has been reached with regard to its usual mode of production; that relatively little attention has been paid to the types and causes of pneumonia occurring later in the neonatal period; and that knowledge of the bacteriology of all types of neonatal pneumonia is very incomplete.
 
The present investigation was based on a series of 541 necropsies performed on stillborn foetuses and liveborn infants who survived not more than 28 days.
 
Among these there were 177 cases (32.7 per cent) with acute inflammatory changes in the lungs. In 174 cases pneumonia was present; in 3 only the bronchi were inflamed.
 
The facts relative to sex, age and seasonal incidence in this series are given.
 
In the pathological study the cases are divide according to their principal pathological characters into four groups:- (1) pneumonia associated with aspiration of contents of the amniotic sac or vagina; (2) pneumonia associated with other pulmonary conditions caused by stress of birth or otherwise peculiar to the newborn; (3) bronchopneumonia and allied types (postnatal respiratory infections); and (4) septicaemia with secondary (haematogenous) involvement of the lungs.
 
The pathological features of each type are described; relevant facts from the clinical and material history, and the results of bacteriological examination are recorded; and an attempt is made to deter mine the probable method and time of infection, wheth er before or after birth.
 
It 'is, shown that congenital pneumonia certainly occurs, but proof of bacterial infection received before birth is often not obtainable. It cannot be assumed that all cases associated with aspiration of liquor amnii are examples of prenatal bacterial infection. Other possible explanations of these cases are discussed.
 
Congestion, oedema, atelectasis and haemorrhage resulting from stress of birth or otherwise, are of great importance as conditions predisposing to pneumonia in the early days of life.
 
Among postnatal respiratory tract infections the principal types are typical bronchopneumonia, due to various bacteria, and special forms caused by staphylococcal and pneumococcal infection.
 
Staphylococcal infection produces a type of pneumonia with distinctive characters, leading to widespread suppuration.
 
Pneumococcal infection, when pure, often produces a special type of pneumonia, which has some features resembling lobar pneumonia but differs in the extent and distribution of the consolidation. The term 'alveolar pneumonia' is suggested for this type.
 
Metastatic lesions in the lungs resulting from septicaemia take various forms, of which a description is given. A form that is apparently peculiar to young infants is described: a septic pleurisy followe by lymphogenous invasion of the lungs by the inflammatory process. An anatomical explanation of the oc- currence of this process only in very young subjects is offered.
 
In this series of cases pleurisy occurred with septicaemia and when pulmonary suppuration was present, but not otherwise.
 
The relation between age and pathological type of pneumonia is discussed.
 
In the bacteriological study the results of examination of 150 cases are presented.
 
The relation of the bacteriology to the pathological type of pneumonia and to the age at death is discussed.
 
An account is given of each of the types of bacteria concerned, as regards its frequency, pathogenic action and other relevant matters.
 
Tree prominent part played by organisms of the colon bacillus group is noted. They were of frequent occurrence in cases of postnatal infection, as well as in those due to infection received before or during birth. The precautions taken to avoid the fallacy of postmortem and terminal invasion by these organisms are described.
 
Observations on the bacterial flora of the mouth and throat of the newborn are recorded, and an account is given of previously published work on this subject.
 
It is concluded from this study that bacteria derived from the environment after birth are in general more important than bacteria aspirated during . birth.
 
In view of the evidence of special susceptibility in the newborn to colon bacillus infections, series of agglutination tests was carried out, in order to determine whether susceptibility could be explained by an absence of antibodies for these organisms in their blood serum.
 
It was found that agglutinins for organisms of the Bact. coli group were often present in low concentration in the blood serum of the newborn, and occasionally in higher concentration, depending upon the amount of agglutinin in the blood serum of the mother.
 
The inconsistent results obtained with different strains of the colon bacillus. group cyst doubt upon the efficacy of protection conferred by agglutinins against these organisms.
 
In the general discussion the importance of the preventive approach to the problem of neonatal pneumonia is emphasised.
 
The intimate connection between complications of labour and those types of pneumonia that prevail in the earliest days of life is indicated. The causes and effeots of atelectasis in relation to neonatal pneumonia are discussed.
 
In connection with pneumonia due to primary respiratory tract infection after birth, the significance of colon bacillus infections is discussed. The frequency of pneumonia due to these organisms is believed to indicate a special susceptibility in the newborn.
 
Further evidence of this susceptibility is found with reference to septicaemia and meningitis in the newborn.
 
A similar susceptibility is manifested towards other common organisms, notably staphylococci.
 
Possible explanations of this susceptibility are discussed.
 
In view of the special susceptibility of tile newborn to infection with common organisms that occur as commensals in older persons, the environmental conditions of newborn babies and the practice of neonatal hygiene of the highest possible standard are vitally important.
 
The truth of this contention is illustrated by a comparison of the incidence of neonatal pneumonia in two hospitals.
 
The conclusion is reached that neonatal pneumonia is to a great extent preventable. The prevention of those types that are prevalent in the earliest days is an obstetrical problem and would be in large measure achieved by the avoidance of severe foetal asphyx- ia. Cases due to postnatal infection can be prevented by strict attention to hygienic principles.
 
URI
http://hdl.handle.net/1842/35024
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