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neonates born to mothers not previously exposed to pertussis or with inadequate
vaccination. These neonates will not have passive immunity from maternal
antibodies. It can present either as an early- or late-onset pneumonia after contact
with an infected family member or sibling.
Neonates with pneumonia present with respiratory distress and increase in
nasal and respiratory secretions. Signs and symptoms similar to neonatal sepsis
can be nonspecific ( Table 96.7 ). Viral infection with RSV, influenza,
parainfluenza viruses, adenovirus, and metapneumovirus can produce a similar
presentation. Apnea is a common presentation in RSV infection.
All neonates with suspected pneumonia should receive a complete workup,
including CBC, CRP, blood, urine, and CSF cultures. CXR may show patchy
infiltrates with air bronchograms, diffuse haziness, or lobar or segmental
consolidation. Pleural effusions are common but CXRs may also be normal in
15% of cases. CXR in babies with C. trachomatis may show hyperinflation with
infiltrates. Nasopharyngeal aspirates can be sent for direct immunofluorescence
or PCR to diagnose chlamydial pneumonia.
Neonatal pneumonia should be differentiated from other pulmonary etiologies
(pneumothorax) and nonpulmonary etiologies of respiratory distress (e.g.,
choanal atresia, tracheoesophageal fistula, CHD, and metabolic etiologies).
Empiric treatment with broad-spectrum antibiotics is indicated similar to
neonatal sepsis. Supportive treatment including intravenous fluids, correction of
electrolyte disturbances, and respiratory support should be initiated as needed.
Therapy should be tailored according to the organism. Oral erythromycin or
azithromycin is indicated for chlamydial infection. Mothers and their partners
should also be treated. Infants born through a vaginal canal infected with
chlamydia are at high risk of contracting pneumonia or conjunctivitis. They
should be observed for emergence of signs and symptoms. Efficacy of antibiotic
prophylaxis is unknown.

Urinary Tract Infections in the Newborn
UTIs occur in 0.1% to 1% of neonates. They are more common in uncircumcised

males because of limited retraction and increased bacterial burden in the foreskin.
This holds true up to 1 year of age, after which the incidence is higher in females.
E. coli is responsible for 50% to 80% of UTIs. E. coli has increased virulence
factors that facilitate adherence and propagation of the organisms. Other gramnegative bacteria can be etiologic agents but gram-positive organisms may also
contribute. Infectious spread to the urinary system can occur hematogenously
from bacteremia (30% of cases) or from an ascending infection. Twenty to 50%