Two cases illustrating the treatment of neonatal pneumonia

Abstract

A review of the pathological features of pneumonia in the new-born infant was recently published, and in that review Macgregor (1940) proposed a classification which would be equally useful clinically. The cases quoted below serve to illustrate the treatment of Macgregor's first type, namely that associated with aspiration of contents of the amniotic sac.Case reports Case 1. Baby K., a male infant, weighing 6 lb. 2 oz., was delivered after a long labour by an easy low forceps operation in the occipito-anterior position. The mother was a healthy primigravida and no abnormality occurred during pregnancy. At birth the infant was in a state of blue asphyxia, and an unusually large quantity of liquor amnii was drained from the mouth. Respiration became established without difficulty, but the lungs remained water-logged and air entry was restricted to the central and anterior parts of the lungs. Three hours after birth the infant breathed comfortably and there was no cyanosis, but respiration was noisy and there were rales to be heard over the anterior and upper parts of the lungs. At the bases and over the back there was little air entry and a few consonating rales.For the first thirty-six hours of life the condition of the infant gave no cause for alarm. The colour was usually good, though there were attacks of cyanosis soon checked by administration of oxygen. No apparatus of the nature of an oxygen tent was available. During this time the infant was nursed on his right side to allow the left lung to become as free from fluid as possible, and the foot of the cot was raised. After the first eighteen to twenty-four hours no further liquor could be wiped from the mouth, and after twenty-four hours the motions passed contained a large proportion of vernix caseosa.At the age of forty hours dyspnoea and cyanosis were much increased; oxygen was thereafter administered continuously through a nasal catheter. The moist sounds in the lungs were uniformly increased and the area of lung into which the air entered was much reduced. Alarming dyspnoea persisted for the next twelve hours and the distress then slowly diminished.At the age of four days the left lung (lying uppermost) had appreciably greater air entry than before, though it was still very moist. The infant took small feeds of breast milk every two hours on this day, whereas only water had been taken until this time. No alteration of the baby's position was allowed.At five days the infant breathed without effort and the moist sounds in the lungs were further reduced. Air entry into the right lung (lying downwards) became perceptible. On this day it appeared that the baby would probably recover if no infection developed in the still water-logged lungs. For this 153