Published: 2022-02-25

Predisposing factors for pneumonia in the neonatal period and acute phase reactants as a prognostic marker-a study in a tertiary care hospital of eastern India

Nilay Ranjan Bagchi


Background: Respiratory distress is the most common cause for NICU admission and pneumonia accounts for more than 50% of cases. There are different predisposing factors for occurrence of neonatal pneumonia. This study aimed to find out different predisposing factors leading to occurrence of pneumonia in neonates and also to study CRP and mESR as acute phase reactants to determine prognosis as these two markers are most widely used marker in clinical practice.

Methods: A total 250 neonates who presented with features of pneumonia were included in the study. All the predisposing factors were corroborated with the clinical findings of the neonates and prognosis were assessed by serial acute phase reactants assay.

Results: Most of the patients (57%) diagnosed with neonatal pneumonia have early onset neonatal sepsis. 66% of them had history of premature rupture of membrane >24 hours (p<0.001). The mean period of gestation is 32.9 weeks, so majority of them are preterm (p<0.001). 30% of them had history of birth asphyxia (p<0.001). The mean Downe’s score comes out to be 3.74 and score >4 had worst outcome (p<0.05). Blood culture become positive in 36% of the cases who carried adverse prognosis (p<0.001). CRP (p<0.0001) has a definite valuable role to determine the prognosis but micro ESR (p=0.2267) found to be non-significant in this study.

Conclusions: Premature rupture of membrane, premature birth, birth asphyxia, Downe’s score >4 and blood culture positivity found to be risk factor for pneumonia in neonates and serial CRP may be done to determine the prognosis.


Predisposing factors, Pneumonia, Neonate, Acute phase reactants

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Bennett D, Bisanzio D, Deribew A. Global, regional and national under-5 mortality, adult mortality, age-specific mortality and life expency,1970-2016: a systemic analysis for the Global Burden of Disease study. 2016,2017.

Duke T. Neonatal pneumonia in developing countries. Arch Dis Child Fetal Neonatal Ed. 2005;90:F211-9.

Bang AT, Bang RA, Tale O. Reduction in pneumonia mortality and total childhood mortality by means of community-based intervention trial in Gadchiroli, India. Lancet 1993;336:201-6.

World Health Organisation (WHO). Neonatal and Child Health profile, India. Department of Maternal Newborn Child and Adolescent Health 2013. Available at: hptt:// Accessed on 10 Feb 2020.

Gouyon JB, Ribakovsky C, Ferdynus C, Quantin C, Sagot P, Gouyon B. Burgundy Perinatal Network. Severe respiratory disorders in term neonates. Paediatr Perinat Epidemiol. 2008;22(1):22-30.

Verani JR, McGee L, Schrag SJ. Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention. Prevention of perinatal group B Streptococcal disease: revised guidelines from CDC, 2010. MMWR Recomm Rep. 2010;59(RR-10):1-36.

Misra S, Bhakoo ON, Ayyagiri A. Clinical and bacteriological profile of neonatal pneumonia. Indian J Med Res. 1991;93:366-70.

Williams O, Hutchings G, Hubinont C, Debauche C, Greenough A. Pulmonary effects of prolonged oligohydramnios following midtrimester rupture of the membranes-antenatal and postnatal management. Neonatology. 2012;101(2):83-90.

Warren JB, Anderson JM. Newborn respiratory disorders. Pediatr Rev. 2010;31(12):487-95.

Magder S. Bench-to-bedside review: ventilatory abnormalities in sepsis. Crit Care. 2009;13(1):202.

Hawk M. C reactive protein in neonatal sepsis. Neonatal Netw. 2008;27(2):11720.

West JB. Respiratory Physiology: The Essentials. Baltimore, MD: Williams and Wilkins. 2012.

Davis RP, Mychaliska GB. Neonatal pulmonary physiology. Semin Pediatr Surg. 2013;22(4):179-84.

Wilmott RW, Boat TF, Bush A, Chernick V, Deterding RR. Kendig and Chernick’s Disorders of the Respiratory Tract in Children. Philadelphia, PA: Elsevier Saunders. 2012.

Choudhury AM, Nargis S, Mollah AH, Kabir M, Sarkar RN. Determination of risk factors of neonatal pneumonia. Mymensingh Med J. 2010;19(3):323-9.

Nair S, Lewis LE, Godinho MA, Murthy S, Lakiang T, Venkatesh BT. Factors associated with neonatal pneumonia in India: Protocol for a systematic review and planned meta-analysis. BMJ Open. 2018;8:e018790.

Hibbard JU, Wilkins I, Sun L. Consortium on Safe Labor. Respiratory morbidity in late preterm births. JAMA. 2010;304(4):419-25.

Bhat R, Vidyasagar D. Delivery room management of meconium-stained infant. Clin Perinatol. 2012;39(4):817-31.