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intrauterine pneumonias


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Dear All,

In our hospital we have come across newborns presenting with respiratory distress.

Their septic screen is invariably negative. Their Xrays have patchy opacities mostly

on left side. Our senior radiologist feels that to be unlikely to be pneumonias but local lung fluid collection lung (like Opaque Rt lung )They needed O2, antibiotics and some ventilation.

Please see the xrays in the folder intrauterine pneumonias and give your opinion

Thanking you










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  • 3 weeks later...

Viewing the xrays it seems that there is cardiomegaly. This may be due to intrauterine hypoxia or myocardial ischemia. In next cases, estimation of cpk, cpk-mb, cardiac andtreponin may be helpful. Try getting echcardiography early if possible, reduced left ventricular ejection fraction or pulmonary arter hypertension may be the etiology in some cases, if all other tests for sepsis are negative.

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I get the impression that the heart may look relatively large, but due to poor lung expansion (the first three pictures). On the fourth xray, lung expansion is better and the heart seem to have a normal size.

Could you please give some more clinical info - was there an inflammatory response (incl elevated CRP)? How long did the respir distress endure? Was mechanical ventilation needed?!

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  • 3 weeks later...

some more information on the X Rays.

1.preterm /IUGR/had apnoea. CRp was raised. band forms > 11%.could not afford treatment .Hence transferred to General Hospital where the baby died.

2.MAS/birth asphyxia.ventilated.Echo moderate PAH. didn't respond to sildenafil, mg so4 infusion,dopamine. Suction tip grew non fermenting gram negative bacilli. died on day 4

3.Term/LSCS/ had polymorps raised. CRP -ve. responded to 7 day course of antibiotics

4.had meconium stained liquor.all septic work up including c& s -ve.x ray clear on day 3.received antibiotics, calcium,




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I think that your spectrum of illnesses are different. Though CXRays may appear similar, neonatal diagnosis is based on multiple factors. Just similar xrays do not make them all similar clinical cases.

Case1: May possibly have RDS with/without sepsis (congenital pneumonia). The maternal history especially of PROM and any HVS C/S growth would be helpful.

Case2: Has all the risk factors for PPHN. Dont blame the death on your gram negative bacilli...remember that almost all the ETTs in any NICU are colonized.

Case3: May have started as TTN and later progressed to RDS or started off as Congenital Pneumonia

Case4:Meconium stained Liquor with respiratory distress is Meconium aspiration untill you find another cause.

All my suggestions are based on your clinical data. I find clinical data more helpful than Xrays only. No doubt CXRays are pivotal to your diagnosis and management but dont use only CXRays for making your working diagnosis.

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some more information...

Aha, I thought the four images came from the same patient, I did not realize that they came from different patients! Sorry about that.

I agree with JACK, different etiologies are quite likely.

In general (and a bit off the topic :) ), I wished we had better tools for ruling out infections, reducing the load of antibiotics we give to non-infected infants. I/we commonly start infant with respiratory distress on antibiotics, and give treatment a few days while awaiting (negative) cultures and CRP responses. Noone (i.e. I/we) wants to be left behind an accelerating septic problem.

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