Neonatal Lung Abscess-Juniper Publishers


Juniper Publishers-Journal of Pediatrics


Neonatal lung abscess

A baby girl was born at 23+4 weeks by precipitate delivery following spontaneous onset of labour and PROM of 121 hours. Mum had received a course of antenatal steroids. Following two unsuccessful trials of extubation on day 7 and 12, she had a significant cardio respiratory deterioration on day 14. She was started on second line antibiotics. Her CRP went up to 20 and her platelet count dropped to 51. Her chest x ray showed a large bullous emphysematous lesion occupying almost all of her right middle lobe (Figure 1 & 2). She became increasingly difficult to ventilate with worsening acidosis, hypotension and hyperglycemia despite maximizing intensive care support. Following discussion with her parents, her care was redirected to a palliative course. Post mortem examination of lungs revealed widespread collections of neutrophils / abscesses consistent with congenital pneumonia with abscess (seen as cavitating lesion on imaging). Her blood cultures did not reveal any growth.

Neonatal lung abscess is very rare [1] and is often of multibacterial etiology [2,3]. Predisposing factors include prematurity, assisted ventilation, congenital lung anomaly and aspiration. Given the range of potential pathogens, direct culture by percutaneous needle aspiration under either ultrasound [4] or CT guidance [2] is recommended to direct early appropriate intravenous medical therapy and hasten recovery, prevent further complications and obviate the need for surgery [4].

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