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新生儿肺炎

Author
Michael E Speer, MD
Section Editors
Joseph A Garcia-Prats, MD
Morven S Edwards, MD
Deputy Editor
Carrie Armsby, MD, MPH
Translators
米荣, 主任医师，副教授

引言

肺炎是新生儿感染的一个重要原因，也是导致新生儿严重并发症及死亡的重要原因，尤其在发展中国家[1,2]。世界卫生组织(World Health Organization, WHO)估计，发展中国家每年约有800,000例新生儿死于急性呼吸道感染(主要为肺炎)[3]。例如，在印度中部农村地区，出生后第1个月内肺炎所致的死亡率为每1000例活产中有29例；在儿童中，一半以上的肺炎相关死亡发生于新生儿[4]。由于许多新生儿并未接受医疗救治，所以这些数据可能低于实际情况。

在发达国家，足月儿中估计的肺炎发病率小于1%。然而，在足月和早产的患儿中，该发病率可能更接近于10%[5]。

相比之下，尸检时发现，活产婴儿的新生儿肺炎发病率为20%-32%，而死产婴儿的则为15%-38%，尽管肺部炎症的病理特征并不总是由感染导致[6]。在一项病例系列研究中，感染是超低出生体重儿最常见的死亡原因(111例中有56例)；在这56例感染中有30例为先天性肺炎[7]。在这些先天性感染中，由母体肠道微生物导致的肺炎常伴有绒毛膜羊膜炎和/或脐带炎。

本文将总结新生儿肺炎的发病机制、临床表现、诊断及治疗。新生儿脓毒症及特定的病原体将单独讨论。 (参见“足月儿和晚期早产儿脓毒症的临床特点和诊断”)

发病机制

新生儿肺炎可以分为早发型或晚发型。这两种类型的主要病原体均为细菌。 (参见下文‘微生物学’)

                              

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Literature review current through: 2017-06 . | This topic last updated: 2015-06-23.
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