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Lower respiratory tract infection 

Lower respiratory tract infection
Chapter:
Lower respiratory tract infection
DOI:
10.1093/med/9780198729228.003.0022
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date: 19 November 2019

Infections are an important cause of morbidity and mortality during the neonatal period, and the incidence of infection is higher in neonates than at any other time in life. Bacteria predominate, but fungi (Candida) are also contributing, especially in extremely low-birthweight babies. Congenital viral infections (especially cytomegalovirus and herpes simplex virus) must be considered where characteristic clinical features are present and/or routine bacterial cultures are negative. The clinical presentation of neonatal infections is often non-specific. Thus antibiotics must be started empirically, based on the age at onset, the clinical symptoms, and the epidemiological considerations. Ongoing (local) surveillance of both pathogens and antimicrobial resistance is therefore vital to ensure optimal selection of antibiotics. The development of resistance to commonly used antibiotics is an emerging global problem and requires vigilance, as well as the implementation of antimicrobial stewardship programmes. Other preventative strategies for congenital and neonatal infections include: antenatal screening programmes (serology); prevention and diagnosis of infections in pregnancy; maternal vaccination; intrapartum antibiotic use to prevent early-onset group B streptococcal infections; infection control measures; central line care; and prophylactic antifungal therapy in selected risk groups.

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