The neonatal period, regardless of gestational age, is a season of vulnerability, in which the new child depends on the circumstances attracted from the maternal cloister, plus the new challenge offered by the extrauterine environment; in addition to the factors of low gestational age, low weight, diseases of the mother prior to pregnancy, those acquired during pregnancy, the emotional and psychological aspect of the mother, socioeconomic conditions, and a whole spectrum that determine the manifestation or not of the pathological entity. In this sense, respiratory pathologies are the most common, and pneumonia is at high risk.

The greatest risk of death from pneumonia in childhood occurs mainly in the neonatal period, thus estimating a contribution between 750,000 and 1.2 million deaths in children under 28 days per year; this represents 10% of world infant mortality [1]. Pneumonias, congenital and neonatal, are a difficult disease to identify and treat, or clinical manifestations often that are specific as many of the normal pulmonary defenses are compromised in the sense of the neonate, leading to increased susceptibility to infection [2].

Pneumonia is an infection that affects the hormonal parenchyma and is associated with love and significant mortality. Its incidence is variable, which depends on local health conditions. In developed countries it occurs in less than 1% of full-term newborns, unlike what happens in developing countries where the incidence can increase to 29 per 1000 prime births. Prematurity increases the risk of developing pneumonia by more than 10 times [3].

Neonatal pneumonia can be caused by bacteria, viruses, spirochetes, protozoa, and fungi. The pneumonic process can begin before, during or after birth, the newborn can become infected through the placenta, through the amniotic fluid, infected during the time of delivery or after birth. Signs and symptoms of mother-acquired pneumonia start early. The incidence of early-onset pneumonia is estimated to account for 0.5% of all births.

In order to determine mortality from congenital pneumonia, a descriptive, observational study was conducted with retrospective data collection. The unit of analysis was newborns admitted to the neonatal intensive care unit of the San Lorenzo de los Mina Maternal and Child Hospital from June 2023 to May 2024. Inclusion criteria included newborns admitted to the neonatal intensive care unit with a diagnosis of congenital pneumonia based on clinical and radiological criteria. Exclusion criteria included newborns with major congenital malformations or any type of genetic diseases that could influence mortality. The data source was the Unit's statistical registry. The variables taken into account were total number of births, number of admissions, gestational age, birth weight, sex, and mortality. During the procedure, with prior authorization from the research management and the neonatal intensive care unit, the statistical records of the cases were accessed. A descriptive analysis of demographic and clinical variables was performed. The mortality rate was calculated, and associated factors were analyzed.

Table 1: Total births during the study period, births, live births and nationality, neonatal intensive care unit.

Source: NICU data collection instrument- HMISLLM

Figure 1: Total number of births during the study period, births, live births and nationality.

Source: Table 1.

During the study period, a total of 6590 births were recorded, of which 6427 were born alive. Among them, there were 3173 births of Dominicans (48.15%), with 3102 live births (48.27%). Haitians had 3411 births (51.76%), of which 3319 were born alive (51.64%). In addition, 6 births of Venezuelans were registered (0.09%), and all were born alive (0.09%).

Table 2: Distribution of cases according to admissions in the neonatal intensive care unit.

Source: NICU data collection instrument- HMISLLM

Figure 2: Distribution of cases according to admissions to the neonatal intensive care unit/proportion due to congenital pneumonia.

Source: Table 2.

In the NICU, 1390 admissions were registered during the study period (21.62% of the total live births). Of these, 57 cases were due to congenital pneumonia (4.10%), while 1333 cases were due to other pathologies (95.90%).

Table 3: Cases of deaths due to connatal pneumonia.

Source: NICU data collection instrument- HMISLLM

Figure 3: Distribution of cases of death due to congenital pneumonia, proportion according to income.

Source: Table 4.

In relation to the number of deaths, 185 were registered (13.3% of the total NICU admissions) and of which 27 were due to congenital pneumonia (14.59%). Deaths from other causes were 158 (85.41%). These deaths accounted for 1.94% of congenital pneumonia cases. The mortality rate for congenital pneumonia was 0.42%.

Table 4: Distribution by sex of neonates admitted for connatal pneumonia.

Source: NICU data collection instrument- HMISLLMFigure 4: Distribution of death cases by gender.

Source: Table 4.

In relation to sex, 30 correspond to male neonates (52.63%), while 27 cases were female neonates (47.37%).

Table 5: Gestational age of neonates admitted for congenital pneumonia.

Source: NICU data collection instrument- HMISLLM

Figure 5: Gestational age of neonates admitted for congenital pneumonia.

Source: Table 5.

Regarding the gestational age of neonates admitted for congenital pneumonia, 7 cases were from 28-31 weeks (12.28%), 9 cases from 32-34 weeks (15.79%), 7 cases from 35-36 weeks (12.28%), 33 cases from 37-41 weeks (57.89%) and 1 case from more than 41 weeks (1.75%).

Table 6: Birth weight in grams of neonates with congenital pneumonia.

Source: NICU data collection instrument- HMISLLM

Figure 6: Distribution of cases of deaths according to birth weight.

Source: Table 6.

Of the total of 57 cases of congenital pneumonia, 28 neonates had a birth weight greater than 2500 grams (49.12%), while 29 neonates had a birth weight less than 2500 grams (50.88%).

The development of this research has facilitated the analysis of mortality due to congenital pneumonia in newborns admitted to the Neonatal Intensive Care Unit (NICU) of the San Lorenzo De Los Mina Maternal and Children's Hospital, based on data collected from statistical records of the unit. The results yielded important findings that have clinical and public health implications. First, the significant proportion of live births requiring admission to the NICU is highlighted, which underlines the high demand for intensive care in this population, as well as the high influx of foreigners. In addition, the prevalence of deaths from congenital pneumonia and the associated mortality rate indicates the severity of this condition and the need for more effective preventive and therapeutic interventions.

During the study period, a total of 6590 births were recorded, of which 6427 were born alive. Among them, there were 3173 births of Dominicans (48.15%), with 3102 live births (48.27%). Haitians had 3411 births (51.76%), of which 3319 were born alive (51.64%). In addition, 6 births of Venezuelans were registered (0.09%), and all were born alive (0.09%).

Sánchez D; Santo Domingo, DR., 2017, a study to determine the profile of respiratory distress in newborns indicated that pneumonia is one of the pathologies causing this difficulty.5

En la UCIN, hubo 1390 ingresos durante el periodo de estudio (21.62% del total de nacidos vivos). De estos, 57 casos fueron por neumonia conginita (4.10%), mientras que 1333 casos fueron por otras patologías (95.90%).

185 deaths were registered during the study period, of which 27 were due to congenital pneumonia (14.59%). Deaths from other causes were 158 (85.41%). These deaths accounted for 13.3% of total NICU admissions and 1.94% of congenital pneumonia cases. The mortality rate for congenital pneumonia was 0.42%.

In that order, Cruz R. et al, Peru, with a retrospective study, reported that patients with congenital pneumonia were admitted to the neonatology ICU in 35.5%.4

In relation to sex, there was a predominance of male neonates (52.63%), while 27 cases were female neonates (47.37%). Sánchez D; Santo Domingo, DR., 2017, corroborates this prevalence by indicating in its study the male sex in 65%. 3

Regarding the gestational age of neonates admitted for congenital pneumonia, 7 cases were from 28-31 weeks (12.28%), 9 cases from 32-34 weeks (15.79%), 7 cases from 35-36 weeks (12.28%), 33 cases from 37-41 weeks (57.89%) and 1 case from more than 41 weeks (1.75%). Also Sánchez D; Santo Domingo, DR., 2017, reports an important contribution in the share of patients, indicating late preterm infants 33-36.6 weeks at (45.77%); This is very close to the results of this study.

As part of the factors that predispose to infection, Nair NS, et al., in India, 2021, point to 11 risk factors from two studies: duration of mechanical ventilation, postnatal age, birth weight, prematurity, sex of the newborn, length of stay in the NICU, primary diagnosis, gestational age, number of reintubations, birth asphyxia, and use of nasogastric tube. 2

Of the total of 57 cases of congenital pneumonia, 28 neonates had a birth weight greater than 2500 grams (49.12%), while 29 neonates had birth weight less than 2500 grams (50.88%).

After the analysis of these results, it is considered that low weight, prematurity, male sex, are factors of high value when this entity occurs, although the study is not entirely conclusive, since other research would be necessary that involves the maternal profile as a determinant of the presentation of the disease and its possible control.  Promoting the sustainable development of the reduction of neonatal mortality.

After obtaining the results, analyzed and discussed, the following conclusions are made:

Prevalence of mortality due to congenital pneumonia: 14.59% of deaths were due to congenital pneumonia.

The prevalence of NICU admissions was 21.62% of all live births.

Mortality rate for congenital pneumonia: 0.42% of all live births.

In relation to gestational age in neonates with congenital pneumonia, a significant 40.35% was due to premature neonates, including late 12.28%.

Regarding birth weight in neonates with congenital pneumonia, 50.88% had a weight of less than 2500 grams: 50.88%.

Given that a high proportion of congenital pneumonia cases occur in preterm infants, it is essential to strengthen antenatal and perinatal care programmes to identify and manage risk factors that can lead to prematurity and congenital pneumonia.

Assess maternal history and follow-up, maintain strict control in order to prevent the disease

Follow up on surveillance and prevention programs, since the mortality rate for congenital pneumonia of 0.42% indicates the need for programs to reduce the incidence and mortality associated with this condition, including vaccination of mothers and special care for newborns at risk.

Develop and update training programs for health personnel in the early identification and appropriate management of congenital pneumonia, as well as in the comprehensive care of premature and low birth weight infants.

To encourage research into new therapies, diagnostic techniques and prevention methods that can be applied in clinical practice.

No conflicts of interest on the part of the authors

Gratitude: To God, to the Maternal and Child Hospital, to the neonatology department.

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