Tracheal asiration and its clinical correlates in the diagnosis of congenital pneumonia.

Tracheal aspirates were obtained from 320 newborns with respiratory distress and one or more perinatal risk factors for infection. Samples were obtained before 8 hours of age, either by direct aspiration or immediately following intubation. Twenty-five infants had bacteria present in the aspirate smear. In each case a pure culture of the organism suspected by smear morphology was grown. The same organism was isolated from blood in 14 of the 25 newborns suspected of having pneumonia. The remaining 11 infants had clinical courses, depressed mature neutrophil counts, and elevated band to total neutrophil ratios consistent with bacterial infection. Twenty-five infants without bacteria in the tracheal aspirate smear were randomly selected as a comparison group. Three of these infants had positive blood cultures, and one of the three also grew the same organism from the tracheal aspirate. The chest radiograph was abnormal in all infants but did not discriminate patients with or without pneumonia. We conclude that examination of the tracheal aspirate obtained within the first 8 hours of age is helpful in the early diagnosis of congenital pneumonia.