Neonatal pneumonia can occur before, during, or after delivery and can be caused by pathogenic infection or foreign body aspiration. For example, aspiration of amniotic fluid and meconium at birth and from milk aspiration after birth. The symptoms of neonatal pneumonia differ from those of pneumonia in older children. Typical respiratory symptoms such as runny nose, coughing and wheezing are generally not obvious, but mostly manifest as choking, spitting, shortness of breath, labored breathing and change in facial color. 1. Infectious pneumonia: Most of the children have no increase in body temperature or fever, hyporesponsiveness, refusal of milk and other systemic symptoms. This is followed by shortness of breath, foaming at the mouth, nasal agitation, inspiratory depression, expiratory moaning, cyanosis, and in a few cases, hyporesponsiveness and greenish-gray around the mouth and lips. Cough symptoms may be absent (especially in premature infants). In severe cases, dyspnea, apnea, and even respiratory failure and heart failure may occur. Intrauterine infections tend to show symptoms within 3 days after birth, and postpartum and postnatal infections tend to show symptoms 3 days after birth. 2, aspiration pneumonia: aspiration pneumonia is one of the symptoms of respiratory distress that occurs early in the newborn. If the fetus in utero or during delivery inhaled a large amount of amniotic fluid called amniotic fluid aspiration pneumonia; if inhaled amniotic fluid contaminated by meconium called meconium aspiration pneumonia; after birth inhaled a large amount of milk to the lungs called lactation aspiration pneumonia. (1) Amniotic fluid aspiration pneumonia: there is a history of asphyxia, shortness of breath or dyspnea with cyanosis and moaning during resuscitation or after birth. When the amount of inhaled amniotic fluid is small, shortness of breath or no symptoms are present. When the amount of inhaled amniotic fluid is high, dyspnea is evident, and fluid or foam may flow from the mouth, and coarse wet rales or fine wet rales may be heard on lung auscultation. (2) Meconium aspiration pneumonia: It is common in term or overdue infants with a history of intrauterine distress and postnatal asphyxia and fecal staining of amniotic fluid. The disease is often severe, with dyspnea, moaning, cyanosis, and trismus signs appearing shortly after birth. The lungs are covered with dry and wet rales, which can cause respiratory failure, pulmonary atelectasis, emphysema, pulmonary hypertension, and central nervous system manifestations of hypoxic-ischemic encephalopathy. Once complicated by pneumothorax and mediastinal emphysema, the condition may change abruptly or even die. (3) Lactation aspiration pneumonia: there is often choking and coughing from breastfeeding, milk flowing from the mouth and nose, accompanied by shortness of breath and cyanosis, which can lead to asphyxia in severe cases.