Pneumonia in a newborn baby. Pneumonia in a newborn child: bilateral, severe, infectious

Are you an active person who cares and thinks about his respiratory system and overall health, keep exercising, healthy lifestyle life, and your body will delight you throughout your life, and no bronchitis will bother you. But do not forget to undergo examinations on time, maintain your immunity, this is very important, do not overcool, avoid severe physical and severe emotional overload.

Young parents should understand that if pneumonia develops for any reason, the newborn needs emergency hospitalization. Why does the disease occur? Who is at risk, and what are the symptoms of a dangerous disease? How much is treated, and how long does it take for a small body to recover after an illness?

The main reasons for the development

Pneumonia (or pneumonia) is considered an acute inflammatory process that occurs in the lung tissues. The disease is infectious. In this case, the alveoli and connective tissues of the respiratory organ are affected. For babies, this disease is considered extremely dangerous. If you do not start treatment, he may end in death.

The disease affects not only newborns, but also older children. Babies have congenital pneumonia and neonatal.

Congenital manifests itself immediately. It is caused by viruses that easily cross the blood-brain barrier. The main causative agents of this type of pneumonia are TORCH infections (which is why the gynecologist, when registering, sends the pregnant woman to be tested for their presence in the blood).

TORCH pathogens include:

• togavirus;
• toxoplasmosis (caused by toxoplasma);
• cytomegalovirus (threatening cytomegalovirus);
• herpesvirus.

If doctors detect such an infection, then, most likely, the infection occurred in utero, even at early dates gestation. Pneumonia appears here not as the main disease, but as severe symptom the main infection that affected the baby.

Intrauterine pneumonia is caused by:

• chlamydia;
• mycoplasmas hominis or genitalia;
• ureaplasmas;
• candida;
• Trichomonas.

Here, the infection of the child occurs during childbirth or the day before (on later dates). Underdevelopment of lung tissues, leading to pneumonia, can occur when a pregnant woman has genitourinary diseases (cystitis, endometritis, etc.).

If the crumbs have a strong gurgling cough, he may develop bronchitis. We have a separate article about this, be sure to read it!

The causes of neonatal pneumonia are highly dependent on the period at which the disease developed. Varies:

1. Early (up to a week). Often caused by infections that hit a newborn baby in the delivery room or in the maternity ward. Premature babies are susceptible to this type of pneumonia. The bacteria of Escherichia coli, staphylococcus, Pseudomonas aeruginosa, Klebsiella also give impetus to the development of the disease.
2. Late (from 1 to 4 weeks). Occurs when infected at home.

Forms of the disease

Congenital (intrauterine) pneumonia of newborns, when infection occurs in the womb, includes:

• transplantental, when the microbe entered the fetus from a sick mother through the placenta;
• aspiration, if suction, ingestion of infected amniotic fluid occurs when the child is prematurely inhaled on the eve of birth. The risk of swallowing is especially increased in postterm infants. Often this pneumonia develops after a caesarean section due to oxygen starvation provoked by the operation;
• intranatal, when the infection of the lungs occurred during the passage of the child through the birth canal.

Acquired (or postnatal) pneumonia includes:

• out-of-hospital, in which the baby falls ill at home;
• hospital, the child becomes infected in the hospital (intensive care unit, neonatal pathology department, etc.).

By clinical picture distinguish the following types of disease:

1. Focal, in which the x-ray shows a significant lesion of the lung. In this case, the disease can develop gradually or actively with a sudden violent manifestation of symptoms. The disease in newborns is benign and easily treatable. In this case, a complete recovery can be achieved in 3-4 weeks.
2. Segmental often without obvious symptoms. The radiographic image shows damage to the segments of the lungs. This type of disease occurs when viral infections. Pneumonia is rampant painful sensations in the chest and abdomen.
3. Croupous, the provocateur of which is often the allergic susceptibility of a newborn child. The disease develops with bacterial infection and is expressed by the defeat of one or more bronchopulmonary segments.
4. Interstitial that disrupts the structure of the pulmonary capillaries.

signs

Congenital pneumonia manifests itself immediately after childbirth or after a few hours. In the womb, the infected lungs of the child suffer little. Pulmonary system until it functions, and the fetus is fed by the placenta. When the baby takes its first breath, blood flow starts and the lungs open. After a few hours it happens oxygen starvation, and the symptoms of pneumonia are expressed much brighter.

The newborn has a pale grayish skin color, a weak, squeaky or absent cry, weakened congenital reflexes due to lack of nutrition nervous system. The respiratory function in such babies is impaired, as the body naturally seeks to eliminate oxygen deficiency in tissues and organs due to an increased respiratory rate. Because of this, there is shortness of breath, palpitations, retraction of the sternum when inhaling. The baby refuses to eat, loses weight. Body temperature rises rapidly and can cause convulsions.

Signs of neonatal pneumonia are not so pronounced, but are similar to congenital. The child is capricious, restless, his temperature rises, shortness of breath is noted. Intoxication of the body is not so active, but it all depends on the type of pathogen.

Bilateral pneumonia in premature newborns, as well as in those born at term, is most common. After all, the tiny body of a newborn child, just starting to work, cannot defend itself and stop the pathological process within one damaged bronchopulmonary segment. The condition is aggravated by the constant horizontal position in which the babies are.

Unilateral pneumonia occurs in early stages disease, especially when it has a late neonatal character. But the process is developing rapidly. The sooner you start treatment, the better.

Treatment plan for newborns

Treatment of pneumonia of any type in newborns begins with diagnosis.

To do this, the doctor asks parents about:

• previously transferred and exacerbated chronic diseases mothers;
• the possibility of overheating or hypothermia of the child;
• allergic reactions to foods that a nursing mother consumes.

The doctor will also know:

• was there any communication between the mother and the baby with sick children, relatives, acquaintances;
• whether there were cases of a long stay of a newborn in busy places (especially during an influenza epidemic).

On examination, the doctor pays attention to:

• on the skin and mucous membranes (whether there is cyanosis or unhealthy pallor);
• a careful listening to the lungs is performed to detect hard breathing or wheezing;
• the affected areas are tapped to detect a dull percussion sound.

The child must be sent to:

• passing urine and blood tests - on the collection of urine from newborns;
• sowing mucus from the nose and throat;
• echocardiogram;
• You may need to see a pulmonologist.

A sick child must be hospitalized in the infectious diseases department. There are created favorable conditions for caring for a newborn. If the baby is premature, it is placed in a couveuse.

The therapy is:

• in regular measurement of body temperature and control of breathing;
• careful care of the skin and mucous membranes;
• breastfeeding (if possible) recommended fractional nutrition and a strict diet for a nursing mother. You may need to supplement the baby;
• antibiotic therapy is carried out taking into account the type of pathogen;
• oxygen therapy is regularly used to normalize breathing and eliminate oxygen starvation;
• saline and diuretic drugs are injected intravenously to speed up excretory processes;
• full-term babies are treated with alkaline inhalations and ultraviolet irradiation. This helps to deal with infections faster;
• vitamin therapy strengthens the immune system (usually newborns are prescribed vitamins of groups B and C in a large dosage).

Possible consequences for babies

Parents often ask doctors what are the consequences of pneumonia suffered by a baby. After all, the health and normal development of the baby is in the first place for them. If treatment is started on time and the therapy is chosen correctly, the prognosis is generally good.

In advanced cases, intoxication is possible due to prolonged exposure to toxic substances on the child's body. This is extremely dangerous and potentially fatal.

With the development of pneumonia in premature infants, there is a risk of lung tissue dysplasia, which increases the possibility of secondary occurrence of the disease in a more severe form.

How long does it take to heal

Doctors give good prognoses in case of timely initiation of therapy. The more the visit to the doctor is postponed, the less likely it is to avoid serious consequences and long-term expensive treatment.

• regularly visit a doctor during the gestation period: take tests to identify and prevent genetic defects, infectious intrauterine diseases;
• treatment of chronic diseases in pregnant women with gentle drugs;
• breastfeeding helps stabilize the immune system due to antibodies in breast milk;
• it is necessary to avoid contact with sick people;
• properly and fully eat a nursing mother. Limit the use of fried, spicy, salty foods, carbonated sugary drinks, energy drinks. It is better to eat food not hot, but warm, drink plenty of fluids, do not overeat;
• breathe fresh air regularly, sleep at least 8 hours, exercise therapeutic gymnastics, in advance to give up bad habits;
• if suspicious symptoms appear, do not postpone going to the doctor. At the reception, describe the condition of the child without withholding information.

A newborn child does not yet have strong immunity, its organs and tissues in the first month of life adapt to environmental conditions. Any infection that enters the baby's body at this time can lead to a serious illness and consequences, sometimes fatal. The infectious process in pneumonia, including intrauterine, is dangerous because it affects not only the lung tissue, but can also spread throughout the body. Knowing the causes, manifestations and preventive measures of the disease, you can avoid serious complications.

What is neonatal pneumonia

Pneumonia of the newborn (pneumonia) is infection lung tissue in children in the first 28 days of life with characteristic symptoms intoxication and changes in the respiratory system.

With inflammation of the lungs, the alveoli are filled with a secret and cease to perform their functions.

At risk are:

• premature babies (born at a gestational age of less than 38 weeks);
• children with intrauterine growth retardation (body weight less than 2500 g);
• children born through caesarean section.

In addition, a number of factors significantly increase the likelihood of developing the disease in crumbs, for example:

• fetal hypoxia (oxygen starvation). Occurs as a result of a lack of oxygen in the blood of the mother, placental insufficiency (lack of oxygen supply to the fetus through the vessels of the placenta);
• aspiration syndrome, when, during inspiration, the child in Airways part of the amniotic fluid enters;
• birth trauma;
• hypoxia in childbirth - a long anhydrous period (more than 24 hours);
• infectious diseases of the genitourinary and respiratory systems of the mother;
• malformations of the lungs (bronchopulmonary dysplasia).

Interestingly, a third of pneumonia in newborns is a secondary concomitant disease against the background of the main one. For example, congenital pneumonia can act against the background hemolytic disease, severe birth trauma, sepsis. Such pneumonia often determine the severity of the course of the underlying disease, as well as its outcome.

Types of disease

1. Congenital (or intrauterine) pneumonia. The infection infects the fetus in the womb. They are divided into transplacental, when the infection gets to the baby from the mother through the placenta. Antenatal, when the fetus becomes infected through the amniotic fluid. And intranatal, when the child is exposed to infection during passage through the birth canal. The causative agent of the disease in this case penetrates from the amniotic fluid or from the infected genital tract of the mother (genital tract).
2. Postnatal pneumonia that occurs after the birth of a child. They are divided into hospital (nosocomial) pneumonia, when infection occurs in the maternity hospital or neonatal pathology department, and out-of-hospital, when the newborn catches the disease after discharge from the hospital.

One of the ways of infection of the fetus from the mother with an infection is through the placenta (transplacental route of infection)

In addition, according to the type of causative agent of pneumonia, it is customary to divide into bacterial, viral and fungal.

Causes

In term newborns, the main cause of pneumonia is infection.. All other factors (maternal infections, hypoxia in childbirth, birth trauma, etc.) only increase the likelihood of pneumonia, but are not its cause!

In antenatal infection, the most common pathogens are cytomegalovirus infection, herpes simplex virus and pneumocystis. The latter becomes the most common cause development of the disease in premature infants. With intranatal infection, the child is exposed to microorganisms that inhabit the birth canal of the mother, these are:

• chlamydia;
• mycoplasma;
• ureaplasma;
• streptococci;
• candida (fungal infection).

Streptococcal infection is the cause of pneumonia in 35% of infants in the first month of life.

Hospital infections that provoke nosocomial pneumonia are Klebsiella, enterococci, Pseudomonas aeruginosa and Staphylococcus aureus.

In premature newborns, the main cause of pneumonia, in addition to infection, is the underdevelopment of the respiratory system and the immune system. It is more difficult for such children to fight infectious agents, they are more easily susceptible to infection.

In children after delivery by caesarean section, the main cause of pneumonia is the suction of infected amniotic fluid or mucus from the birth canal. As a result of this, atelectasis occurs (collapse of part of the lung), which contributes to the development of pneumonia.

Ways of infection with pneumonia in newborn children:

• Hematogenous (with blood flow). This is the most common route of infection for intrauterine pneumonia. From the foci of infection of a pregnant woman with a bloodstream, a virus or bacterium enters the fetus. Hence, intrauterine infection of the fetus occurs.
• Bronchogenic. This is the route of infection in postnatal pneumonia, when a child picks up an infection from a sick mother or relatives. Infection occurs by airborne droplets.

Symptoms of the disease

AT clinical manifestation pneumonia in newborns, there are several groups of symptoms:

• Intoxication syndrome - occurs as a result of poisoning of the child's body with toxins from viruses or bacteria. First of all, the nervous and immune systems are affected. This is manifested in the weakness of the child, refusal to eat, drowsiness, pallor or dullness. skin. There may also be frequent regurgitation or bouts of short-term respiratory arrest (apnea).
• Respiratory disorders - occur as a result of lung tissue damage and, as a result, a lack of oxygen. Manifested in an increase in breathing, participation in the act of breathing of auxiliary muscles (retraction of the intercostal spaces, swelling of the wings of the nose). The breath of a newborn becomes groaning, noisy, sometimes wheezing is heard in the distance. The skin around the lips and on the extremities acquire a bluish tint, which is a sign of oxygen starvation.
• Violations by of cardio-vascular system manifest as tachycardia (increased heart rate), decreased blood pressure, edema.
• Disorders of the nervous system - increased excitability of the child, anxiety, regurgitation, decreased muscle tone.
• Manifestations from other organs and systems - enlargement of the liver and spleen, early jaundice(yellowing of the skin before 3 days of a child's life).

Symptoms of pneumonia in newborns - photo gallery

With pneumonia in newborns, breathing is disturbed, wheezing may be heard during auscultation In congenital pneumonia, prolonged jaundice is a common symptom Lack of oxygen in the tissues manifests itself in the form of cyanosis (cyanosis) of the extremities or lips

It is important to know that an increase in body temperature in newborns with pneumonia is an optional sign. In children of the first day of life, hypothermia (body temperature below 36 degrees) may occur. This indicates a reduced immune reactivity and severe intoxication.

The most common cause of pneumonia in medical institutions becomes Staphylococcus aureus. A feature of staphylococcal pneumonia is a strong intoxication syndrome (body temperature above 38.5 ° C, respiratory failure). The child quickly develops respiratory failure.

Staphylococcus destroys lung tissue, resulting in the formation of cavities and bullae filled with pus. The inflammatory process often passes to neighboring tissues, and pleurisy develops. Complicated by an abscess or pleurisy, staphylococcal pneumonia is often the cause of death in newborns.

Specificity of congenital pneumonia in infants:

• Clinical and radiological manifestations of the disease occur in the first 72 hours of a child's life.
• The source of infection is the mother - the same pathogenic flora is sown in her as in the baby.
• The child often has infectious foci in organs adjacent to the lungs.
• Characterized by an increase in the liver and spleen from the first day of the baby's life.
• In the placenta after childbirth, inflammatory changes are found.

Features of pneumonia in premature babies

• The onset of the disease with nonspecific signs is poor sucking, increased excitability of the child, pallor or cyanosis of the skin, a decrease in body temperature, sleep disturbance, weight loss or an increase due to edema.
• Late manifestation of respiratory disorders (at 1-2 weeks of life).
• More frequent occurrence of complications of pneumonia than in full-term newborns.
• Foamy discharge from the mouth. This occurs as a result of congestion in the lungs.
• Premature babies are more likely to develop blood poisoning due to pneumonia.

The most common causative agent of pneumonia in premature newborns is pneumocystis. The course of such pneumonia lasts 4–8 weeks and is divided into several stages:

1. Initial manifestations (first 1–2 weeks of illness). Characterized by nonspecific symptoms in the form of sluggish sucking, poor weight gain, rapid breathing when bathing, sucking. Sometimes there is a slight cough, liquid stool(diarrhea).
2. The height of the disease (2–4 weeks of illness). Manifested by severe shortness of breath (increase in the number of breaths up to 80–140 per minute), paroxysmal cough, discoloration of the skin (blue, gray). Body temperature rarely rises.
3. The stage of resorption (reparation) is characterized by the slow disappearance of shortness of breath, cough, signs of intoxication.

Video of Dr. Komarovsky's school about pneumonia in children

Treatment

Treatment of newborns continues until the acute period of the disease is relieved (about 2 weeks). During the period of resorption of pneumonia, supportive and restorative therapy is used.

Treatment of pneumonia in newborns is carried out only in a hospital under the strict supervision of a neonatologist!

The main aspects in the treatment of pneumonia in newborns are:

1. Protective mode. Maintaining optimal temperature and air humidity (+24…+26 °C in the ward at 60–70% humidity). For premature babies weighing up to 1.5 kg, the temperature in the incubator is maintained at +34…+36 °C. Overheating is undesirable, as is hypothermia. Regular ventilation is required. It is not recommended to swaddle babies and restrict their movements, it is necessary to change their body position frequently during the day.
2. Feeding. If the child is in serious condition or in deep prematurity, he is fed through a tube or drip method. For this, mother's milk or adapted mixtures are used. With the improvement of the condition and the formation of the sucking reflex, the child is fed with a spoon or breast. In a serious condition, the child is not able to absorb all the necessary amount of food, therefore, between feedings, he is given liquid (glucose, oralitis) through a probe or pipette.
3. Oxygen therapy is the introduction of heated and humidified oxygen through a mask, catheter, into the incubator.
4. Antibacterial therapy - depending on the pathogen and type of pneumonia.
5. Immunocorrective therapy - the introduction of immunoglobulins, blood plasma.
6. Treatment of cardiovascular insufficiency - the use of cardiac glycosides for health reasons, diuretics.
7. With obstructive syndrome (bronchospasm), bronchodilators are used (for example, Alupent).
8. Sanitation of the upper respiratory tract - removal of mucus with the help of an electric suction.
9. Vibration massage - stroking, light tapping, squeezing chest from the sides.

Treatment of pneumonia in newborns - photo gallery

Stronger children are fed from a bottle with a nipple Weakened newborns are fed through a tube It is important for a newborn child to maintain a constant body temperature and humidity level - for this he is placed in an incubator The supply of humidified oxygen to the baby is carried out through a mask or nasal catheter

Combinations of antibiotics for different types of pneumonia - table

Antibacterial therapy is carried out intravenously - jet or drip. Antibiotics should be treated for at least 5 days, sometimes their intake is extended up to 10 days.

Possible complications and consequences

1. Pleurisy is an inflammation of the pleura (the membrane that covers the lungs). Occurs when the infection passes from the pulmonary focus to neighboring tissues.
2. An abscess is a cavity in the lung filled with pus.
3. Sepsis is an infectious infection of the blood and the spread of infection throughout the body with the formation of many foci of infection.
4. Atelectasis - collapse of part of the lung;
5. Pneumothorax - air entering the pleural cavity, normally it should not be there.

Very often, the result of a viral or bacterial infection in infants is complications affecting various organs. This is due to the fact that the nasal cavities and airways in infants are very narrow, underdeveloped. The mucous membrane of these organs is susceptible to pathogenic bacteria, quickly swells, because of this, it becomes more difficult to remove microbes. Pneumonia in infants is an inflammatory focus in the lungs.

Children with weakened immune systems are more susceptible to inflammation.

It is important not to passto plan preventive examinations doctors. Even more important is the introduction of vaccines, if there are no contraindications to this. Vaccination can prevent the disease, and if infection occurs, the signs will be mild and will not lead to dangerous consequences for the body. There is a vaccine that prevents the occurrence of pneumonia.

The main manifestations of the disease

Inflammation of the lungs is most often the result of a respiratory disease.

If these symptoms appear, you should immediately consult a doctor. The condition of the baby can worsen at any time.

Description of the disease

Lung disease can be caused by various viruses, bacteria, fungi. The most common causative organism is pneumococcal infection.

There are cases when children are already born with pneumonia, or it occurs in the first days after birth. Symptoms are the same as with other pathogens of pneumonia. At risk are, first of all, premature children, since one of the causes of premature birth is infection of the amniotic fluid. In the future, there is a high risk that the lower respiratory tract of the baby will suffer with a cold.

The doctor must prescribe additional examinations to determine the pathogen. From this will depend on the further plan of therapeutic measures. Even if pneumonia was caused by a virus, a bacterial infection very often joins. That is why, especially in the treatment of infants, antibiotics are immediately started along with antiviral drugs.

Inflammation can capture a small area of ​​\u200b\u200bthe lungs - then they talk about a focal lesion. In the event that the disease covers a whole lobe of the lungs, the diagnosis is made - lobar pneumonia. Symptoms of the disease in the latter case are much more pronounced.

During pneumonia, the function of gas exchange in the lungs is disrupted. The body begins to experience a lack of oxygen necessary for the normal functioning of all organs. In addition, the waste products of harmful microbes poison the child's body. There are symptoms of intoxication: nausea, loss of appetite, pain in the head and abdomen, fever.

During illness, antibodies act to protect the body. One of the symptoms of the "struggle" is an increase in temperature. If it remains high for several days, danger arises. The metabolism in the child's body is disturbed, inflammation can spread to other organs. There are changes in the brain that lead to seizures.

Diagnostic measures

Treatment of pneumonia should be carried out under the strict supervision of medical personnel in a hospital where the necessary examination will be carried out.

• Analysis of blood, urine.
• X-rays of light.
• Abdominal ultrasound.

An additional examination of all organs is necessary in order to determine the extent of the spread of the disease.

Features of therapeutic measures

• Antibiotics are the basis of all therapy. Babies are given injections.
• Inhalation using a nebulizer with the addition of medicines that improve the functioning of the respiratory organs.
• Droppers may be given intravenous administration medicines containing glucose, saline solutions and other components.
• Antipyretic drugs.
• Antiviral drugs.
• Drugs that increase immunity.
• Vitamin complex.
• Drugs that improve the intestinal microflora.

The dosage and duration of medication is determined only by the doctor. He, taking into account the condition of the child, the severity of the disease, his age, will determine the plan of therapeutic measures.

Possible complications of the disease

In the event that the treatment was prescribed correctly and on time, the disease gradually disappears. No risk of overgrowing acute form disease into a chronic one.

• AT inflammatory process all areas of the lung, including the pleura, may be involved. The pleura is the membrane that covers the lungs. Inflammation of the pleura is called pleurisy.
• There may be swelling of the tissue, which leads to the development of pulmonary insufficiency.
• In rare advanced cases, tissue death occurs.

The acute course of the disease lasts approximately 1 month. lingering pneumonia lasts more than 1 month.

Preventive measures

The pneumococcal bacterium can cause serious illness: otitis media, pneumonia, arthritis, pleurisy, meningitis. This bacterium makes itself felt after illnesses (flu, measles). Vaccination, for example, the preventive vaccine Prevenar, acts as a preventive measure.

The vaccine is given from the age of three months of a child's life. In the future - at 4.5 months, 6 months. At 1.5 years - vaccination revaccination.

The vaccine is well combined with other administered drugs, except for BCG. Already by the age of two, a child develops immunity to pneumococcal bacteria.

Side effects after having been vaccinated with Prevenar.

• At the injection site, pain may be felt, there may be induration, swelling, redness.
• In rare cases, there may be an increase in temperature.
• Capriciousness, refusal to eat, sleep disturbance.

All these signs pass quickly, leaving no consequences.

The vaccine should not be given in the following cases.

• Allergic reaction to vaccine components.
• Signs of colds.
• Exacerbation of chronic diseases.
• A slight increase in the temperature of the child.

Vaccination against pneumococcal infection in these cases is delayed for some time. Allergy is an exception. In this case, vaccination is cancelled.

Pneumonia is serious illness which is difficult for infants to tolerate. It is important for parents to protect the child from various kinds of infections. Properly organized daily routine will help to avoid such a problem.

Neonatal pneumonia is an inflammatory process localized in the lungs that occurs within 4 weeks from birth. Unlike childhood pneumonia, this disease has a number of features associated with the process of infection, diagnosis and treatment. Given the danger of inflammation of the lung tissue, it is important to know about the nuances of this disease in newborns.

Forms

Pathogens

If the infection occurred in utero, it was caused by viruses that can penetrate the blood-brain barrier. Such provocateurs of the inflammatory process are called TORCH pathogens. In order to minimize the risk of disease in the newborn, the obstetrician usually refers the patient to a blood test to identify:

• herpesvirus;
• cytomegalovirus;
• toxoplasmosis;
• syphilis;
• listeriosis;
• togavirus.

In late pregnancy or directly during labor, the following microorganisms can enter the child's body from the mother:

• fungi (candida);
• trichomonas;
• ureaplasma;
• chlamydia;
• mycoplasmas.

In the maternal body, they may be present as a result of acute or chronic pathologies of the genitourinary, respiratory or digestive system. Sometimes they can be asymptomatic, which is why it is so important to carefully monitor your health before and during a planned pregnancy.

Causes of pneumonia in newborns

Pneumonia can be classified into 2 categories:

• intrauterine;
• neonatal.

The cause of intrauterine pneumonia is infection of the fetus from the mother's body. In addition to TORCH infection, somatic pathology can be provoked by underdevelopment of the lung tissue, which happens if a pregnant woman encounters urinary infections. There is also a high probability of illness in a child if a woman has had an acute viral or bacterial infection, especially in late pregnancy.

Neonatal pneumonia, which develops after the birth of the baby, is divided into early and late.

1. The cause of early pneumonia is an infection that occurs when the infant's body interacts directly in maternity hospital Staphylococcus, Klebsiella, Pseudomonas aeruginosa or coli. immune cells mothers who protect the body of a newborn until six months old usually prevent infection, but its risk is still high, especially if the baby was born prematurely.
2. Late pneumonia develops outside the walls of the hospital, at home. It occurs after discharge from the maternity ward up to 4 weeks. A pathogenic microorganism enters the child's body, and if the immune system cannot cope with the antigen, it begins to actively develop in the lung tissue, provoking the appearance of signs of the clinical picture of pneumonia.

Features of the course of the disease in newborns

The extent to which the clinical picture of pneumonia in a newborn will correspond to the classical variant of the course of the disease depends on a number of factors, which include:

• full-term baby;
• the degree of maturity of its organs and systems;
• the presence of other pathological processes.

However, as a rule, the clinical picture has a number of features that distinguish neonatal pneumonia from the course of the disease in an adult or older child.

1. After the inflammatory process occurs in the body, the symptoms do not appear immediately, but only after a few hours, sometimes several days.
2. Usually, pneumonia in an adult begins with a sharp rise in temperature, but in a newborn, the immune system has not yet been formed and cannot give the necessary immune response in the form of an increase in body temperature, so the first symptoms of pneumonia in children are weakness and drowsiness.
3. In most cases, children are diagnosed with a small-focal type of inflammation, which is almost impossible to recognize by listening to the chest organs with a stethoscope. Therefore, it is possible to understand that the pathological process is localized precisely in the lungs only after the appearance of the corresponding symptoms: cough, shortness of breath, frequent breathing.
4. Any catarrhal phenomena: cough, runny nose, sore throat, are absent in the viral etiology of pneumonia in newborns.

Risk factors

The following factors significantly increase pneumonia in newborns:

Symptoms of pneumonia in a newborn baby

If the infection occurred in utero, no signs of the disease appear before birth, since until the moment the child is born and takes the first breath, his lungs do not function. After the child is born, the clinical picture of the pathology begins to develop within a few hours.

It is important to know exactly what signs indicate intrauterine pneumonia:

• the baby is weak, does not cry or the cry is weak;
• hypoxia leads to damage to the nervous system, so congenital reflexes are weakly expressed (food, orientation, protective);
• breathing is frequent and shallow due to the fact that the body wants to compensate for the lack of oxygen in the tissues;
• the heartbeat is speeded up, the sternum sinks when inhaling;
• the baby has no appetite;
• body temperature rises rapidly, convulsions may occur;
• the baby's skin is pale, grayish.

If infection with the causative agent of pneumonia occurred after birth, the symptoms of the disease practically do not differ from congenital:

• the child is capricious, cries a lot;
• body temperature rises;
• shortness of breath occurs.

How exactly pneumonia will develop in a baby depends on the pathogen, but usually intoxication is quite pronounced and is the prevailing symptom.

Severity

The severity of pneumonia is assessed by clinical signs, and the evaluation criteria differ little from the classification of the severity of pneumonia in adults.

Features of pneumonia in premature babies

Premature babies develop pneumonia much more often than full-term babies, both congenital and neonatal.

The course of the disease in premature newborns is characterized by a number of features:

• the clinical picture of the newborn is dominated by non-specific signs of the disease: weakness, lethargy, impaired sucking and swallowing reflex;
• inhibition of the sucking and swallowing reflex in an infant leads to a decrease in its body weight;
• body temperature against the background of infection in premature patients not only does not increase, but often decreases (hypothermia);
• the baby is dominated by signs of toxicosis, and only after a few days are signs of respiratory failure detected;
• complications after pneumonia suffered at birth after a premature pregnancy in an infant are very common, especially bronchopulmonary dysplasia.

Diagnosis of pneumonia in newborns

Diagnosis always begins with anamnesis. The doctor asks the child's mother what chronic diseases she suffers, what is the likelihood that the child was hypothermic or overheated, was next to people who could be a source of infection.

During the examination, the doctor performs the following actions:

• evaluates the degree of pallor of the baby's skin;
• listens to the lungs for wheezing;
• taps the lungs to find the location of inflammation by a shortened sound.

If the suspicion of pneumonia is confirmed, the child is immediately hospitalized in a hospital (infectious diseases department). There, the diagnosis of a newborn is carried out using:

• clinical blood test;
• urinalysis;
• sowing mucus from the nasopharynx with the detection of sensitivity to different groups of antibiotics;

Treatment

If pneumonia is suspected, the newborn should be immediately hospitalized in the infectious diseases department. It is strictly forbidden to independently diagnose and treat a pathology, since inflammation localized in the respiratory system of an infant, in case of incorrect or untimely treatment, can lead to death.

Mode and nutrition

In a hospital, the most comfortable conditions are provided for the baby: a microclimate is created that does not allow either hypothermia or overheating of the child. Patient care includes the necessary hygiene procedures, as well as regular changes in the position of the child.

The nutrition of a newborn with pneumonia is an important topic, because a violation of respiratory activity inhibits the baby's sucking reflex. And until the activity of the bronchopulmonary system is fully restored during proper treatment, the baby must be fed through a tube: mother's milk or a special mixture. The calorie content of the daily diet is reduced, but the number of feedings per day must be increased.

Antibiotic therapy

Taking antibiotics is the main method of treating pneumonia in patients of any age, including newborns. The purpose of a particular medication depends on the causative agent of the disease, the type of pneumonia (congenital, early, late).

• Until the moment the causative agent of pneumonia is detected, broad-spectrum antibiotics are used: Cefuroxime, Amoxicillin.
• In pneumonia, cephalosporins (Cefotaxime) and macrolides (Erythromycin) have proven their effectiveness.

After 72 hours, it will be possible to evaluate the effectiveness of the drug, and if the health of the newborn patient has not improved, the prescription is adjusted taking into account new diagnostic data.

With congenital and early type of pneumonia provoked by group B streptococci, Klebsiella, Listeria, Escherichia coli and Staphylococcus aureus, the following are prescribed:

• Ampicillin plus aminoglycoside (Amicin);
• Amoxicillin and clavulanic acid (Amoxicav, Augmentin), plus an aminoglycoside (Amicacin);
• Ampicillin and sulbactam (Sultasin, Unazine), plus an aminoglycoside (Amicacin).

This treatment regimen has a high degree of effectiveness, but in case of low dynamics of recovery or in the presence of contraindications, Cefotaxime with Amikacin can be prescribed.

With late pneumonia in newborns, provoked by infection with Pseudomonas aeruginosa, enterobacteria and Staphylococcus aureus are assigned:

• Ceftazidime or Fortum;
• Cefoperazone or Cefobid;
• antipseudomonal penicillin (Carbenicillin, Azlocillin).

The drugs are also prescribed together with an aminoglycoside.

Only a doctor can prescribe antibiotics. All drugs for newborns are taken by injection.

Detoxification therapy

Intoxication of the body is one of the most dangerous phenomena during pneumonia in a newborn child. The purpose of detoxification is to remove from the body toxins formed as a result of the presence and reproduction of pathogenic organisms in the body.

• With moderate intoxication, newborns only need to maintain water and electrolyte balance, which is ensured by the constant administration of fluid intravenously by drip or through a nasogastric tube.
• In severe intoxication, the method of hemodialysis, plasmapheresis is used - the purification of blood or plasma from toxins, followed by return to the bloodstream.

Violation of the respiratory process as a result of pneumonia entails hypoxia or oxygen starvation - an extremely dangerous phenomenon for health and life. You can compensate for the lack of oxygen in the body with the help of oxygen therapy, when pure oxygen or a gas with a high level of oxygen content is supplied to the respiratory tract. For newborns, only the second option is used, since pure oxygen can cause eye damage.

It helps:

• reduce pulmonary edema;
• activate the respiratory system;
• positively affect the molecular characteristics of the blood.

Oxygen gas is given through nasal cannulas, a mask (there is a risk of aspiration from vomit), or by placing the person in an oxygen tent. In severe cases, an apparatus for artificial lung ventilation (ALV) is indicated.

Probiotics

Probiotics for newborns during the treatment of pneumonia are necessary to restore bowel function due to antibiotic therapy.

For treatment are used:

• Bifidumbacterin;
• Bifiform Baby;
• Biovestin;
• Linex;
• Narine.

The drug is added to breast milk or special mixtures.

Treatment of cardiovascular insufficiency

Cardiovascular insufficiency often becomes a complication of severe pneumonia. Its signs can occur within a few hours after the onset of the disease, subject to severe intoxication and dehydration.

Treatment of heart failure should be carried out immediately by an experienced physician. Therapy requires:

• intravenous prednisolone or hydrocortisone;
• plasma and 5% albumin intravenously.

With inefficiency - drip administration of dopamine, artificial ventilation of the lungs.

Symptomatic treatment

Symptomatic treatment aimed at alleviating the patient's well-being with pneumonia includes the normalization of temperature and sputum thinning.

1. Antipyretic drugs should not be used up to the mark on the thermometer at 39 degrees to enable immune system fight the disease. The exception is the risk febrile seizures- in this case antipyretic drug is given to a newborn already at a temperature of 37.5 degrees.
   Paracetamol or nimesulide are used as a means to normalize body temperature. Aspirin is strictly contraindicated.
2. The removal of bronchial secretions from the lungs is facilitated with the help of mucolytics:

• Ambrobene;
• Bromhexine.

Newborns can receive any drugs for symptomatic treatment only under the strict supervision and supervision of a doctor.

Treatment of the mother of the child while breastfeeding

For a newborn child, use drugs during treatment traditional medicine it is impossible, but his mother can do this if she feeds him with breast milk. Useful substances will be transferred to the baby's body during breastfeeding and are likely to speed up the healing process.

Thus, you can apply:

• 30 g of lime leaves, 30 g of viburnum berries, 1 liter of boiling water; drink the resulting tea 50 ml throughout the day;
• regular tea with the addition of raspberries, fresh or dried;
• pour 60 g of wild rosemary and coltsfoot leaves with a liter of boiling water; take twice a day, 50 ml of decoction.

Methods of treating a newborn with enrichment useful substances breast milk mothers are famous in homeopathy. But the effectiveness of this branch of medicine is not scientifically proven.

Complications and consequences

What are the consequences of pneumonia in infancy:

• The danger of pathology lies mainly in the intoxication of the body. Exposure to toxic microbial decay products can be fatal if the child is not given proper medical care.
• Another dangerous complication pneumonia is bronchopulmonary dysplasia, that is, damage to the tissues of the organ and small bronchi. This entails a breach respiratory function, hypoxia of the whole organism. Subsequently, the risk of repeated, recurrent, pneumonia is very high.
• An extrapulmonary complication is cardiovascular insufficiency, sepsis, asthenic syndrome, delayed diuresis.

Prevention

Prevention of pneumonia in newborns is a set of measures that must be taken even before the conception of a child. The list of preventive measures includes:

• complete medical examination before a planned pregnancy;
• carrying out all the necessary blood tests during the bearing of the baby;
• if possible, choose natural childbirth, and not caesarean section;
• give preference breastfeeding rather than using formula for feeding;
• avoid crowded places during epidemics.

A healthy lifestyle during pregnancy and proper care of the newborn significantly reduces the risk of pathology.

Forecast

The prognosis of pneumonia in newborns is favorable with timely initiation of treatment (on the first day). The prognosis for premature babies is the least favorable - they have a higher mortality rate.

Conclusion

Pneumonia in a newborn is a disease provoked by pathologies that occur against the background of pregnancy or childbirth, as well as improper care of the child in the first days of his life. Pneumonia, like its complications, is very dangerous, so it is extremely important to take all measures to prevent it. And in case of illness, immediately consult a doctor.