Bronchitis in a newborn: obstructive, without temperature, acute, allergic

Bronchitis in a newborn is an inflammation of the bronchi with a violation of normal breathing and the corresponding symptoms. This disease in the newborn very quickly flows and can become an impetus to the development of pneumonia, so it is important to know about the symptoms of the disease and the main principles of diagnosis.

[1], [2], [3], [4], [5], [6], [7], [8], [9]

Epidemiology

Statistics of the distribution of bronchitis suggests that this disease ranks first among infants and the second among infants among infectious lesions of the respiratory system. About 23% of newborn babies face bronchitis in the first month of life. In infants this pathology occurs in almost every child until the child reaches one year of life.

[10], [11], [12], [13], [14], [15], [16], [17]

Causes of the bronchitis in infants

Bronchitis is an inflammatory process in bronchuses of various calibres - from the smallest to the largest bronchi. It occurs due to the development of infectious inflammation in the epithelium of the bronchi in the case of an infectious agent. Therefore, the main reason and even the obligatory factor of such a disease is an infectious agent.

The causes of bronchitis in a newborn are presented by both viruses and bacteria. The primary cause of bronchitis in a newborn is often various viruses, with which the child meets immediately after discharge from the hospital or during the first month of life. The cause of the development of the inflammatory process of the respiratory system involving bronchial tubes in newborns and infants is: in infants and preschool children, the respiratory syncytial virus and adenovirus; parainfluenza virus, cytomegalovirus; rhinovirus; influenza virus; mycoplasma.

Primary symptoms can be caused precisely by these pathogens. Features of the structure of the bronchi in newborns are such that they are very narrow and, with their inflammation, the process can quickly spread further. In this case, the bacterial flora can join and then it already causes bronchitis. If untimely initiation of treatment, this can also be the reason that bacteria can join. Among the bacterial flora the most common: E. Coli, various strains of staphylococci and streptococci.

Industrial pollution of atmospheric air, cooling or sharp overheating, passive smoking - all these influences can become the basis for the development of inflammatory changes in bronchi in newborns and infants.

[18], [19], [20], [21]

Risk factors

Risk factors for bronchitis:

1. premature babies have lower immunity in order to prevent the development of infectious lung lesions;
2. children on artificial feeding do not receive immunoglobulins and protective factors that are present in the milk of the mother, which reduces the protective activity of the child;
3. children with asphyxiation in childbirth have a weak development of the respiratory system;
4. congenital pneumonia can become a factor in the development of frequent bronchitis later in infants;
5. congenital heart defects or ENT-organs create conditions for the persistence of sources of infection;
6. children with low birth weight;
7. congenital or acquired immunodeficiencies;
8. The presence of other children in the family increases the likelihood of more frequent morbidity due to epidemics.

[22], [23], [24], [25], [26], [27]

Pathogenesis

At the heart of pathogenetic mechanisms of bronchitis development in newborns and infants is the defeat by microorganisms that damage the epithelium at the site of penetration, which suppresses the barrier abilities of the bronchi. The ingress of viral or infectious factors contributes to the fact that the integrity of the epithelium is violated at the site of entry and the protective immune forces are activated in response to such a reaction. There is activation of immune cells - neutrophilic leukocytes, macrophages, eosinophils. These cells secrete biologically active substances - prostaglandins, histamine, which have a variety of pathophysiological effects, they increase the cause of edema and increased transit of intercellular fluid into the cavity of the bronchus. As a result, mucociliary clearance and active air movement in the lungs are disrupted. In this case, hyperproduction of viscous bronchial secretion occurs, which becomes dominant in clinical manifestations and in the maintenance of the infectious process in the bronchi. Epithelium of the bronchial tree is not able to provide adequate drainage of mucus from the bronchi, and the accumulation of viscous mucus contributes to its even greater infection, inhibition of ciliary activity and impairment of ventilation and respiratory functions of the lungs. Mophologically, during the multiplication of viruses, the destruction of epithelial cells appears, the bonds between cells are broken and they are destroyed. All this secret together with the fallen epithelium is evacuated to the cavity of the bronchus, which further disturbs the normal outflow of phlegm and further narrows the lumen of small and large bronchi.

This pathogenesis affects the development of symptoms, causing all clinical manifestations almost simultaneously.

[28], [29], [30], [31], [32], [33], [34], [35]

Symptoms of the bronchitis in infants

Symptoms of bronchitis in a newborn usually begin with a simple virus infection of the upper respiratory tract - with rhinitis, pharyngitis, less often with laryngitis (inflammation of the larynx), tracheitis, conjunctivitis. A newborn baby is most of the time, which contributes to the fact that infection from the nasal cavity quickly spreads to the bronchi with the development of inflammation there.

The first signs of bronchitis depend on the etiological factor. Usually the first symptoms of bronchitis are weakness of the child, lethargy, capriciousness, anxiety, and after a while the body temperature rises. Together with these manifestations, other symptoms of intoxication quickly appear. The child begins to eat poorly, is capricious, does not sleep, there is a cough. Cough is the main symptom of this disease. With initial changes, the cough has a dry character, and from the 4th to the 6th day of the disease it becomes wet. But this pattern of symptoms is more typical of infants, but in newborns, cough is always wet. Sometimes this cough is accompanied by discomfort or even pain in the chest, which becomes worse with a cough. When you cough, you have mucous sputum first, and after a few days of illness it can have a greenish tinge. The cough can last from 2 to 4-6 weeks.

Depending on the type of bronchitis, there are certain differences in the symptomatology and the degree of its severity.

When obstructive bronchitis in a newborn cough can be expressed slightly, then one of the main symptoms is shortness of breath. When large areas of bronchial tissue become inflamed, the baby's lungs can not compensate for oxygen deficiency, so additional musculature is connected. Shortness of breath in the baby with bronchitis manifests pallor of the skin and cyanosis around the mouth, which appears when the child is restless. In addition, additional muscles participate in the act of breathing - you can notice the child's swelling of the wings of the nose, retraction of the supraclavicular areas. Symptoms of dyspnea appear even with more severe bronchitis, when together with the blockage of the bronchi occurs their spasm. In this case, we are talking about obstructive bronchitis. Obstructive bronchitis in a newborn is characterized by intoxication manifestations, a violation of the general condition, hyperthermia.

How long does the bronchitis last for the baby? Acute bronchitis in infants lasts up to three weeks, and if the process is more than three weeks, it is a protracted bronchitis. At the same time, there are different stages of the disease that the child undergoes. The first three to five days there is an active inflammatory process in the bronchi and the child can be highly fever. A feature of bronchitis in newborns is that their temperature may not rise because of the immaturity of the center of thermoregulation. Therefore, when it comes to newborns, then hyperthermia is not their main symptom. Bronchitis with fever lasts up to five days, then under the influence of treatment the disease passes to the next stage of evacuation of the inflammatory secretion in the bronchi. At the same time, the temperature should be normalized, while the cough becomes moist. The next stage can be considered recovery, when the inflammatory process is extinguished and the cough is removed, and the epithelium in the bronchi is restored.

Bronchitis without a cough in the baby is also found, mainly in children up to six months. They still do not sit and most of the time they lie, which does not allow them to cough normally. Therefore, such an active cough as an adult, these children may not be, which does not exclude his bronchitis.

Viral bronchitis in infants is most common and is a continuation of the virus infection of the upper respiratory tract. It is accompanied by a weak severity of intoxication syndrome and within a week almost all symptoms can be resolved. If the bacterial flora is attached, the process is accompanied by a cough with purulent sputum and often a high temperature.

There is another type of bronchitis - allergic or asthmatic. Allergic bronchitis in infants, as a separate diagnosis, do not mark. But in children with atopic dermatitis and a tendency to allergies in the family, the risk of developing such asthmatic bronchitis is very high. In this case, cough is always dry or unproductive without raising the temperature of the body and the effects of intoxication. It occurs when the allergen acts and can be spasmodic.

[36], [37], [38], [39]

Complications and consequences

The consequences of bronchitis can be in the form of infectious complications of local and systemic nature. The most frequent complication of bronchitis is the development of pneumonia, as the process immediately spreads to the alveoli. Local complications can be in the form of pleurisy development, and systemic complications can develop sepsis. Cough in the baby after bronchitis may still be a single up to three weeks, which is considered normal for the restoration of the bronchi. If the baby does not go through bronchitis for three weeks, then it is a question of its protracted character and it is necessary to exclude the foreign body of the bronchus.

[40], [41], [42], [43], [44], [45], [46], [47], [48]

Diagnostics of the bronchitis in infants

Diagnosis of bronchitis in a newborn should begin with anamnestic data and clarify the nature of the cough, its duration, the presence of hyperthermia. All these symptoms are very important not only for diagnosis, but also for starting treatment.

When examining a child with the phenomena of simple uncomplicated bronchitis, as a rule there are no manifestations of shortness of breath or respiratory disorders. Dyspnea occurs only with obstructive bronchitis, which already makes it possible to talk about a preliminary diagnosis. With percussion, pulmonary sound is determined over the entire surface even in places with a tympanic tinge. At auscultation, the variability of the picture is listened: dry, and over time, moist medium vesicles in inspiration, as well as hard breathing. Chrypses are often scattered, diffuse, bilateral.
In obstructive process in the bronchi, wheezing is also from both sides, but they are dry wheezing on exhalation. Sometimes even when the child lies, you can hear that he "whistles." After examining the child, you can see that there is a bloating of the chest and an entrainment of the dodgy places of the chest, that is, pronounced dyspnea.

Analyzes for bronchitis that need to be performed are a blood test for determining the etiology of bronchitis and excluding infectious lesions with a bacterial flora. In laboratory examination, changes in the general blood test are manifested by an acceleration of the ESR, with a normal or reduced number of leukocytes. Depending on the etiological factor (viral or bacterial flora), the parameters of white blood - stab and segmented nuclear neutrophils in bacterial etiology, or lymphocytes in viral - have been changed.

Instrumental diagnosis of bronchitis is not carried out, but with the complexity of differential diagnosis with pneumonia, it is sometimes necessary to perform lung radiography in different projections.

At X-ray examination of anterior rectal projection symmetrical enhancement of the bronchial tree pattern is observed due to bronchopulmonary structures; infiltration of the root of the lungs.

In obstructive bronchitis, the low stance or flatness of the diaphragm domes is radihenologically visible when the bronchial tree pattern is bilaterally strengthened. There is also an increase in the transparency of the lung fields, an increase in pulmonary fields, the location of ribs of a horizontal nature, that is, signs of bloating.

[49], [50], [51], [52], [53], [54], [55], [56], [57]

Differential diagnosis

Differential diagnosis of bronchitis in a newborn and infants should be carried out primarily with pneumonia. Bronchitis and pneumonia in infants have similar symptoms, the difference is only in the radiological picture, so it is very difficult to differentiate these two pathologies. On x-rays, pneumonia will have foci of infiltration of the lung tissue, and in bronchitis only signs of an expansion of the roots of the lungs.

Also, bronchitis needs to be differentiated with the foreign body of the respiratory tract. It is also accompanied by a cough, but coughing occurs suddenly without previous intoxication and fever. If there is a prolonged cough for more than three weeks without signs of positive dynamics, then in order to exclude a foreign body, bronchoscopy is performed.

Differential diagnosis of obstructive bronchitis should be carried out with stenosing laryngitis, congenital stridor, intrathoracic neoplasm, congenital malformations of the bronchopulmonary system, cystic fibrosis attacks of bronchial asthma.

Treatment of the bronchitis in infants

Treatment of bronchitis in a newborn is usually done at home, only in the presence of complications or in babies of premature babies, it is possible to carry out treatment in a hospital.

The regimen is a bed for the duration of the fever, which means for both the newborn and the baby not to walk outdoors and not bathe the baby until the fever keeps up. In the future - a sparing regime without contact with sick children. The newborn should receive only breast milk. Food for babies with bronchitis should be increased by 10-15% in calorie content, thermally and mechanically sparing. The protein content in the diet also increases by 10-15%, the diet should be enriched with calcium, vitamins (fruit drinks, sour juices), fruits, vegetables, if the child's age allows. If the kid in case of illness does not want to eat anything other than the breast, then do not force him. In a febrile period, it is useful to drink a lot 1.5-2 times the age norms. For newborns, it can be just watering in half a teaspoon, and for babies use tea with ginger, water with lemon, mineral still water, children's water, mors, of course, given the child's allergies.

Etiotropic therapy begins with taking into account the viral nature of bronchitis, so the modern strategy is precisely the use of specific antiviral drugs. It should be noted that this therapy is effective only in the first two days of the disease, as well as in the prevention of contact persons.

1. Nasoferon  is a drug of leukocyte interferon that is used for the purpose of a specific antiviral effect. Method of administration - in both nasal entrances in the form of drops for newborns and you can use a spray for babies. Dosage - one drop or one spray spray five times a day. Side effects are very rare.
2. Antifungal immunoglobulins  are administered in the first 2-3 days of the disease, intramuscularly, once in a dose of 0.1-0.2 ml / kg. Indications for its use are the severe course of bronchitis caused by the influenza virus with neurotoxicosis. Side effects can only be at the injection site in the form of seals and soreness. Precautions - for newborns is used only with confirmed influenza.
3. A DNAase solution  is a specific preparation that is effective against viruses containing DNA. When adenovirus infection is used this drug in the form of drops. Dosage for newborns - 2 drops in each nasal passage and in the eye sockets every 2 hours. Side effects are very rare.

Symptomatic methods of treatment are also very important:

• Means for improving the rheology of sputum and its better separation contribute to faster evacuation of bronchial secretions. Such preparations can be used in the form of syrups or inhalation.
• Drugs that reduce cough due to the effect on its central mechanisms in children up to a year, and even more so in newborns are practically not used.
• Antiallergic agents can be used in children with atopic dermatitis, against which bronchitis and dry cough developed.
• Vitamin funds can be used in the period of convalescence.
• An increase in body temperature above 38.5 requires the administration of antipyretic drugs.

1. Drugs that reduce cough can not be widely used because it is a protective reaction that helps to remove sputum from the respiratory tract. In newborns, such drugs generally only on strict indications. The use of expectorants stimulates cough reflex. With the dry nature of cough in children from one month, you can apply Gerbion with Icelandic moss. Assign 5 milliliters three times a day. A simple means for use in children is Ambroxol, which is used in the same dose. Mucolytics are widely used  Acetylcysteine  is a drug that affects the sputum gel phase and thus dilutes it. This drug is available in convenient forms, for oral as well as parenteral administration, as well as for inhalation. Assign it at a rate of 15-20 mg / kg / day in 4 divided doses. Side effects can be in the form of allergic manifestations and strengthening of cough. For newborns, the most acceptable method of application is inhalation.
2. Reduces the severity of edema and inflammatory phenomena of the bronchial epithelium preparation on the basis of the erupal  Bronchomax. This drug is able to reduce the inflammatory response by disrupting the activation of inflammatory cytokines. This leads to a decrease in the amount of histamine in the source and reduces edema. For the newborn, the drug is not used. For babies, the dosage is 5 milligrams per kilogram of body weight.

Antibiotics for bronchitis in infants are used only in certain conditions. There are cases when a severe degree of the disease is visually determined and the use of active antibacterial therapy is necessary:

1. cough in a newborn for three days,
2. signs of shortness of breath in the first six months of life;
3. high degree of intoxication with violation of a child's sleep;
4. frequency of respiratory movements is more than 50.

When choosing antibacterial therapy, you should give preference to such modern drugs: Augmentin, new macrolides (Rulid, Rovamycin, Azithromycin, Clarithromycin), oral cephalosporins of the 2nd-3rd generation.

Inhalation of bronchitis in infants can be carried out both at home and in a hospital. To do this, use Neutamol, Ventolin, Nebuftuson. Especially important are inhalations in the therapy of the obstructive component of bronchitis. Very often in complicated cases, drugs with an effect on bronchial adrenoreceptors are used, which leads to their prolonged expansion and achievement of sufficient mucus evacuation. The drug salbutamol is used in a dosage of 0.1 milligrams per kilogram of body weight with dilution of this preparation with physiological solutions one to one. Inhalations of drugs should be given to young children through spacers with a mask or with the help of nasal cannula, which will reduce the toxic and systemic effects of sympathomimetics.

Pulmicort for bronchitis in infants can be used no more than twice a day as a means of emergency therapy with a pronounced obstructive component. The drug contains a hormone that quickly removes inflammation in the bronchi and relieves a fit of coughing. Such inhalations are not recommended for more than two days. Prednisolone infants with bronchitis can be administered only in a hospital to provide emergency care.

Euphyllinum infants with bronchitis may be prescribed in a hospital much less frequently than previously used, because there are other more effective and less dangerous drugs for children. Euphyllin is prescribed at a rate of 3-5 milligrams per kilogram of drip on a saline single dose. Supportive doses are already calculated individually.

Vitamin preparations can be used in the form of multivitamin complexes when the child begins to recover to maintain his strength and energy reserve of the body. Antiallergic agents can be used only in children with atopic dermatitis or with wet rales, since these drugs have the ability to "dry out" the mucous membranes.

Physiotherapeutic treatment of bronchitis in the hospital provides for the appointment in the acute period - infrared irradiation, microcurrents, electrophoresis with resorbable solutions.

Massage for newborns with bronchitis is very important, because the child is constantly lying and can not self-cough up the whole secret.

Drainage massage with bronchitis infants also helps to withdraw the entire secret and speeds up recovery. How to massage a baby with bronchitis? It needs to be put on the back and with light movements of the hands to knock the ribs in parallel several times. Then massage movements need to pat the skin in the direction from the waist to the neck. These are the most simple massage movements that a mother can do up to three times a day, and then abuse the child vertically.

Alternative treatment of bronchitis

Alternative methods of treatment very widely can be used as infusions of herbs. But if the baby is a newborn, then this treatment is limited, since it is not recommended to give herbs to avoid allergic reactions. In such a case, such methods of treatment can be used by the mother if she is breastfeeding. Alternative methods of treating bronchitis in infants can be used a bit wider.

1. Make infusion of herbs. To do this, you need to take a herb of licorice, Icelandic moss and a burdock root for every forty grams. These herbs are steamed in 100 - 200 milliliters of boiling water and takes a mom a tablespoon of infusion 5 times a day or for a baby half a teaspoon every hour.
2. Flowers violet trichthorn and thyme, leaves elecampane 30 grams, the fruits of sea buckthorn - 10 g. From this make infusion, pouring all the glass of hot water. Take half a cup twice or put on a teaspoon for a child.
3. For a better expectorant effect, such a collection is used: sosonka - 10 grams, Labrador tea - 20 grams, pine bark chips - 5 grams, St. John's wort - 40 grams. A mixture of these herbs knead, one part is poured hot water with a hundred milliliters and insist 10 minutes. For treatment, you should drink half the tablespoon in the morning and evening.
4. In the future, when cough softening is achieved, an infusion of thermopsis-mushchatnik is used. To do this, for 100 grams of grass you need to add one hundred grams of honey and the same amount of boiling water. It must take a month to take and take two drops for the baby on an empty stomach.
5. Breastfeeding - linden, licorice, mint, altaika and cowshed must be mixed in equal parts and made tea. Leaves and roots are ground and one teaspoon is brewed in 200 milliliters of boiling water. After insisting, they drink tea instead of tea during the day.

Homeopathy in the treatment of bronchitis in infants can also be used.

1. Mercurius is a homeopathic remedy that is especially effective in children with a prolonged and pronounced dry cough. Dosage of the drug for children can be three granules, which must first be dissolved in boiled water and the first week to apply three times a day, and then for another week until the cough disappears once a day. Side effects are in the form of rapid heart rate.
2. Ipecacuan is a homeopathic herbal remedy that is used to treat bronchitis in children and adults. It is used in children with a pale anemic complexion against the background of a pronounced moist cough with the release of a large amount of sputum. The drug is applied to the mother in a dose of one granule four times a day. Side effects can be a baby in the form of a stool.
3. Potassium Bichromicum is a homeopathic preparation of organic origin, which is used to treat bronchitis accompanied by a cough of asthmatic at night. Dosage of the drug for a child at the beginning of therapy - two pellets three times, and in more severe cases, the dose is doubled. There may be side effects in the form of drowsiness, sluggishness of the baby.
4. Arsenicum Albumum - used to treat bronchitis in children with allergies to medicines and food. Cough in such children is dry, irritating with poor separation of sputum. For the purpose of correcting this condition, one granule per day is used, which can be used for the baby, rastered, and given under the tongue. Side effects can be in the form of a cough boost for a while.

These are the main methods of treatment by alternative means, which can only be used on the recommendation of a doctor.

Surgical treatment of bronchitis is used very rarely, only in cases of advanced cases with the development of gangrene of the lung, which in modern medicine practically does not occur.

[58], [59], [60], [61], [62], [63], [64], [65], [66]

Prevention

Prevention of bronchitis in most cases is nonspecific and is aimed at correcting risk factors. If we are talking about bronchitis in a newborn baby, the main method of prevention is breastfeeding, the correct temperature regime in the room and avoid contact with patients.

[67], [68], [69], [70], [71], [72], [73], [74], [75]

Forecast

The prognosis of bronchitis for recovery is favorable, despite its etiology. Bronchitis in newborns can occur instantaneously with the development of complications, but despite this prognosis for recovery is also good.

Bronchitis in infants is the most common disease that affects children of the first year of life. Nevertheless, this pathology is fairly easy to diagnose and treat. Therefore, it is important to notice the first symptoms in time and contact the doctor.

[76], [77]