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

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

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Epidemiology

Statistics on the spread of bronchitis indicate that this disease ranks first among infants and second among newborns among infectious diseases of the respiratory system. About 23% of newborns experience bronchitis in the first month of life. In infants, this pathology occurs in almost every child until the child reaches one year of age.

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Causes bronchitis in a baby

Bronchitis is an inflammatory process in bronchi of various sizes – from the smallest to the largest bronchi. It occurs as a result of the development of infectious inflammation in the bronchial epithelium when an infectious agent enters. Therefore, the main cause and even an obligatory factor of such a disease is an infectious agent.

The causes of bronchitis in newborns are represented by both viruses and bacteria. The primary cause of bronchitis in newborns is most often various viruses that the child encounters immediately after discharge from the maternity hospital or during the first month of life. The cause of the development of the inflammatory process of the respiratory system involving the bronchi in newborns and infants are: in infants and preschoolers, respiratory syncytial virus and adenovirus; parainfluenza virus, cytomegalovirus; rhinoviruses; influenza virus; mycoplasma.

Primary symptoms can be caused by these pathogens. The structure of the bronchi in newborns is such that they are very narrow and when they become inflamed, the process can quickly spread further. Bacterial flora can join in and then it causes bronchitis. If treatment is not started in time, this can also cause bacteria to join in. Among the bacterial flora, the most common are: E. coli, various strains of staphylococci and streptococci.

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

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Risk factors

Risk factors for developing bronchitis:

1. Premature babies have a lower immunity to prevent the development of infectious lung lesions;
2. children on artificial feeding do not receive immunoglobulins and protective factors that are present in their mother’s milk, which reduces the child’s protective activity;
3. children with birth asphyxia have poorly developed respiratory systems;
4. congenital pneumonia can become a factor in the development of frequent bronchitis in the future 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 illness due to the epidemiological environment.

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Pathogenesis

The pathogenetic mechanisms of bronchitis development in newborns and infants are based on damage by microorganisms that damage the epithelium at the site of penetration, which suppresses the barrier capabilities of the bronchi. Penetration of viral or infectious factors contributes to the fact that the integrity of the epithelium is disrupted at the site of penetration and the protective immune forces are activated in response to such a reaction. Activation of immune cells occurs - neutrophilic leukocytes, macrophages, eosinophils. These cells secrete biologically active substances - prostaglandins, histamine, which have a variety of pathophysiological effects - they increase, cause edema and increased transit of intercellular fluid into the bronchial cavity. As a result, mucociliary clearance and active air movement in the lungs are disrupted. At the same time, hyperproduction of viscous bronchial secretion occurs, which becomes dominant in clinical manifestations and in maintaining the infectious process in the bronchi. The epithelium of the bronchial tree is unable to provide adequate drainage of mucus from the bronchi, and the accumulation of viscous mucus contributes to its further infection, suppression of ciliary activity and disruption of the ventilation and respiratory functions of the lungs. Morphologically, when viruses multiply, destruction of epithelial cells occurs, the connections between cells are disrupted and they are destroyed. All this secretion, together with the exfoliated epithelium, is evacuated into the bronchial cavity, which further disrupts the normal outflow of sputum and further narrows the lumen of small and large bronchi.

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

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Symptoms bronchitis in a baby

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

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

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

With obstructive bronchitis in a newborn, the cough may not be very pronounced, then one of the main symptoms is shortness of breath. When a large area of bronchial tissue is inflamed, the baby's lungs cannot compensate for oxygen deficiency, so additional muscles are involved. Shortness of breath in an infant with bronchitis is manifested by pale 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 baby's nasal wings flaring, retraction of the supraclavicular areas. Symptoms of shortness of breath appear with more serious bronchitis, when, along with blockage of the bronchi, their spasm occurs. In this case, we are talking about obstructive bronchitis. Obstructive bronchitis in a newborn is characterized by intoxication, a violation of the general condition, hyperthermia.

How long does bronchitis last in infants? Acute bronchitis in infants lasts up to three weeks, and if the process is already more than three weeks, then it is protracted bronchitis. At the same time, there are different stages of the disease that the child goes through. The first three to five days there is an active inflammatory process in the bronchi and the child may have a high temperature. A feature of bronchitis in newborns is that their temperature may not rise due to the immaturity of the thermoregulation center. Therefore, when it comes to newborns, hyperthermia is not the main symptom for them. Bronchitis with fever in infants lasts up to five days, then, under the influence of treatment, the disease moves to the next stage of evacuation of inflammatory secretion in the bronchi. In this case, the temperature should already normalize, while the cough becomes wet. The next stage can be considered recovery, when the inflammatory process subsides and is removed with a cough, and the epithelium in the bronchi is restored.

Bronchitis without cough in infants also occurs, mainly in children under six months. They do not sit yet and lie down most of the time, which does not allow them to cough normally. Therefore, such children may not have such an active cough as an adult, which does not exclude bronchitis.

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

There is another type of bronchitis - allergic or asthmatic. Allergic bronchitis in infants is not noted as a separate diagnosis. 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, the cough is always dry or unproductive without an increase in body temperature and intoxication. It occurs when an allergen acts and can be spasmodic.

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Complications and consequences

The consequences of bronchitis can be in the form of infectious complications of a local and systemic nature. The most common complication of bronchitis is the development of pneumonia, since the process immediately spreads to the alveoli. Local complications can be in the form of the development of pleurisy, and systemic ones - the development of sepsis. A cough in an infant after bronchitis can still be single for up to three weeks, which is considered a normal phenomenon of bronchial recovery. If an infant's bronchitis does not go away within three weeks, then we are talking about its protracted nature and it is necessary to exclude a foreign body in the bronchus.

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Diagnostics bronchitis in a baby

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

When examining a child with symptoms of simple uncomplicated bronchitis, as a rule, there are no manifestations of pronounced dyspnea or respiratory disorders. Dyspnea occurs only with obstructive bronchitis, which already makes it possible to talk about a preliminary diagnosis. Percussion reveals a pulmonary sound over the entire surface, even in places with a tympanic tint. Auscultation reveals a variability of the picture: dry, and over time, moist medium-bubble rales on inspiration, as well as harsh breathing. Wheezing is often scattered, diffuse, bilateral.
With an obstructive process in the bronchi, wheezing is also on both sides, but they are dry whistling on exhalation. Sometimes, even when the child is lying down, you can hear that he is “whistles”. After examining the child, you can see that there is swelling of the chest and retraction of the pliable areas of the chest, that is, pronounced dyspnea.

The tests for bronchitis that need to be done are blood tests to determine the etiology of bronchitis and exclude infectious lesions by bacterial flora. During 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 white blood counts are changed - band and segmented neutrophils in case of bacterial etiology, or lymphocytes in case of viral etiology.

Instrumental diagnostics of bronchitis is not performed, but when differential diagnostics with pneumonia is difficult, it is sometimes necessary to perform chest X-rays in different projections.

During X-ray examination of the anterior direct projection, a symmetrical enhancement of the bronchial tree pattern is observed precisely due to the bronchopulmonary structures; infiltration of the root of the lungs.

In obstructive bronchitis, radiologically, with bilateral enhancement of the bronchial tree pattern, low standing or flattening of the diaphragm domes is visible. There is also increased transparency of the lung fields, an increase in the lung fields, a horizontal arrangement of the ribs, that is, signs of pulmonary distension.

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Differential diagnosis

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

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

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

Treatment bronchitis in a baby

Treatment of bronchitis in a newborn is usually carried out at home, only in the presence of complications or in premature babies, treatment can be carried out in a hospital.

The regime is bed rest for the entire duration of the fever, which means for both the newborn and the infant, do not walk outside and do not bathe the child as long as the elevated body temperature persists. In the future, a gentle regime without contact with sick children. The newborn should receive only breast milk. Food for an infant with bronchitis should be increased in calories by 10-15%, thermally and mechanically gentle. 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 baby does not want to eat anything except breast milk during illness, then there is no need to force him. During the feverish period, it is useful to drink a lot, 1.5-2 times the age norm. For newborns, this can be just water, half a teaspoon, and for infants, use tea with ginger, water with lemon, non-carbonated mineral water, baby water, fruit drink, of course, taking into account 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 for prevention in contact persons.

1. Nazoferon is a leukocyte interferon preparation used for a specific antiviral effect. Method of application - in both nasal passages in the form of drops for newborns and you can use a spray for infants. Dosage - one drop or one spray injection five times a day. Side effects are very rare.
2. Anti-flu immunoglobulins are administered in the first 2-3 days of the disease, intramuscularly, once at a dose of 0.1 - 0.2 ml / kg. The indication for its use is severe bronchitis caused by the flu virus with neurotoxicosis. Side effects can only be at the injection site in the form of compaction and soreness. Precautions - for newborns, it is used only with confirmed flu.
3. DNAase solution is a specific drug that is effective against viruses containing DNA. For adenovirus infection, this drug is used in the form of drops. The dosage for newborns is 2 drops in each nasal passage and in the eyes every 2 hours. Side effects are very rare.

Symptomatic treatments are also very important:

• Means for improving the rheology of sputum and its better discharge contribute to a more rapid evacuation of bronchial secretions. Such drugs can be used in the form of syrups or inhalation.
• Medicines that reduce cough by acting on its central mechanisms in children under one year old, and especially in newborns, are practically not used.
• Antiallergic drugs can be used in children with atopic dermatitis, against the background of which bronchitis and dry cough have developed.
• Vitamin preparations can be used during the convalescence period.
• An increase in body temperature above 38.5 requires the administration of antipyretic drugs.

1. Medicines that reduce cough cannot be widely used because it is a protective reaction that helps remove sputum from the respiratory tract. In newborns, such drugs are generally only for strict indications. The use of expectorants stimulates the cough reflex. With a dry cough in children from one month old, you can use Gerbion with Icelandic moss. Prescribed 5 milliliters three times a day. Ambroxol is considered a simple remedy for use in children, which is used in the same dose. Among mucolytics, Acetylcysteine is widely used - this is a drug that affects the gel phase of sputum and thus liquefies it. This drug is available in convenient forms, both for oral and parenteral use, as well as for inhalation. It is prescribed at a rate of 15-20 mg / kg / day in 4 doses. Side effects can be in the form of allergic reactions and increased cough. For newborns, the most acceptable method of administration is inhalation.
2. Reduces the severity of edema and inflammatory phenomena of the bronchial epithelium, a drug based on Erespal 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 lesion and reduces edema. The drug is not used for newborns. For infants, the dosage is 5 milligrams per kilogram of body weight.

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

1. cough in a newborn for three days,
2. signs of shortness of breath in children in the first six months of life;
3. high degree of intoxication with sleep disturbance in the child;
4. respiratory rate greater than 50.

When choosing antibacterial therapy, preference should be given to the following modern drugs: Augmentin, new macrolides (Rulid, Rovamycin, Azithromycin, Clarithromycin), oral cephalosporins of the 2nd and 3rd generation.

Inhalations for bronchitis in infants can be carried out both at home and in hospital. Nebutamol, Ventolin, Nebufluzone are used for this. Inhalations are especially important in the treatment of the obstructive component of bronchitis. Very often in difficult cases, drugs are used that act on the adrenoreceptors of the bronchi, which leads to their long-term expansion and the achievement of sufficient evacuation of mucus. The drug salbutamol is used in a dosage of 0.1 milligrams per kilogram of body weight with a dilution of this drug with physiological solutions one to one. Inhalations of drugs should be carried out for small children through spacers with a mask or using nasal cannulas, 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 an emergency treatment for a pronounced obstructive component. The drug contains a hormone that quickly relieves inflammation in the bronchi and relieves coughing fits. Such inhalations are not recommended for more than two days. Prednisolone can be administered to an infant with bronchitis only in a hospital setting to provide emergency care.

Euphyllin can be prescribed to a baby with bronchitis in a hospital setting much less frequently than it was used before, since there are other more effective and less dangerous drugs for children. Euphyllin is prescribed at a rate of 3-5 milligrams per kilogram by drip in a physiological solution, a single dose. Maintenance doses are 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 reserves of the body. Antiallergic drugs can only be used in children with atopic dermatitis or with wet wheezing, since these drugs have the ability to "dry out" the mucous membranes.

Physiotherapeutic treatment of bronchitis in a hospital includes the use of ultraviolet radiation, microcurrents, and electrophoresis with absorbable solutions in the acute period.

Massage for newborns with bronchitis is very important, since the child is constantly lying down and cannot cough up all the secretions on his own.

Drainage massage for bronchitis in infants also helps to remove all the secretions and speeds up recovery. How to massage an infant with bronchitis? You need to put him on his back and lightly tap him parallel to the ribs several times with your hands. Then, with massage movements, you need to stroke the skin in the direction from the waist to the neck. These are the simplest massage movements that a mother can do up to three times a day, and then carry the child vertically.

Traditional treatment of bronchitis

Traditional methods of treatment can be widely used in the form of herbal infusions. But if the child is a newborn, then such treatment is limited, since it is not recommended to give herbs to avoid allergic reactions. In this case, such methods of treatment can be used by the mother if she is breastfeeding. Traditional methods of treating bronchitis in infants can be used a little more widely.

1. Make an infusion of herbs. To do this, take licorice, Icelandic moss and burdock root, each forty grams. These herbs are steamed in 100 - 200 milliliters of boiling water and the mother takes a tablespoon of the infusion 5 times a day or half a teaspoon every hour for a baby.
2. Flowers of wild pansy and thyme, elecampane leaves - 30 g each, sea buckthorn fruits - 10 g. Make an infusion from this, pouring a glass of hot water over everything. Take half a glass twice a day or a teaspoon for a child.
3. For a better expectorant effect, use the following mixture: pine needles - 10 grams, wild rosemary herb - 20 grams, pine bark shavings - 5 grams, St. John's wort - 40 grams. The mixture of these herbs is kneaded, one part is poured with hot water of one hundred milliliters and infused for 10 minutes. For treatment, you need to drink half a tablespoon in the morning and evening.
4. Later, when the cough has been softened, an infusion of Thermopsis-mousewort is used. To do this, add one hundred grams of honey and the same amount of boiling water to 100 grams of grass. This should be infused for a month and taken two drops per child on an empty stomach.
5. Breast collection - linden, licorice, mint, marshmallow and cowberry should be mixed in equal parts and made into tea. Leaves and roots are crushed and one teaspoon is brewed in 200 milliliters of boiling water. After infusion, drink instead of tea during the day.

Homeopathy can also be used to treat bronchitis in infants.

1. Mercurius is a homeopathic remedy that is especially effective for children with a long and severe dry cough. The dosage of the drug for children can be three granules, which must first be dissolved in boiled water and used three times a day for the first week, and then for another week until the cough completely disappears once a day. Side effects can include increased heart rate.
2. Ipecacuanha is a homeopathic herbal remedy used to treat bronchitis in children and adults. It is used in children with a pale, anemic complexion against the background of a pronounced wet cough with the release of a large amount of sputum. The drug is used for the mother in a dose of one granule four times a day. Side effects may be in the baby in the form of loose stools.
3. Potassium Bichromicum is a homeopathic preparation of organic origin, which is used to treat bronchitis, which is accompanied by a cough at night of an asthmatic nature. The dosage of the drug for a child at the beginning of therapy is two granules three times, and in more severe cases the dose is doubled. There may be side effects in the form of drowsiness, lethargy of the baby.
4. Arsenicum Album is used to treat bronchitis in children with allergies to medications and food products. The cough in such children is dry, irritating with poor sputum separation. In order to correct this condition, the drug is used one granule per day, which can be used for a baby, grinding, and given under the tongue. Side effects can be in the form of increased coughing for some time.

These are the main methods of treatment with folk remedies, which can be used only on the recommendation of a doctor.

Surgical treatment of bronchitis is used very rarely, only in advanced cases with the development of gangrene of the lung, which is practically unheard of in modern medicine.

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Prevention

Prevention of bronchitis in most cases is non-specific and aimed at correcting risk factors. If we are talking about bronchitis in a newborn child, the main method of prevention is breastfeeding, the correct temperature in the room and avoiding contact with sick people.

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Forecast

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

Bronchitis in infants is the most common disease that children in their first year of life suffer from. However, this pathology is quite easy to diagnose and treat. Therefore, it is important to notice the first symptoms in time and consult a doctor.

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