Congenital pneumonia in a newborn baby

Congenital pneumonia in a newborn is an inflammation of the lungs that develops immediately after the birth of the child or within three days. The disease develops equally in full-term and premature babies, but the severity of the course and consequences are slightly different. Such inflammation should be recognized immediately when the first symptoms appear, so knowledge of these symptoms is very important for correct diagnosis.

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Epidemiology

Statistics on the incidence of congenital pneumonia indicate that the disease most often develops in women with a burdened history of infection during pregnancy. In premature babies and in babies with aspiration, pneumonia occurs one and a half times more often than in babies born at term.

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Causes congenital pneumonia in a newborn baby

Congenital pneumonia in a child is called such because infection and inflammation occur during pregnancy or childbirth, and external factors play an insignificant role in this disease. The cause of such pneumonia is an infectious agent that is in the woman's body and can be activated during pregnancy, or the pathogen is activated during childbirth. Therefore, all congenital pneumonias can be divided by the time of development into antenatal (those that develop in utero before childbirth) and intranatal (develop during childbirth). In each case, the cause may be a specific microorganism or virus, which is important for correct diagnosis and treatment.

Antenatal pneumonia is most often caused by viruses, since it is during this period that the child is vulnerable to their effects. For the infectious process to develop in the lungs, the virus must begin to act in the last trimester, and if earlier, it can cause congenital defects. The most common causes of congenital pneumonia in utero include the TORCH group. These include toxoplasmosis, rubella, cytomegalovirus and herpes virus, as well as some others. Each such pathogen has its own structural and developmental features, and, accordingly, treatment.

Toxoplasmosis is a disease caused by Toxoplasma gondii, which is a protozoan. The pathogen is transmitted through cats that are its carriers, or through poorly cooked meat. Infection can occur during pregnancy in the last stages, then it will cause pneumonia in the child. If infection occurs before pregnancy, the woman may not know about the presence of such an antigen in her body, since the clinical picture is nonspecific.

Rubella is an acute viral disease that is transmitted by airborne droplets and poses a potential threat to the fetus in the early stages due to the development of congenital defects. The virus can provoke the development of pneumonia in the child if the mother is infected just before giving birth.

Cytomegalovirus infection is a disease that can be transmitted by airborne droplets, sexually and by contact. More than 60% of people are infected with this virus, but not everyone develops the disease. When a pregnant woman is infected, the virus can penetrate the placenta and induce the development of an inflammatory process in many organs - the lungs, liver, brain.

Herpes is a virus that has a tropism for the nervous system, but it can also cause pneumonia with the same frequency. There are two main types - herpes labialis, which is transmitted by airborne droplets and contact, and herpes genitalis, which is transmitted sexually. The first virus is important in the development of antenatal pneumonia, and the second - intranatal, since infection occurs through contact with affected genitals.

Infections from the TORCH group are dangerous in terms of pneumonia when infected in the last stages or just before childbirth. As for other causes, they can also be an etiological factor.

Congenital pneumonia can also be caused by bacteria - chlamydia, mycoplasma, listeria, ureaplasma, candida, trichomonas. Their role in the development of congenital pneumonia in a child is important already at the stage of infection before or during childbirth. Ureaplasma and trichomonas are sexually transmitted infections that can rarely cause pneumonia in an absolutely healthy child. Such infections, including candida, infect the already sensitive organism of a premature baby or a child with immunodeficiency. Chlamydia and mycoplasma are intracellular microorganisms that play a primary role in the development of congenital pneumonia of bacterial etiology. They can cause a respiratory infection in a child already at birth or in the first hours after that, if appropriate conditions are present.

Summarizing the above listed causes of congenital pneumonia, we can say that viruses can be the most common cause of this, but at the same time bacteria also play a role in the development of inflammation. The pathogenesis of pneumonia in a newborn does not depend so much on the etiological factor. Any pathogen for the development of an infectious process first gets through the feto-placental barrier. Be it a virus or bacteria, it has a tropism for the lung tissue and gets into the lungs with the bloodstream. The features of the lung tissue of a newborn are such that the alveoli are not open and can become a substrate for the development of an infection. Inflammation occurs there, which is already revealed by symptoms at birth due to insufficient lung function, because it is after birth that the lungs should work at full strength. Therefore, the inflammatory process is even more activated with the first breath and symptoms appear.

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Risk factors

There are children who have a higher risk of developing congenital pneumonia than others. Risk factors include:

1. pathologies of pregnancy and diseases of the mother lead to disruption of the formation of the normal protective barrier – the placenta;
2. infectious diseases of the mother, especially from the TORCH group, increase the risk of infection through the placenta and the development of infectious lesions;
3. Prematurity increases the risk of infection due to weak immune defenses;
4. birth conditions and external interventions increase the risk of infection.

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Symptoms congenital pneumonia in a newborn baby

Congenital pneumonia is characterized by the fact that symptoms begin to appear immediately after birth or in the early postnatal period. If the clinical picture develops within 72 hours from the moment of birth, then this also refers to the concept of congenital pneumonia, but here the intranatal route of infection plays a role. If pneumonia is caused by intrauterine infection with a certain virus, then often along with symptoms from the respiratory system there are manifestations from other systems. This must be taken into account when diagnosing congenital pneumonia, since approaches to the treatment of pneumonia of viral and bacterial etiology are slightly different.

The first signs of the disease appear immediately after birth. The general condition of the child may be severe due to severe respiratory disorders. The child is born with a cyanotic or pale gray complexion, there may be a petechial rash due to intoxication. The child has a weak cry and depressed congenital reflexes due to hypoxia of the central nervous system during an infectious lesion. Therefore, the child's assessment on the Apgar scale may be low, which does not allow immediate skin contact. Sometimes children with congenital pneumonia need resuscitation measures immediately after birth, and sometimes the degree of respiratory disorders is not so pronounced. Manifestations of pneumonia are respiratory disorders that are clinically determined by shortness of breath. Shortness of breath, depending on its severity, is characterized by retraction of the intercostal spaces and areas above and below the collarbones, and retraction of the sternum during breathing. Against the background of respiratory disorders, tachypnea and rapid heartbeat are determined. All this indicates a clear pathology of the respiratory organs and requires immediate further verification.

If pneumonia is caused by a virus from the TORCH group, there may be other symptoms of a generalized infection. For example, cytomegalovirus has a tropism for the child's brain and liver, so when it affects the fetus, this infection causes severe brain damage in the form of ischemic lesions and cysts, as well as liver enlargement and severe jaundice with bilirubin encephalopathy. Therefore, pneumonia against the background of these symptoms may be a specific manifestation of this virus.

Congenital pneumonia caused by the rubella virus can present with a characteristic rash on the child's body with symptoms from the respiratory system.

Bacterial pneumonias have their own peculiarities, since the inflammatory process is purulent. They most often develop during the first two days, when the baby's condition deteriorates sharply. Against the background of severe shortness of breath, symptoms of intoxication appear - the child's body temperature rises, or if it is a premature baby, then hypothermia most likely develops. The newborn refuses to breastfeed, loses weight and becomes restless. All this, together with respiratory symptoms, should prompt the thought of pneumonia.

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Stages

The stages of pneumonia are no different from those in adults, the only thing is that inflammation spreads quickly and some pathogens quickly cause necrosis (staphylococcus, influenza virus, pneumocystis).

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Forms

Types of pneumonia in newborns can be classified by pathogen into viral and bacterial, as well as specific and non-specific, which is very important when choosing treatment.

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Complications and consequences

Complications of congenital pneumonia depend on the type of pathogen and can be immediate or delayed. If the pathogen quickly causes destruction of lung tissue, complications in the form of infection spread are possible. Such a widespread infection with lung damage can quickly cause the pathogen to enter the blood and develop bacteremia. Sepsis for such a small child threatens a fatal outcome. Other systemic complications may include hemorrhagic syndrome, DIC syndrome, hemodynamic disorders, persistence of fetal communications and, against this background, acute cardiovascular failure.

Among the pulmonary complications, the development of pleurisy, atelectasis, and pneumothorax is possible.

The consequences of pneumonia can be more serious if the damage is systemic. If pneumonia is viral, there may be damage to other organs and systemic manifestations - congenital defects, chronic forms of infections and intellectual disabilities.

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Diagnostics congenital pneumonia in a newborn baby

Diagnosis of congenital pneumonia is always complicated by the fact that there may be many variants of respiratory failure and it is necessary to differentiate these conditions. If the diagnosis of congenital pneumonia is confirmed, it is important to diagnose the type of pathogen, since the treatment tactics are different. Therefore, diagnostics should begin with the mother's anamnestic data on the course of pregnancy and childbirth. It is very important to find out whether the mother has infections and whether a study was conducted on the TORCH group, because these are the most serious pathogens.

A feature of congenital pneumonia, mainly in a premature baby, is an unclear objective picture. Auscultation data usually do not give a clear picture of pneumonia, since a bilateral process can indicate both pneumonia and respiratory distress syndrome. Therefore, additional laboratory and instrumental research methods can be considered the main diagnostic methods.

Newborn tests have their own characteristics due to physiological reasons - the number of formed elements of the blood increases to ensure normal cellular respiration, and on the fifth day, physiological leukocyte crossover occurs. Therefore, changes in laboratory data that may indicate pneumonia are not as specific as in older children. But an increase in the number of leukocytes in dynamics and the absence of leukocyte crossover on the fifth day of the child's life may indicate pneumonia. This indicates a bacterial infection, and one can exclude the viral etiology of pneumonia or think about the association of viruses and bacteria.

Sometimes, when treating pneumonia in a child, it is not possible to achieve results, then the mother is examined to determine the specific pathogen. After all, in this case, the mother is the main source of infection for the child, while the child has not yet formed antibodies and they cannot be determined. For this, a serological study of the mother's blood is carried out to determine antibodies to certain infections. The level of antibodies of the immunoglobulin class G and M is determined. In this case, special reagents are used that allow you to determine the level of these antibodies to a specific infection. If there is an increase in the level of immunoglobulins G, then this virus cannot participate in the development of pneumonia in the child, since it only indicates an old infection. But if immunoglobulins M are detected, this indicates an acute infection, that is, there is a high probability that the fetus is also infected. Among the special tests for suspected sexually transmitted infections, a smear from the vagina is also examined. This is necessary for bacterial pneumonia, when it is possible to accurately determine the pathogen and its sensitivity to antibacterial agents.

Instrumental diagnostics allows to accurately diagnose lung damage and to specify the localization of the process. X-ray signs of congenital pneumonia of a newborn are deflated lungs and increased vascular pattern in the initial stages of the disease, and then inflammatory-infiltrative changes of a confluent nature appear. But if the child is premature, then the X-ray does not allow to accurately diagnose between pneumonia and hyaline membrane disease, since the changes are identical in both pathologies. Therefore, there is a need for additional treatment measures.

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Differential diagnosis

Differential diagnostics of congenital pneumonia should be carried out with hyaline membrane disease, primarily in premature infants, as well as with aspiration syndrome, congenital malformations of the lungs, diaphragmatic hernia, heart disease and CNS injuries, which are accompanied by respiratory failure. Hyaline membrane disease is a pathology of premature babies, which develops against the background of surfactant deficiency in the lungs. The pathology is characterized by similar changes in radiography in the form of "cotton wool" lungs, so such children need to be administered exogenous surfactant.

Congenital defects of the respiratory system can also manifest with respiratory disorders, so they need to be excluded. As for congenital heart defects, the clinical picture appears at a later time, and an ultrasound of the heart allows for accurate differentiation. Some "critical" heart defects can manifest in the first hours, in which case there will be a corresponding anamnesis for detecting the defect in utero.

Treatment congenital pneumonia in a newborn baby

Treatment of congenital pneumonia should begin immediately after diagnosis. The approach to treatment is complex, taking into account many links of pathogenesis and conditions for nursing the child. Therefore, treatment should begin with a regimen.

The most acceptable mode for a newborn with pneumonia is considered to be the incubator mode, since the correct temperature regime can be used. The average temperature in the incubator for children is 32-34 degrees, and the air humidity is 80-90% in the first days. It is very important to provide oxygen support, which can also be done directly in the incubator.

The child with congenital pneumonia should continue to be fed with breast milk, the total caloric intake should be limited but with an increase in the frequency of feedings. Oxygen support for the child is mandatory, since metabolic disorders have a very negative effect on the cardiovascular system. If the child is in an incubator, then free oxygen can be supplied or through a mask. If the child is weak or premature and correction of the breathing act itself is necessary, then special oxygen supply devices with constant positive pressure in the respiratory tract or artificial ventilation, if necessary, are connected.

Only after such measures can we talk about other drug therapy.

If the causative agent of pneumonia is precisely established, then the treatment should be as specific as possible. Of course, if the causative agent is of viral etiology, then antibacterial therapy is used together with antiviral therapy. If congenital pneumonia is caused by cytomegalovirus with systemic damage to organs and systems, then therapy is carried out with special agents from the interferon group.

1. Viferon is an antiviral drug that contains recombinant human interferon, active against most viruses from the herpes group. It acts on cytomegalovirus, hepatitis virus, and some bacterial infections by immunomodulatory action. The drug is available in the form of an ointment, gel, suppositories. For the treatment of newborns, it is recommended in the form of rectal suppositories. The dosage of the drug is 500,000 IU twice a day, and then according to a special scheme with monitoring of the child's blood tests for specific antibodies in the future. Side effects are possible: thrombocytopenia, itching at the injection site, redness, and allergies. Precautions - it is not recommended for use in children with severe congenital immunodeficiencies.
2. If toxoplasma is confirmed as a manifestation of pneumonia and generalized infection, specific treatment is carried out.

Spiramycin is an antibiotic from the macrolide group, which is the drug of choice for the treatment of toxoplasmosis. It has the highest activity against toxoplasma, inhibiting the synthesis of proteins of its wall, but does not have a teratogenic effect. The dosage of the drug is 6-9 million IU per day. Side effects of spiramycin are paresthesia, impaired skin sensitivity, numbness of the arms and legs, tremor, impaired bile outflow, and prolonged jaundice in the child.

1. Antibiotics for pneumonia in newborns are considered the main and mandatory means of treatment. In this case, treatment is carried out with two drugs, the methods of application of which are only parenteral (intramuscular and intravenous). Treatment is carried out in stages: the first course is prescribed b-lactam antibiotic (semi-synthetic penicillin or 2nd generation cephalosporin) in combination with aminoglycosides. If this combination of drugs is ineffective, second-course drugs are prescribed - cephalosporins 3-4 with amikacin or vancomycin.

Netromycin is an aminoglycoside antibiotic, the active ingredient of which is netilmicin. The drug is effective against staphylococcus, klebsiella, E. coli and some other bacteria that play a significant role in lung damage in utero. In the treatment of pneumonia in newborns, a dosage of 15 mg / kg / day in 2 doses is used. Side effects include sleep disturbance, drowsiness or lethargy, damage to the renal parenchyma, and stool disorders. Precautions - do not use in case of kidney damage.

Cefpirome is a 4th generation antibacterial agent of the cephalosporin group. The drug has a bactericidal effect on many extracellular opportunistic microorganisms. In the treatment of pneumonia, this drug is used intravenously or intramuscularly. The dosage of the drug is from 50 to 100 milligrams per kilogram of weight per day. The drug does not have a pronounced effect on the organs of the newborn, so it can be used for treatment. Side effects are possible in the form of diarrhea in the baby or disruption of the formation of intestinal biocenosis, so treatment is carried out together with probiotic drugs.

1. Probiotics are always used in such children in order to correct disturbances in the bacterial composition of the intestine.

Acidolak is a drug that contains lactobacilli, which form lactic acid and prevent pathogenic bacteria from multiplying. Due to this, the drug creates favorable conditions for the development of beneficial intestinal microflora. Lactobacillus reuteri, which is part of the drug, is completely resistant to antibiotics, so it can be used in the complex treatment of such pathologies. The dosage sufficient to restore microflora and normalize intestinal peristalsis in children is half a sachet per day in two doses. The powder can be dissolved in milk and given to the child before feeding. Side effects include diarrhea, stool discoloration, rumbling in the intestines.

Vitamins and physiotherapy for pneumonia in a newborn are not used in the acute period. The mother can take vitamin supplements during breastfeeding even after the child has recovered in courses, which will improve the prognosis for the baby.

Traditional treatment of congenital pneumonia

Treatment with folk remedies can only be used by the mother, and prescribing any herbs or infusions to the child is contraindicated. If the mother is diagnosed with any infection, then folk remedies can be used in combination with medications.

1. Medicinal herbs are highly effective in treating infections that are chronic in the mother and can cause illness in the child. To prepare medicinal tea, take 25 grams of mint, 50 grams of licorice and the same amount of wild rosemary leaves, boil it over low heat for five to ten minutes and then strain. Drink this tea three times a day, half a cup at a time.
2. A decoction of marshmallow, cinquefoil, and rose hips is especially effective against cytomegalovirus infection. You need to make tea from a liter of water and these herbs and drink in small sips throughout the day. The course of treatment is four weeks.
3. Tea made from chamomile leaves, oak bark and anise bark has antiviral and antibacterial activity. To prepare it, all ingredients need to be poured with water and boiled. Take half a shot in the morning and evening.

Homeopathic medicines can also be successfully used for the mother, which improves the child's response to drug therapy and speeds up his recovery.

1. Antimonium Tartaricum is a homeopathic remedy of natural plant origin. It is used in the treatment of pneumonia in children with pronounced moist rales in the sixth dilution. The dosage of the drug is two drops every six hours in tea or water for the mother. Side effects are possible in the form of allergic reactions. Precautions - the drug should not be used if there is a suspicion of congenital defects in the baby.
2. Gepar sulfur is an inorganic homeopathic preparation. It is used in premature babies with breathing problems and surfactant deficiency. The method of using the drug in capsules. The dosage of the drug is two capsules three times a day. Side effects are possible in the form of hyperemia of the skin of the hands and feet, as well as a feeling of heat. Precautions - do not use in combination with sorbents.
3. Veratrum viride is a homeopathic remedy that has a composition of organic agents and helps to activate the body's natural defenses, including in the fight against viral agents. The drug is used for pneumonia with severe heart failure in a child. Dosed four drops twice a day half an hour before meals at the same time. The course of treatment is three months.
4. Aconite is a homeopathic remedy of natural plant origin, which is recommended to be used in the acute period in the third dilution, with a subsequent transition to the same dosage of Bryonia. Dosage - three drops per fifty grams of water for the mother three times a day. The first drug is taken for two weeks, and then they switch to the next one. Side effects - tremor of the fingers or chin of the child.

It is important to remember that folk and homeopathic remedies are not a priority in treatment and can only be used on the recommendation of a doctor.

Surgical treatment of congenital pneumonia is used very rarely, only in isolated cases of complications. Then, with bacterial destruction of the lungs, interventions to install drainage or sanitize the bronchial tree are possible.

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Prevention

Prevention of any infection in a child should begin at the stage of early diagnosis and examination of the mother during pregnancy. In Ukraine, before pregnancy and already during pregnancy, examination for the TORCH group is not mandatory, but is always recommended by a doctor and the woman herself decides whether to conduct it or not, since this is a very expensive examination. But given the possible risks, it is necessary to emphasize the high importance of this study for timely diagnosis and treatment. If a woman has not suffered from certain infections in childhood and does not have antibodies, then specific immunization should be carried out. Given the risk factors for the development of congenital pneumonia, the main preventive measures can be considered a normal pregnancy and the birth of a healthy child on time.

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Forecast

The prognosis for pneumonia can be favorable if treatment is started on time and care for the baby is adequately organized by both the mother and the doctors.

Congenital pneumonia in a newborn often occurs against the background of infection of the child or mother during pregnancy. This proves the high need for examination of pregnant women and careful diagnostics of dangerous infections. The birth of a child with signs of respiratory failure should prompt the idea of possible pneumonia and immediate adequate therapy, which improves the prognosis of such children.

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