Noninfectious diarrhea - diarrhea in a newborn child in the first four weeks of life, according to ICD-10, refers to digestive system disorders and has code P78.3.
Short-term digestive and intestinal problems in children in the neonatal period - dyspepsia and diarrhea - is part of the process of adapting to feeding breast milk that requires certain enzymes.
However, diarrhea in a newborn can also have an infectious origin, so bacterial or viral diarrhea is already classified as an enteric infection (code A00-A09).
According to UNICEF, only 38-40% of infants under six months of age are breastfed all over the world.
The annual number of cases of gastroenteritis with diarrhea in young children in the UK is 9-9.3 million. In the United States, 10% (or 220 thousand) of all cases of urgent hospitalization of infants are acute diarrhea; a year, an average of 450 newborns die due to dehydration.
In Europe, more than 50% of hospitalizations for gastroenteritis in younger children (including newborns) and about one third of emergency calls are associated with diarrhea in rotavirus infection.
In developing countries, one in 250 children dies of dehydration with diarrhea; in South-East Asia, the mortality rate for this reason is more than 31% of all deaths due to medical problems in childhood.
The global lethality from dehydration, which occurs with diarrhea of various etiologies, among children from birth to five years of age reaches 1.7-2 million cases annually.
Causes of the diarrhea in the newborn
Considering the causes of diarrhea in a newborn, specialists pay attention to possible congenital dyspeptic disorders, which are manifested by chronic diarrhea in newborns and constitute a group of hereditary enteropathies.
Most of the cases of intestinal enzyme pathologies (detected in one of 1-2.5 thousand newborns) occur in lactase deficiency in children (hypolactasia) - that is, a low level of the specific enzyme lactase (galactosidase), which is necessary for the hydrolysis of lactose (milk sugar). Also, this pathology is called lactose intolerance, and the pathogenesis of diarrhea due to it is due to the increase in osmotic pressure in the intestine (due to the accumulation of unsplit milk sugar) and the emergence into its lumens of a fluid that increases the volume of feces and dilutes their consistency.
Food intolerances and allergies can also be triggers of an intestinal disorder in an infant, and more often for this reason diarrhea occurs in a newborn with artificial feeding, as well as diarrhea in a newborn with mixed feeding. The main cause is an allergy to cow milk (whey proteins, which are part of the milk formula); while specific IgE against dairy proteins is detected in the blood. There may be an allergic reaction to soy lecithin or maltodextrin (corn starch syrup) in certain mixtures that replace breast milk. Read more - Allergy to milk in children
The products used by the lactating mother to cause diarrhea in the newborn: milk and all dairy products (including cottage cheese, cheese, butter, etc.), soy products and soybean meal, wheat, corn, chicken eggs, seafood, nuts, peanuts, strawberries, citrus fruits .
But the key causes of diarrhea in newborn pediatricians see in the intestinal dysbiosis, more precisely, in the inadequate composition of the intestinal microbiota of the baby, which is transmitted at birth from the mother. It is known that the digestive tract of the fetus is sterile in the womb, but a few hours after birth the child acquires a whole "set" of microorganisms. In this case, the intestinal microflora of newborns emerging as a result of natural childbirth is similar to the vaginal microflora of the mother (including Lactobacillus acidophilus, Bifidobacterium, Escherichia coli and Enterococcus). But in cesarean-borne sections of the microflora is closer to the microbiota of the mother skin and the environment and contains, in particular, the bacteria Clostridium difficile and Streptococcus spp. With significant colonization of the intestine with clostridia, the pathogenesis of neonatal diarrhea is associated with the production of enterotoxins (TcdA and TcdB) which damage the intestinal mucosa. Often, cases of neonatal intestinal infection with lesions of Staphylococcus aureus, whose toxins cause diarrhea in the newborn with mucus and atrophy of the villi of the intestine, which slows the growth of the child during the first weeks of life.
Why diarrhea in a newborn during breastfeeding occurs in 3-6 times less often than diarrhea in a newborn with artificial feeding? Because when breastfeeding in the digestive tract of the baby, bifido- and lactobacilli are sufficient, the interaction of which leads to the production of acids (acetic, oily and lactic), which protect the intestines from pathogens. Moreover, mother's milk has antimicrobial antibodies to the mother (secretory IgA), which reduce the growth of facultative anaerobes and prevent the development of enterovirus infections.
Very often causes diarrhea in newborn - infection p otavirusami that are highly contagious and easily transmitted by the fecal-oral route. Diarrhea and vomiting in a newborn due to rotavirus gastroenteritis account for 40% of all cases. In addition, gastroenteritis with watery diarrhea and frequent vomiting causes norovirus and astrovirus.
To microorganisms that can cause diarrhea with mucus, vomiting, intestinal spasms and febrile state in a newborn, enter enterobacteria Klebsiella oxytoca, Enterobacter cloacae, Citrobacter freundii, Shigella spp and Salmonella spp. For example, salmonella usually enters the intestine of a newborn when passing through the birth canal of the mother, which can be an asymptomatic carrier of the infection.
Risk factors for the development of diarrhea in newborns: a deficiency of zinc in the body (reducing the function of immunity) and insufficient intake of vitamin A. The use of antibacterial drugs by the mother or their appointment to the child in the postpartum period in 90% of cases guarantees diarrhea in a newborn after antibiotics, leading to a change in the composition of the intestinal microbiota .
Among the rare diseases in which there is congenital diarrhea in a newborn (regardless of the type of feeding), experts call:
autoimmune enteropathy or IPEX syndrome caused by a violation of the immune response of the intestine;
hereditary dysplasia of the intestinal epithelium (piercing enteropathy), associated with partial atrophy of the villi of the small intestine mucosa; causes in the first few days after birth a life-threatening diarrhea in the newborn infant, forcing to use parenteral nutrition.
Symptoms of the diarrhea in the newborn
It should be borne in mind that during the first month the consistency of the feces of a healthy baby is semi-liquid, and defecation can occur up to 5-6 times a day. Moreover, children who are breastfed tend to have a more frequent stool, and the baby can spoil the diaper after each feeding and even during breast sucking (due to intestinal stimulation when filling the stomach).
Realizing that the symptoms of diarrhea in a child are found when changing diapers, mothers are asked the question, what does the diarrhea look like in the newborn? Consistency of feces is always liquid, but its color depends on the origin of diarrhea.
The very first signs of diarrhea - a significant increase in stool and a more liquid (watery) consistency of stool.
Rotavirus infection causes gastroenteritis with symptoms such as fever to + 38-39 ° C, watery diarrhea and vomiting in the newborn, bloating and flatulence; can be a cramping pain in the abdomen (causing the baby crying and convulsive movements of the legs). Often there is a multiple yellow diarrhea in a newborn with gray or green impurities, with a very unpleasant odor.
With bacterial infection, which is difficult to distinguish from viral, there is a high (up to + 40 ° C) temperature and diarrhea in a newborn, also characterized by diarrhea with mucus and bloody inclusions. With infection - viral or bacterial - most often diarrhea in a newborn with a smelly smell.
As with viral intestinal infection, an allergy to cow's milk with artificial feeding gives a yellow or green diarrhea in a newborn. Doctors pay attention to the fact that sometimes bright green color diarrhea can develop in infants with a lack of breast milk, and this is due to the intake of excess bile in the intestine.
In the case of intestinal dysbiosis in a newborn, diarrhea with mucus, if there are congenital enzymes (in the form of lactase deficiency) in a newborn diarrhea with foam and impurities of mucus.
In addition to signs of the nature of bowel movements, diarrhea develops with diarrhea: decreased diuresis (decreased urine volume and frequency of urination); increased urine color; dryness of mucous membranes; absence of tears when crying; cyanosis of the skin; reduction of skin elasticity; the westing of the great fontanel; a state of lethargy and increased drowsiness; increased pulse and respiration.
The main and most dangerous consequences and complications of neonatal diarrhea are dehydration of the body or intestinal exciksis in children, which leads to a disruption of the water-electrolyte balance, a decrease in the pH of the blood (ie, an increase in its acidity) and the development of metabolic acidosis with possible shock and comatose state.
And the result of prolonged dyspepsia and diarrhea (within 10-14 days) is anemia (with insufficient vitamins and microelements necessary for the body) and slowing the growth and development of the child.
Diagnostics of the diarrhea in the newborn
Pediatrician diagnosis of diarrhea in a newborn should establish its etiology, for which a physical examination of the child is carried out, an anamnesis is made, the mode and method of feeding the baby is clarified.
For the same purpose, analyzes are given: coprogram (microbiological analysis of feces); general analysis of blood and urine; a blood test for electrolytes and IgE immunoglobulin.
Hypalactasia is diagnosed by the results of the analysis of feces on the level of carbohydrates, and by using a functional test (test) with lactose. More detailed - in the publication Lactase insufficiency in children
The main treatment for diarrhea in a newborn is replacement of fluid loss (rehydration) and restoration of electrolyte balance. For this, babies should be given Regidron (in the form of a solution with glucose, potassium chloride, sodium chloride and sodium citrate). The amount of solution is calculated by the weight of the child's body and the intensity of diarrhea and vomiting: from 60 to 100 ml per kilogram. The solution should be given in the first 5-6 hours at least 5 ml (one teaspoonful) every 10 minutes and after each bowel movement or vomiting. In hospitals with particularly severe conditions, a solution of Ringer-Lock is injected infusion. The child is fed normally.
Medications - Medications such as antibiotics and antidiarrheal agents are generally not necessary and may be harmful to infants or children with diarrhea. In rare cases, antibiotics can be used in cases of bacterial infection when a particular cause of diarrhea occurs.
Drugs against diarrhea are not recommended for newborns: their use can mask the worsening of symptoms and prolong treatment. In some situations - in the case of viral diarrhea - doctors can be prescribed Smecta (Diosmectit) - in a daily dosage of a solution made from a single sachet (3 g).
The remedy Imodium (with loperamide) for children under the age of six is prohibited. Espumizan drops belong to carminative drugs and infants are used only for flatulence and colic.
With intestinal dysbiosis - to improve the intestinal microbial balance, reduce the duration and severity of acute infectious diarrhea, and when diarrhea in a newborn is caused by antibiotics - probiotics are used. According to the recommendations of the European Society of Pediatric Infectious Diseases (ESPID), efficacy in the acute gastroenteritis of such "healthy bacteria" as Lactobacillus rhamnosus GG, Lactobacillus reuteri and Saccharomyces boulardii has been proven.
Probiotic in the form of lyophilizate Bifidumbacterin (containing lactobacilli) is taken orally in the form of a prepared suspension - before feeding, one to two doses three times a day.
In conditions of complex immunological adaptation during the transition period from intra-to extrauterine life and increased susceptibility of newborns to infection, the prevention of neonatal diarrhea consists in strict adherence to hygiene rules. For this, the mother needs to wash her hands with soap more often, special attention should be paid to the nails (more microbes gather under the long nails).
Keep in mind that rotaviruses, noroviruses and clostridia do not respond to the action of antiseptics based on ethyl alcohol.
Diarrhea in newborns or neonatal diarrhea is one of the main factors of child mortality worldwide. Only early diagnosis and timely treatment can help to avoid life-threatening dehydration.
Severe diarrhea is observed periodically in many patients. There are many reasons for this. This phenomenon brings discomfort to a person, reduces the quality of life, restricts freedom of action and work capacity.
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