Diarrhea in a newborn baby: how it looks, what to do, what to treat

Non-infectious diarrhea - diarrhea in a newborn child in the first four weeks of life, according to ICD-10, refers to disorders of the digestive system and has the code P78.3.

Short-term digestive and intestinal problems in children in the neonatal period - dyspepsia and diarrhea - are part of the process of adaptation to breast milk nutrition, which requires certain enzymes.

However, diarrhea in a newborn can also be of infectious origin, therefore bacterial or viral diarrhea is already classified as an intestinal infection (code A00-A09).

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Epidemiology

According to UNICEF, worldwide only 38-40% of infants under six months of age are breastfed.

The annual incidence of gastroenteritis with diarrhoea in young children in the UK is 9-9.3 million. In the USA, 10% (or 220,000) of all emergency admissions to hospital in infants are due to acute diarrhoea; an average of 450 newborn babies die each year due to dehydration.

In Europe, more than 50% of hospital admissions for gastroenteritis in young children (including neonates) and about one third of emergency room visits are due to rotavirus diarrhoea.

In developing countries, one in 250 children dies from dehydration due to diarrhea; in Southeast Asia, the death rate from this cause is more than 31% of all deaths due to medical problems in childhood.

The global mortality rate 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.

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Causes newborn diarrhea

When considering the causes of diarrhea in newborns, experts pay attention to possible congenital dyspeptic disorders, which manifest as chronic diarrhea in newborns and represent a group of hereditary enteropathies.

Most cases of intestinal enzyme pathologies (detected in one of 1-2.5 thousand newborns) are due to 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). This pathology is also called lactose intolerance, and the pathogenesis of diarrhea in it is explained by an increase in osmotic pressure in the intestine (due to the accumulation of undigested milk sugar) and the release of fluid into its lumens, which increases the volume of feces and liquefies their consistency.

Food intolerances and allergies can also trigger an upset stomach in an infant, and this is the most common cause of diarrhea in a bottle-fed newborn, as well as diarrhea in a mixed-fed newborn. The main cause is an allergy to cow's milk (whey proteins found in formulas); in this case, specific IgE against milk proteins is found in the blood. There may be an allergic reaction to soy lecithin or maltodextrin (molasses from corn starch) in some formulas that replace breast milk. Read more - Milk allergy in children

Products consumed by a nursing mother that cause diarrhea in a newborn: milk and all dairy products (including cottage cheese, cheese, butter, etc.), soy and soy flour-containing products, wheat, corn, chicken eggs, seafood, nuts, peanuts, strawberries, citrus fruits.

But pediatricians see the key causes of diarrhea in newborns in intestinal dysbiosis, or more precisely, in the inadequate composition of the infant's intestinal microbiota, which is transmitted from the mother at birth. It is known that the gastrointestinal tract of the fetus in the womb is sterile, but a few hours after birth, the child acquires a whole "set" of microorganisms. At the same time, the intestinal microflora of newborns born 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 those born by cesarean section, the microflora is closer to the microbiota of the mother's skin and environment and contains, among other things, the bacteria Clostridium difficile and Streptococcus spp. With significant colonization of the intestine by clostridia, the pathogenesis of neonatal diarrhea is associated with the production of enterotoxins (TcdA and TcdB), which damage the intestinal mucosa. There are frequent cases of neonatal intestinal infection with Staphylococcus aureus, whose toxins cause diarrhea with mucus and atrophy of the intestinal villi in the newborn, which slows the child's growth during the first weeks of life.

Why does diarrhea in a breastfed newborn occur 3-6 times less frequently than diarrhea in a bottle-fed newborn? Because when breastfeeding, the baby's gastrointestinal tract contains enough bifido- and lactobacteria, the interaction of which leads to the production of acids (acetic, butyric and lactic), protecting the intestines from pathogens. Moreover, breast milk contains the mother's antimicrobial antibodies (secretory IgA), which reduce the growth of facultative anaerobes and prevent the development of enterovirus infections.

Very often, the causes of diarrhea in a newborn are infection with rotaviruses, which are very contagious and easily transmitted by the feco-oral route. Diarrhea and vomiting in a newborn due to rotavirus gastroenteritis accounts for 40% of all cases. In addition, gastroenteritis with watery diarrhea and frequent vomiting is caused by norovirus and astrovirus.

Microorganisms that can cause diarrhea with mucus, vomiting, intestinal cramps, and fever in newborns include Enterobacter Klebsiella oxytoca, Enterobacter cloacae, Citrobacter freundii, Shigella spp, and Salmonella spp. For example, Salmonella usually enters the intestines of newborns when passing through the birth canal of the mother, who may be an asymptomatic carrier of this infection.

Risk factors for the development of diarrhea in newborns: zinc deficiency in the body (reducing immune function) and insufficient intake of vitamin A. The use of antibacterial drugs by the mother or their prescription to the child in the postpartum period in 90% of cases guarantees diarrhea in the newborn after antibiotics, leading to a change in the composition of the intestinal microbiota.

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Risk factors

Among the rare diseases that cause congenital diarrhea in a newborn (regardless of the type of feeding), experts name:

• autoimmune enteropathy or IPEX syndrome, caused by a disorder of the intestinal immune response;
• hereditary intestinal epithelial dysplasia (suturing enteropathy) associated with partial atrophy of the villi of the small intestinal mucosa; causes life-threatening watery diarrhea in the newborn in the first few days after birth, requiring parenteral nutrition.

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Symptoms newborn diarrhea

It should be borne in mind that during the first month, the consistency of a healthy baby's stool is semi-liquid, and defecation can occur up to 5-6 times a day. Moreover, children who are breastfed, as a rule, have more frequent stools, and the child can soil the diaper after each feeding and even while sucking the breast (due to stimulation of the intestines when the stomach is full).

Understanding that the symptoms of diarrhea in a child are detected when changing diapers, mothers ask the question, what does diarrhea look like in a newborn? The consistency of feces is always liquid, but its color depends on the origin of diarrhea.

The very first signs of diarrhea are a significant increase in the frequency of stools and a more liquid (watery) consistency of stool.

Rotavirus infection causes gastroenteritis with symptoms such as fever up to +38-39°C, watery diarrhea and vomiting in the newborn, bloating and flatulence; there may be cramping pain in the abdomen (causing the child to cry and make convulsive movements of the legs). Frequently, there is repeated yellow diarrhea in the newborn with gray or green impurities, with a very unpleasant odor.

In case of a bacterial infection, which is difficult to distinguish from a viral one, high (up to +40°C) temperature and diarrhea in a newborn are observed, diarrhea with mucus and bloody inclusions is also typical. In case of an infection – viral or bacterial – most often diarrhea in a newborn has a foul odor.

As with a viral intestinal infection, an allergy to cow's milk during artificial feeding causes yellow or green diarrhea in a newborn. Doctors point out that sometimes bright green diarrhea can begin in infants with a lack of breast milk, and this is due to the flow of excess bile into the intestines.

In case of intestinal dysbiosis, the newborn has diarrhea with mucus; if there are congenital enzymopathies (in the form of lactase deficiency), the newborn has diarrhea with foam and mucus impurities.

In addition to the signs related to the nature of the stool, symptoms of dehydration develop with diarrhea: decreased diuresis (decreased urine volume and frequency of urination); increased color of urine; dry mucous membranes; lack of tears when crying; cyanosis of the skin; decreased elasticity of the skin; sunken large fontanelle; lethargy and increased sleepiness; increased heart rate and respiration.

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Complications and consequences

The main and most dangerous consequences and complications of neonatal diarrhea are dehydration or intestinal exicosis in children, which leads to a disruption of water-electrolyte balance, a decrease in the hydrogen index (pH) of the blood (that is, 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 (for 10-14 days) is anemia (with a deficiency of vitamins and microelements necessary for the body) and a slowdown in the growth and development of the child.

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Diagnostics newborn diarrhea

The diagnosis of diarrhea in a newborn carried out by pediatricians should establish its etiology, for which a physical examination of the child is carried out, anamnesis is collected, and the infant's feeding regimen and method are determined.

For the same purpose, the following tests are taken: coprogram (microbiological analysis of feces); general blood and urine tests; blood tests for electrolytes and immunoglobulin IgE.

Hypalactasia is diagnosed by the results of a stool analysis for carbohydrate levels, and with the help of a functional test with lactose. For more details, see the publication Lactase deficiency in children

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Differential diagnosis

Differential diagnostics are necessary to identify the infectious, functional, enzymatic or allergic nature of diarrhea.

Treatment newborn diarrhea

The main treatment for diarrhea in a newborn is replacing fluid loss (rehydration) and restoring electrolyte balance. To do this, infants need to be given Regidron (as a solution with glucose, potassium chloride, sodium chloride and sodium citrate). The amount of solution is calculated based on the child's body weight 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 teaspoon) every 10 minutes and after each bowel movement or vomiting. In medical institutions, in particularly severe conditions, Ringer-Locke solution is administered by infusion. The child is fed as usual.

Medications - Medications such as antibiotics and antidiarrheal agents are usually unnecessary and may be harmful to infants or children with diarrhea. In rare cases, antibiotics may be used in cases of bacterial infection when the cause of diarrhea is determined.

Antidiarrheal medications are not recommended for newborns: their use may mask worsening symptoms and prolong treatment. In some situations – with viral diarrhea – doctors may prescribe Smecta (Diosmectite) – in a daily dose of a solution prepared from one sachet (3 g).

Imodium (with loperamide) is prohibited for children under six years of age. And Espumisan drops are carminatives and are used in infants only for flatulence and colic.

In case of intestinal dysbiosis – to improve the intestinal microbial balance, reduce the duration and severity of acute infectious diarrhea, and also when diarrhea in a newborn is caused by antibiotics – probiotics are used. According to the recommendations of the European Society for Paediatric Infectious Diseases (ESPID), the effectiveness of such “healthy bacteria” as Lactobacillus rhamnosus GG, Lactobacillus reuteri and Saccharomyces boulardii in acute gastroenteritis has been proven.

The probiotic in the form of lyophilisate Bifidumbacterin (containing lactobacilli) is taken orally in the form of a prepared suspension - before feeding, one to two doses three times a day.

To ensure a more gentle regime of the child's intestines, a diet for a nursing mother with diarrhea in a newborn is recommended - see Diet during lactation and Hypoallergenic diet for nursing mothers

Prevention

In the conditions of complex immunological adaptation during the transition period from intra- to extrauterine life and increased susceptibility of newborns to infection, prevention of neonatal diarrhea consists of strict adherence to hygiene rules. To do this, the mother needs to wash her hands with soap more often, and special attention should be paid to her nails (more germs accumulate under long nails).

Please note that rotaviruses, noroviruses and clostridia are not affected by ethyl alcohol-based antiseptics.

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Forecast

Diarrhea in newborns or neonatal diarrhea is one of the leading causes of infant mortality worldwide. Only early diagnosis and prompt treatment can help avoid life-threatening dehydration.

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