Pneumonia in a newborn baby: bilateral, severe, infectious

Pneumonia in a newborn baby is an inflammation of the lungs that develops immediately after birth or in the first twenty-eight days of the baby's life. The peculiarity of pneumonia in such small children is that the inflammatory process quickly spreads to both lungs, and the child's condition worsens with each passing minute. Complications of the disease are very serious, so it is necessary to know the main symptoms and principles of treatment of such a pathology.

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Epidemiology

Pneumonia statistics show a high percentage of the disease in children born from pathological pregnancy and childbirth. In mothers who are active carriers of dangerous viral and bacterial infections, pneumonia, as a manifestation of generalized infection, occurs in 78% of cases. Among the total number of patients, premature babies are 40% more likely to have congenital pneumonia even with uncomplicated pregnancy.

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Causes pneumonia in a newborn baby

Pneumonia is an acute inflammatory process of the lung tissue, which is accompanied by the accumulation of inflammatory exudate inside the alveoli and symptoms from the respiratory system. Despite such a small age, pneumonia in newborns can be as common as in older children. This is due to many factors and reasons. Different pathogens play a role in the development of different types of pneumonia in newborns. Therefore, in order to understand the etiology of pneumonia, you must first consider what types there are.

Depending on the time of manifestation of symptoms, congenital and neonatal pneumonia are distinguished. Congenital pneumonia manifests itself in the first three days after birth. The cause of such pneumonia are viruses that penetrate the blood-brain barrier. Therefore, the main causative agents of such pneumonia are considered to be systemic viruses from the TORCH group - this is the rubella virus, cytomegalovirus, herpes viruses, toxoplasmosis and syphilis. If we are talking about such an infection, then the infection occurred in the early stages of pregnancy transplacentally and pneumonia can be one of the manifestations of an intrauterine infection. Bacteria can also cause congenital pneumonia - chlamydia, mycoplasma, listeria, ureaplasma, candida, trichomonas. Then there is a high probability that the infection occurred during childbirth or before the birth itself.

The causes of neonatal pneumonia depend on the time of occurrence: there are early (up to 7 days) pneumonia and late (from 7 to 28 days of life). Early pneumonia refers to those whose pathogens can be stationary flora - infection occurs in the delivery room, in the premature baby department, during artificial ventilation. Then the probable causes can be considered staphylococci, E. coli, Pseudomonas aeruginosa, Klebsiella. Late pneumonia occurs when infected with domestic flora and more often these are associations of viruses with bacteria.

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Risk factors

Such precise division by etiological factors is very important, since approaches to the treatment of such pneumonias differ. But fortunately, not all children get sick, there are risk factors for this pathology, which include:

1. complicated pregnancy and maternal illnesses lead to disruption of the formation of the normal protective barrier – the placenta;
2. pathological births – cesarean section, use of obstetric forceps – all this increases the risk of additional infection;
3. Chronic or acute infectious diseases of the mother with damage to the reproductive system and urinary tract increase the risk of infection during passage through the birth canal;
4. meconium aspiration during labor;
5. application of resuscitation measures for a child or mechanical ventilation;
6. prematurity, birth trauma or CNS damage;
7. improper sanitary and epidemiological conditions in the delivery room.

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Pathogenesis

The pathogenesis of pneumonia in a newborn is associated with the immaturity of its respiratory system, which increases the risk of infection and rapid development of the infectious process. Under the influence of pathogenic flora that penetrates the lungs, due to the presence of intensive blood supply, pathogens quickly spread to both lungs with the blood flow. At the same time, an inflammatory process occurs in the alveoli, the severity of which develops over minutes and hours. This disrupts the gas composition of the blood and severe hypoxia of the cells occurs - they do not have enough oxygen at the very moment when it is needed most after birth. Oxygen deficiency quickly disrupts the functioning of the brain, and then other internal organs, so intoxication develops very quickly. Such features of pathogenesis affect the clinical course of pneumonia in newborn babies.

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Symptoms pneumonia in a newborn baby

Clinical manifestations of congenital pneumonia appear immediately after birth or after a few hours. As a rule, even before birth, pneumonia is slightly compensated due to the fact that the child is nourished through the placenta. When a child is born, two circles of blood circulation begin to function and the lungs straighten out after the first breath. And then, a few hours after birth, tissue hypoxia increases and symptoms of congenital pneumonia appear. The first signs of the disease are manifested by a general severe condition - 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. Respiratory disorders are also expressed, as the body tries to restore the required amount of oxygen in the lungs by increasing breathing. This is manifested by shortness of breath, and when examining the baby, attention is drawn to the retraction of the intercostal spaces and areas above and below the collarbones, the sinking of the sternum during breathing. Against the background of respiratory failure, tachypnea and rapid heartbeat are determined. This is accompanied by weight loss against the background of refusal to breastfeed, which further complicates the situation. All symptoms increase very quickly and against the background of an increase in body temperature, convulsions often occur.

The peculiarities of the course of neonatal pneumonia, especially the community-acquired form, are its milder course. The lungs are affected, but already against the background of relative compensation of the child's body to the external environment. During the period when there were no symptoms, the child managed to breastfeed a little, which gave not only strength, but also factors of immune protection against infections. Therefore, the symptoms of neonatal pneumonia are not so pronounced, but they are similar. The child becomes restless, the body temperature rises. Against this background, shortness of breath appears with the participation of additional muscles in this. Intoxication increases more slowly, but it is also pronounced and depends on the rate of spread of the infection.

Bilateral pneumonia in newborns is very common. This is because the child's body is unable to limit the inflammatory process within one segment, as in an older child. In addition, the constant horizontal position and wide bronchi with thin alveolar septa only contribute to the rapid spread of infection further to new areas. Therefore, it is impossible to talk about focal pneumonia in newborns. But unilateral pneumonia can occur at the initial stages of the disease, especially if we are talking about late neonatal pneumonia. Then it is more often right-sided due to the fact that the right bronchus is wider and shorter than the left. But the process quickly spreads to the other lung, which is important in treatment.

Stages

During a clinical examination, the degree of respiratory failure is determined in order to accurately determine the severity and need for oxygen support or artificial ventilation. The degree of respiratory failure can be equated with the severity, taking into account other clinical symptoms. Mild pneumonia in newborns is accompanied by shortness of breath and cyanosis, which appear when the child is restless, there are no symptoms from other organs, since acidosis is moderate.

Moderate pneumonia is characterized by shortness of breath and cyanosis at rest, generalized cyanosis with anxiety, tachycardia, tachypnea, and decreased levels of cellular oxygen saturation.

Severe pneumonia in newborns is accompanied by severe respiratory distress, convulsions, CNS symptoms and the need for mandatory mechanical ventilation.

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

The main types of pneumonia depend on the time of infection and the onset of symptoms.

Thus, congenital pneumonia has its manifestations immediately after birth - the child has a low degree of adaptation (low score on the Apgar scale) and manifestations of respiratory failure are immediately visible. Intrauterine pneumonia in a newborn is characterized by systemic symptoms, since the virus passes through the placenta and has the ability to penetrate many internal organs. Therefore, against the background of respiratory symptoms, other manifestations are also expressed - there may be a generalized rash on the child's body, congenital heart defects, blindness, damage to the brain or ventricles, an enlarged liver.

Pneumonia in newborns after cesarean section is caused by bacteria that are on the instruments or in the delivery room. Therefore, its diagnostic and treatment principles are close to early neonatal.

Aspiration pneumonia in a newborn develops against the background of meconium aspiration in a child. This may occur during a post-term pregnancy or a long anhydrous period. The microflora of such pneumonia may be not only opportunistic, but also anaerobic. In addition, meconium itself is an aggressive substance that can damage the lung tissue itself.

Pneumonia in a premature newborn has its own characteristics, since its body is underdeveloped, including the respiratory and immune systems, which cannot respond to infection so quickly. Therefore, in premature babies, the onset of pneumonia is gradual with an increase in general weakness, hypotension, and hyporeflexia. Then, symptoms of intoxication and respiratory failure come to the fore, while other symptoms are poorly expressed. Premature babies are prone to low temperatures due to the underdevelopment of the thermoregulation center, and they cannot have a fever. In addition, objective and laboratory data do not indicate the presence of pneumonia. Premature babies have a very high risk of complications after pneumonia and the development of sepsis.

There are some peculiarities of the course of viral and bacterial pneumonia. Viral pneumonia of newborns is more often catarrhal in nature, but with a pronounced intoxication syndrome, and bacterial pneumonia is purulent in nature. Purulent pneumonia in a newborn is often caused by intracellular pathogens, such as chlamydia. In this case, it is very difficult for the cells of the immune system to get the bacteria, which is accompanied by the formation of a large amount of pus. This is accompanied by symptoms from the respiratory system and pronounced destructive processes in the lungs.

Speaking about the symptoms of pneumonia in newborns, it should be emphasized that even a mother can determine the initial manifestations of respiratory failure in a child. And such timely diagnosis will allow treatment to begin as early as possible.

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Complications and consequences

The newborn's body has a low level of defenses, which contributes to the rapid spread of infection in the child's body. Therefore, complications can develop within a few hours with serious consequences. All complications of pneumonia can be divided into pulmonary and extrapulmonary. Pulmonary complications include pleurisy (inflammation of the pleura), atelectasis (collapse of a part of the lungs), pneumothorax (accumulation of air in the chest cavity, which compresses the lungs from the outside). These complications can occur as early as the second day of untreated pneumonia. Extrapulmonary complications develop as a result of the spread of infection by the lymphogenous or hematogenous route. These include acute otitis, hemorrhagic syndrome, DIC syndrome, hemodynamic disorders, persistence of fetal communications, and sepsis. 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 is fatal, since removing the bacteria in this case is a very difficult task.

Among the later consequences in children who have had pneumonia, there is a more frequent development of rickets and anemia, which must be taken into account in further care of the child after discharge from the hospital.

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Diagnostics pneumonia in a newborn baby

The mother's medical history regarding pregnancy and childbirth can provide a lot of information about the type of pneumonia and possible etiologic factors. Therefore, it is necessary to ask in detail about all episodes of the mother's illness, chronic infections and examinations during pregnancy.

Diagnosis of pneumonia by external symptoms should also include an objective examination. In case of pneumonia, percussion of the chest will reveal a shortened percussion sound. Auscultation of the lungs may reveal weakened breathing, but moist rales and crepitations are observed only in 10-15% of cases of children with pneumonia. Therefore, one should not rely so much on objective symptoms, and here visual changes from other systems play an important role. Therefore, laboratory and instrumental diagnostic methods play a key role in confirming the diagnosis.

Tests that could confirm the etiology of pneumonia in newborns are not so informative. This is due to the fact that immediately after birth, the child undergoes physiological adaptation of all organs and systems, including the circulatory system. The number of formed elements of the blood increases, and on the fifth day, physiological leukocyte crossing occurs. Therefore, changes in laboratory data that may indicate pneumonia are not as specific as in older children. But the main changes are an increase in the number of leukocytes in dynamics and the absence of leukocyte crossing on the fifth day of the child's life.

If it is necessary to conduct specific treatment for pneumonia in a child or the therapy is ineffective, then it is possible to conduct an examination of the mother for viruses and bacteria that could cause the disease in the baby. For this purpose, a serological blood test is carried out to determine antibodies to certain pathogens.

Instrumental diagnostics is of primary importance in confirming the diagnosis of pneumonia. Today, no doctor can establish such a diagnosis without chest X-ray. This method allows you to clearly determine the extent of lung damage and the localization of the process. X-ray signs of pneumonia in newborns are deflated lungs and increased vascular pattern in the early stages of the disease, and then inflammatory-infiltrative changes of a confluent nature appear.

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Differential diagnosis

Differential diagnosis of pneumonia should be carried out with hyaline membrane disease, aspiration syndrome, congenital malformations of the lungs, diaphragmatic hernia, heart pathology and CNS injuries, which are accompanied by respiratory failure.

The symptoms of congenital pneumonia and respiratory distress syndrome are very similar, so the main diagnostic method can be considered radiography. With RDS, the lungs look like "cotton wool", while with pneumonia, the foci are more confluent and clear. But still, these pathologies are difficult to differentiate, so the principles of treatment of both pathologies are not particularly different.

Cardiac pathology can be ruled out using ultrasound data, which allows for the assessment of the condition and function of the heart. Congenital lung defects can also be diagnosed on X-rays, as can diaphragmatic hernia.

It is very important to differentiate the etiology of pneumonia, because the approach to treatment is different.

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Treatment pneumonia in a newborn baby

The peculiarity of treating pneumonia in newborns is that it is necessary to use not only etiological methods, but also pathogenetic, symptomatic ones. After all, for such a baby, even the air temperature is important, since hypothermia threatens a sharp deterioration in the condition. 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 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. Only after such measures can we talk about other drug therapy.

Treatment periods for pneumonia in newborns range from 14 to 20 days, depending on the severity of the process. Antibiotics for pneumonia in newborns are considered the main and mandatory treatment. In this case, treatment is carried out with two drugs, the methods of administration of which are only parenteral (intramuscular and intravenous).
Treatment is carried out in stages: there are several courses of treatment depending on the type of antibiotic used. The first course prescribes a 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.

What indicators are important in the treatment of neonatal pneumonia? First of all, they focus on the severity of dyspnea, blood saturation and intoxication syndrome. The effect of treatment is assessed 48-72 hours after the start of therapy, and if there is no effect, then another line of therapy is used.

Along with antibiotics, it is essential to use probiotic preparations, since dysbiosis in such children can cause diarrhea and dehydration, which will further worsen the condition.

Detoxification therapy should be carried out to correct hemodynamic disorders and restore metabolic systems. For this purpose, the infusion is calculated based on the child's weight, taking into account all losses and needs. If it is necessary to correct the function of vital organs, inotropic, antispasmodic and other drugs are added to the treatment.

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 act of breathing itself is necessary, then special oxygen supply devices with constant positive pressure in the respiratory tract are connected. Mechanical ventilation for pneumonia in a newborn is used when the degree of respiratory failure is extremely severe and the child needs support for the act of breathing itself.

The main drugs used in the treatment of pneumonia in newborns are:

1. Cefuroxime acetyl is a second-generation beta-lactam antibiotic used for its bactericidal action 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. Side effects are possible when affecting the stomach - colitis or dysbacteriosis develops, which is manifested by bloating, stool disorders. Precautions - the drug cannot be used if the mother or close relatives are allergic to penicillin antibiotics.
2. Amikacin is an antibiotic of the aminoglycoside group, which 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 - sleep disturbance, drowsiness or lethargy, damage to the renal parenchyma, stool disorders. Precautions - do not use in case of kidney damage.
3. Vancomycin is an antibiotic from the glycopeptide group, which is effective against many gram-positive bacteria, as well as some anaerobes. It can be used in case of allergy to penicillin antibiotics. The dosage of the drug on the first day is 15, and then 10 mg / kg / day in 2 doses for children of the first seven days, and for older children the same dosage three times a day. Side effects may appear with rapid administration in the form of anaphylactic reactions or in the future there may be hearing loss or effects on the kidneys. Precautions - the drug can cause inflammatory changes in the veins, so slow administration with a change in the injection site is recommended.
4. Lactovit is a drug that contains lactobacilli that produce lactic acid and prevent pathogenic bacteria from multiplying. Due to this, the drug creates favorable conditions for the development of beneficial intestinal microflora. At the same time, an important factor is that such bacteria are completely resistant to antibiotics, so they can be used against the background of antibacterial therapy. The dosage sufficient to restore microflora and normalize intestinal peristalsis in children is half a packet per day in two doses. The powder can be dissolved in milk and given to the child before feeding. Side effects are diarrhea, stool color changes, rumbling in the intestines.

Vitamins and physiotherapy for pneumonia in a newborn are not used in the acute period. During the child's recovery after illness, massage and some procedures aimed at resolving adhesions can be used.

A nursing mother can take vitamins, which improves the regeneration processes of the baby's lung tissue and speeds up recovery.

Traditional treatment of pneumonia in newborns

It should be said that treatment of a newborn at home is not carried out in any case, therefore folk remedies for treatment of such babies are not used. But considering that the mother feeds the child with breast milk, with which many useful substances and immune factors can be transferred, folk methods can be used by the mother. Knowing about women from the risk group who had similar cases in the anamnesis or during complicated pregnancy, it is possible to take some homeopathic remedies for the purpose of prevention. But any appointments should only be on the recommendation of a doctor.

Mom can use herbal teas that help remove toxins:

1. Tea from linden leaves and viburnum berries can be used in small quantities after each feeding. For such tea, you need to take thirty grams of linden leaves and the same amount of viburnum berries per liter of water. You need to drink 50 grams of tea, so by the next feeding the child will receive such useful substances.
2. Raspberry has high antiviral and antibacterial activity as a natural antioxidant. But it has a high degree of allergization of the body, so raspberry tea can be taken no more than twice a day. It is better to use fresh raspberries to make tea, if the season allows. But raspberries from a jar should be given less preference than pods from a raspberry bush, which has more useful properties. You need to make regular tea with the addition of a certain amount of either berries or pods.
3. Buckthorn berries can also be used to make medicinal tea. Before this, the berries need to stand in sugar for two weeks, and then add two berries to water to make such tea. You can drink it two or three times a day.
4. A decoction of coltsfoot and wild rosemary leaves can be used already during the period of active recovery of the child, which improves the discharge of purulent sputum and improves breathing. To do this, make a tea from 60 grams of leaves of both herbs and one liter of water, and the mother takes 50 milliliters twice a day.

Homeopathy can also be used during the mother's pregnancy and until the child has fully recovered from the illness.

1. Witch hazel is a homeopathic remedy of natural plant origin. The drug can be used for diseases in children who are born prematurely during pathological pregnancy. The method of using the drug is for the mother for three weeks. Dosage - five grains three times a day. Side effects can be in the form of insomnia or stool disorders in the form of diarrhea, which requires halving the dose.
2. Phosphorus is a homeopathic remedy of inorganic origin. This remedy works by enhancing the synthesis of immune cells of the non-specific link of immunity. It is used in the treatment of pneumonia in children when adding the medicine to the mother's diet. 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.
3. Argentum nitricum is a complex drug of inorganic origin. It is used to treat babies born on time or post-term after cesarean section. The method of using the drug in tablets. The dosage of the drug for the mother is one tablet every six hours in the acute period. Side effects can only be in the form of allergic reactions.
4. Thuja compositum is a homeopathic remedy of natural plant origin, which is recommended for use specifically to normalize the recovery of the body after discharge home. This plant is an excellent means of restoring the child's appetite and adapting to the outside world after a respiratory disease. Method of application - in the form of drops, dissolving them in clean water. Dosage - three drops per fifty grams of water for the mother three times a day. Side effects are often observed in the form of stool disorders, insomnia. Precautions - cannot be used if there is an allergy to conifers in the family.

The recovery of a newborn after pneumonia is not so fast, since not only clinical recovery with the elimination of the pathogen is necessary, but also the restoration of normal lung and heart function and control of vital functions. With pneumonia, the natural process of synthesis and restoration of surfactant levels is disrupted, so it takes time for the normal function of the respiratory system. In general, if there are no complications, the acute period can end after four weeks, but full recovery comes after three to four months. At this time, the child requires the most gentle and attentive home care, adequate nutrition and good care.

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Prevention

Prevention of pneumonia in newborns is very important due to many serious complications. And such measures should be applied during pregnancy by carefully examining the expectant mother and excluding chronic infections in her. It is important that the birth takes place naturally, then the mother's microflora will be familiar to the child with a set of its own antibodies, which are then transmitted with milk. After birth, the joint stay of the mother with the child reduces the possibility of infection with other pathogenic bacteria. The place where the birth takes place and the correct organization of this process are very important. The most important point of prevention can be considered a careful attitude to the future child and the birth of a healthy baby on time, which reduces the risk of any diseases in the neonatal period.

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Forecast

The prognosis for pneumonia can be favorable if treatment is started within the first day. The longer the diagnosis and treatment are delayed, the less chance there is to avoid all complications. Mortality from pneumonia in newborns is very high, especially in premature babies.

Pneumonia in a newborn often develops against the background of pathology of pregnancy, childbirth or prematurity. This is caused by low immunity of the baby's body, which must be taken into account when treating such children. Complications of pneumonia are very serious, so it is important to prevent the disease. But every mother should remember that the best prevention is the birth of a healthy and strong baby and breastfeeding.

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