Pneumonia in a newborn child: bilateral, severe, infectious

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

[1], [2]

Epidemiology

Statistics of pneumonia indicate a high percentage of the disease in children who are born from pathological pregnancy and childbirth. In mums, which are active carriers of dangerous viral and bacterial infections of pneumonia, as a manifestation of generalized infection, occurs in 78% of cases. Among the total number of patients, preterm infants are 40% more likely to have congenital pneumonia, even in uncomplicated pregnancies.

[3], [4], [5], [6],

Causes of the pneumonia in a newborn child

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

By the time of manifestation of symptoms distinguish congenital and neonatal pneumonia. 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 pathogens of such pneumonias are systemic viruses from the TORCH group - the rubella virus, cytomegalovirus, herpesvirus, toxoplasmosis and also syphilis. If it is a question of such infection, the infection occurred in the early stages of pregnancy transplacental and pneumonia may be one of the manifestations of intrauterine infection. The cause of congenital pneumonia can also be bacteria - chlamydia, mycoplasma, listeria, ureaplasma, candida, trichomonas. Then there is a high probability that infection occurred already at birth or before the birth itself.

The causes of neonatal pneumonia depend on the time of occurrence: distinguish between early (up to 7 days) pneumonia and late (from 7 to 28 days of life). Early pneumonia refers to those whose pathogens can be a stationary flora - infection occurs in the ancestral hall, in the department of prematurity, during ventilation. Then probable causes can be considered staphylococci, E. Coli, Pseudomonas aeruginosa, Klebsiel. Late pneumonia occurs even when infected with domestic flora and more often it is the association of viruses with bacteria.

[7], [8],

Risk factors

This precise division by etiologic factors is very important, since the approaches to the treatment of such pneumonias differ. But not all children are happy for happiness, there are risk factors for this pathology, which include:

1. complicated pregnancy and mother's diseases lead to a violation of the formation of a normal protective barrier - the placenta;
2. pathological births - caesarean section, use of obstetric forceps - all this increases the risk of additional infection;
3. chronic or acute infectious diseases of the mother with lesions of the reproductive system and urinary tract increase the risk of infection during passage through the birth canal;
4. meconial aspiration in childbirth;
5. the use of resuscitative measures for a child or ventilation;
6. prematurity, birth trauma or injury to the central nervous system;
7. improper sanitary and epidemiological situation in the family.

[9], [10], [11], [12], [13], [14]

Pathogenesis

The pathogenesis of pneumonia in a newborn is associated with the immaturity of his respiratory system, which increases the risk of infection and the rapid development of the infectious process. Under the influence of pathogenic flora, which penetrates the lungs, due to the presence of intensive blood supply, pathogens with blood flow rapidly spread to both lungs. Thus in the alveoli there is an inflammatory process, the severity of which develops over the course of minutes and hours. This violates the gas composition of the blood and there is a pronounced hypoxia of the cells - they lack oxygen at the exact moment when it is most needed after birth. Insufficiency of oxygen quickly disrupts the work of the brain, and then of other internal organs, so intoxication develops very quickly. Such features of pathogenesis affect the clinical course of pneumonia in newborn babies.

[15], [16], [17],

Symptoms of the pneumonia in a newborn child

Clinical manifestations of congenital pneumonia appear immediately after birth or several hours later. As a rule, even before birth, inflammation of the lungs is slightly compensated by the fact that there is a baby's nutrition through the placenta. When a child is born, then two circles of blood circulation begin to function and the lungs straighten out after the first inhalation. And then several hours after birth, hypoxia of tissues develops and symptoms of congenital pneumonia appear. The first signs of the disease manifest a general severe condition - the child is born with a cyanotic or pale gray complexion, there may be a petechial rash against the background of intoxication. The child has a weak cry and depressed congenital reflexes on the background of hypoxia of the central nervous system. Also respiratory disorders are expressed, as the body tries to restore the necessary amount of oxygen in the lungs by increasing respiration. This is manifested by shortness of breath, and when examining the baby draws attention to the entrainment of the intercostal spaces and areas above and under the clavicles, the sternum of the sternum during breathing. Against the background of a violation of breathing, tachypnea and palpitations are determined. This is accompanied by a loss of body weight on the background of rejection of the breast, which further complicates the situation. All the symptoms grow very quickly and against the background of fever, there are often seizures.

Features of the course of neonatal pneumonia, especially the community-acquired form, are in its lighter flow. Affected lungs, but against a background of relative compensation of the child's body to the external environment. During the period when there were no symptoms, the child had time to breast feed a little, which gave not only strength, but also immune defenses 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, dyspnea appears with the involvement of additional muscles in this. Intoxication develops more slowly, but it is also expressed and depends on the speed of infection.

Two-sided pneumonia in a newborn is very common. This is due to the fact that the child's body is not able to limit the inflammatory process within a single segment, as in an older child. In addition, a 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 not necessary to talk about focal pneumonia in a newborn. And one-sided pneumonia can be at the initial stages of the disease, and especially if it is a question of late neonatal pneumonia. Then it is more often right-sided because the right bronchus is wider and shorter than the left one. But the process quickly spreads to another lung, which is important in treatment.

Stages

In clinical examination, the degree of respiratory failure is determined to accurately indicate the severity and the need for oxygen support or mechanical ventilation. The degree of respiratory failure can be equated with severity, taking into account other clinical symptoms. The mild form of pneumonia in newborns is accompanied by shortness of breath and cyanosis, which appear with the child's anxiety, there are no symptoms from other organs, since acidosis is mild.

Pneumonia of moderate severity is characterized by dyspnea and cyanosis at rest, generalized cyanosis with anxiety, tachycardia, tachypnoe, decreased oxygen saturation of the cells.

Severe pneumonia of newborns is accompanied by severe respiratory disorders, seizures, symptoms from the central nervous system and the need for mandatory ventilation.

Stages of pneumonia do not differ from those in adults, the only thing that quickly spreads inflammation and some pathogens quickly cause necrosis (staphylococcus, influenza virus, pneumocyst).

[18], [19], [20],

Forms

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

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

Pneumonia in newborns after cesarean section is caused by bacteria that are on the instruments or in the ancestral hall. Therefore, it has the principles of diagnosis and treatment close to the early neonatal.

Aspiration pneumonia in a newborn develops against a background of meconial aspiration in a child. This can be with a pregnant pregnancy or a long anhydrous period. The microflora of such pneumonia can 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 system, which can not respond to infection so quickly. Therefore, in preterm infants, the onset of pneumonia is gradual with a build-up of general weakness, hypotension, hyporeflexia. Then the symptoms of intoxication and respiratory failure come to the forefront, while the other symptoms are little pronounced. In premature infants due to underdevelopment of the thermoregulation center, a tendency to low temperature, and they can not have fever. In addition, objective and laboratory data do not indicate the presence of pneumonia. Preterm patients have a very high risk of complications after pneumonia and sepsis development.

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

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

[21], [22], [23], [24]

Complications and consequences

The newborn has a low level of protective forces, which contributes to the rapid spread of infection in the child's body. Therefore complications can develop for several hours with serious consequences. All complications of pneumonia can be divided into pulmonary and extrapulmonary. Pulmonary complications include pleurisy (inflammation of the pleura), atelectasis (a decay of a lung particle), pneumothorax (an accumulation of air in the chest cavity that squeezes the lungs from the outside). These complications can already be on the second day of untreated pneumonia. Extrapulmonary complications develop due to the spread of infection by lymphogenous or hematogenous pathways. These include acute otitis media, hemorrhagic syndrome, DIC syndrome, hemodynamic disorders, persistent fetal communications, and sepsis. Such a common infection with lung damage can quickly cause the causative agent to enter the bloodstream and develop bacteremia. Sepsis for such a small child is fraught with a lethal outcome, since excretion of the bacterium in this case is a very difficult task.

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

[25], [26], [27], [28],

Diagnostics of the pneumonia in a newborn child

Anamnesis of mother regarding pregnancy and childbirth can give a lot of information about what kind of pneumonia and what can be the etiological factors. Therefore, it is necessary to interview in detail all the episodes of maternal illness, chronic infections and research during pregnancy.

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

Analyzes 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 is physiological adaptation of all organs and systems, including the circulatory system. The number of blood cells is increased, and on the fifth day there is a physiological leukocyte cross-over. 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 white blood cells in the dynamics and the absence of a leukocyte crossover on the fifth day of a child's life.

If it is necessary to carry out a specific treatment of pneumonia in a child or if the therapy is ineffective, it is possible to conduct a mum's test for viruses and bacteria that could cause illness in the baby. For this purpose, a blood serological test is carried out to determine antibodies to certain pathogens.

Instrumental diagnosis is a priority in confirming the diagnosis of pneumonia. To date, no doctor can establish such a diagnosis without chest radiography. This method allows you to clearly establish the extent of lung damage and the localization of the process. X-ray signs of a newborn's pneumonia are a bloating of the lungs and augmentation of the vascular pattern at the initial stages of the disease, and then inflammatory-infiltrative changes in the draining character already appear.

[29], [30], [31], [32], [33],

Differential diagnosis

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

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

The pathology of the heart can be excluded by ultrasound, which makes it possible to assess the condition and function of the heart. Congenital malformations of the lungs on radiographs can also be diagnosed, as well as diaphragmatic hernia.

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

[34], [35], [36], [37], [38]

Treatment of the pneumonia in a newborn child

A feature of the treatment of pneumonia in newborns is that it is necessary to use not only etiological methods, but also pathogenetic, symptomatic. After all, for such a baby, even the air temperature is important, since hypothermia threatens a sharp deterioration in the condition. Therefore, you need to start treatment with the regime.

The most suitable for a newborn with pneumonia is the cuvette mode, since it is possible to use the correct temperature regime. The average temperature in the cuvette for children is 32-34 degrees, and the humidity of air is 80-90% in the first days. It is very important to give oxygen support, which can also be done directly in the cuvies.

Nutrition of the child with pneumonia should be continued with breast milk, the total calorie need to be limited but with increasing frequency of feeding. Only after such measures it is possible to speak about other medicamentous therapy.

The duration of treatment of pneumonia in newborns is from 14 to 20 days, depending on the severity of the process. Antibiotics for pneumonia in newborns are considered to be the main and mandatory remedies. In this case, the treatment is carried out by two drugs, the methods of using 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 that is used. The first course is prescribed b-lactam antibiotic (semisynthetic penicillin or cephalosporin 2 generations) in combination with aminoglycosides. If this combination of drugs is ineffective, second-line 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 estimated after 48-72 hours after the start of therapy, and if there is no effect, then another line of therapy is used.

Along with antibiotics, the use of probiotic drugs is mandatory, since dysbiosis in such children can cause diarrhea and dehydration, which will further worsen the condition.

Disintoxication therapy should be used to correct hemodynamic disorders and restore metabolic systems. To do this, calculate the infusion for the weight of the child, taking into account all losses and needs. If necessary, correction of the function of vital organs is added to the treatment of inotropic, antispasmodic and other drugs.

Oxygen support of the child is necessarily carried out, since metabolic disturbances very badly affect the cardiovascular system. If the child is in the cuvete, then there may be free oxygen supply or through a mask. If the child is weak or premature and needs correction of the act of breathing, then connect special oxygen supply devices with a constant positive pressure in the airways. IVL in 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.

The main drugs that are used in the treatment of pneumonia in neonates are the following:

1. Cefuroxime acetyl-beta-lactam antibiotic of the second generation, which is used because of its bactericidal action on many extracellular opportunistic microorganisms. In the treatment of pneumonia this drug is used intravenously or intramuscularly. Dosage of the drug - from 50 to 100 milligrams per kilogram of weight per day. Side effects are possible with the influence on the stomach - develops colitis or dysbiosis, which manifests itself by bloating, a violation of the stool. Precautions - do not use the drug for allergies to antibiotics-penicillins in the mother or close relatives.
2. Amikacin is an antibiotic of the aminoglycoside group, which is effective against staphylococcus, Klebsiels, Escherichia coli and some other bacteria that play a significant role in lung damage in utero. In the treatment of neonatal pneumonia, a dosage of 15 mg / kg / day in 2 divided doses is used. Side effects - sleep disturbance, drowsiness or blocking, damage to the renal parenchyma, stool disorders. Precautions - do not use with kidney damage.
3. Vancomycin is an antibiotic from the glycopeide group, which is effective against many gram-positive bacteria, as well as some anaerobes. It can be used for allergy to penicillin antibiotics. Dosage of the drug on the first day of 15, and then 10 mg / kg / day in 2 divided doses for the first seven days, and for the elderly the same dosage three times a day. Side effects may occur with rapid administration in the form of anaphylactic reactions or may subsequently be a hearing impairment or an effect on the kidneys. Precautionary measures - the drug can cause inflammatory changes in the veins, so a slow administration with a change in the injection site is recommended.
4. Lactovit - a drug that has in its composition lactobacilli, which form lactic acid and do not allow reproducing pathogenic bacteria. Due to this, the preparation forms favorable conditions for the development of useful 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. Dosage, sufficient to restore the microflora and normalize the function of intestinal peristalsis in children - is half a sachet per day in two divided doses. The powder can be dissolved in milk and given to the baby before feeding. Side effects are diarrhea, stool color disorder, rumbling in the intestine.

Vitamins and physiotherapy for pneumonia in a newborn are not used in the acute period. When restoring a child after illness, you can use massage and some procedures aimed at resolving adhesions.

Vitamins can be taken by a nursing mother, which improves the regeneration of lung tissue in the baby and accelerates recovery.

Alternative treatment of pneumonia in a newborn

Need to say that the treatment of a newborn at home is not done in any case, so alternative treatment for these babies are not applied. But given that mother feeds the baby with breast milk, which can transfer many useful substances and immune factors, Mom can use alternative methods. Knowing about women from the risk group who have had similar cases in anamnesis or with complicated pregnancy, it is possible to take some homeopathic remedies for the purpose of prevention. But any appointments should be only on the recommendation of the doctor.

Mom can use herbal teas that help eliminate toxins:

1. Tea made from linden leaves and viburnum fruits can be used in small amounts after each feeding. For such a tea you need to take thirty grams of linden leaves and the same number of berries of viburnum per liter of water. You need to drink 50 grams of tea, so to the next feeding the child will receive such useful substances.
2. Raspberry, as a natural antioxidant, has high antiviral and antibacterial activity. But it has a high degree of allergic organism, so the reception of raspberry tea can be no more than two times a day. It is better to use fresh raspberries for 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. Tea should be made ordinary with the addition of a certain amount or berries or pods.
3. Berry berries can also be used to make medicinal tea. Before this, it is necessary for the berries to stand in sugar for two weeks, and then adding two berries to the water to make such tea. You can drink two or three times a day.
4. Decoction of the leaves of mother-stepmother and ledum can be used already during the active recovery of the child, which improves the passage of purulent sputum and improves breathing. To do this, make tea from 60 grams of leaves of both herbs and one liter of water, and the mother takes twice 50 ml.

Homeopathy can also be used during pregnancy by the mother, and until the child is fully recovered from the disease.

1. Gammamelis is a homeopathic remedy of natural plant origin. The drug can be used in cases of illness in children who are born before the term in the pathological course of pregnancy. The method of application of 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 disruption in the form of breakouts, which requires reducing the dose in half.
2. Phosphorus is a homeopathic remedy of inorganic origin. This drug acts by enhancing the synthesis of immune cells of the nonspecific link of immunity. Used in the treatment of pneumonia in children with the addition of medication in the diet of the mother. 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 - do not use the drug if you suspect congenital malformations in the baby.
3. Argentum nitrikum is a complex preparation of inorganic origin. It is used to treat babies born on time or transferred after cesarean section. Method of application of the drug in tablets. Dosage of the drug for the mother - on a tablet every six hours in an acute period. Side effects can only be in the form of allergic manifestations.
4. Tuya compositum is a homeopathic remedy of natural plant origin, which is recommended to be used for normalization of recovery of the body after discharge. This plant is an excellent tool for restoring the child's appetite and adapting it to the outside world after suffering a respiratory pathology. The method of application - in the form of drops dissolving them in pure 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 disturbances in stool, insomnia. Precautions - should not be used if there is an allergy in the family to conifers.

Restoration of the newborn after pneumonia is not so fast, as it is necessary not only to clinically recover from the elimination of the pathogen, but also to restore the normal operation of the lungs, the heart, and control of vital functions. With pneumonia, the natural process of synthesis and restoration of the surfactant level is disrupted, therefore time is needed for the normal function of the respiratory system. In general, if there are no complications, then the acute period may end four weeks later, but a full recovery comes three or four months later. At this time the child requires the most gentle and attentive home care, adequate nutrition and good care.

[39], [40], [41]

Prevention

Prevention of pneumonia in newborns is very important because of a number of serious complications. And such measures should be used even during pregnancy by careful examination of the future mother and the exclusion of chronic infections in her. It is important that the birth takes place naturally, then the microflora of the mother will be familiar to the child with a set of her own antibodies, which are later given in milk. After childbirth, mum's joint stay with a child reduces the possibility of infection with other pathogenic bacteria. It is very important to place the birth and the correct organization of this process. The most important aspect of prevention can be considered a cautious attitude to the future child and the birth of a healthy baby in time, which reduces the risk of any disease in the period of newborn.

[42], [43], [44],

Forecast

The prognosis of pneumonia can be favorable at the beginning of treatment in the first day. The longer the diagnosis and treatment is delayed, the less chance of avoiding all complications. Mortality from pneumonia in newborns is very high, especially in premature babies.

Pneumonia in a newborn develops more often on 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 babies. Complications of pneumonia are very serious, so it is important to prevent the disease. But every mom should remember that the best prevention is the birth of a healthy and strong baby and feeding it with breast milk.

[45], [46], [47], [48], [49],