Stomatitis in a newborn baby: signs, how and what to treat
Stomatitis in newborns is an inflammation of the oral mucosa in a baby. This causes a lot of unpleasant sensations, first of all, it breaks the process of feeding the child, which indicates a big problem of such a disease. Knowledge of the etiology and pathogenesis of the development of this disease is very important, since the tactics of treatment are different for different types of pathology.
Epidemiology
Statistics of the spread of stomatitis indicate that in most cases this pathology occurs in children who after birth needed invasive interventions or in prolonged antibacterial therapy. More than 65% of cases of stomatitis in newborns are fungal etiology, and about 30% of bacterial origin. This tells not only about the etiological features, but also about the tactics of treatment that must be used.
Causes of the stomatitis in newborns
To understand what is stomatitis, you need to understand the concept of normal microflora of the oral cavity of the child and the factors that affect it. In the total amount in the oral cavity there are more than 100 different types of microorganisms, but the mucosa of the oral cavity of the child has slightly less bacteria. They fall on the mucosa immediately after birth, and the first way is through the birth canal. Therefore, the bacteria that mothers have are transmitted to the baby. This is the primary colonization of the oral cavity by that flora, which is conditionally pathogenic. The next way is direct ingress of bacteria with food. For the newborn, the main food is breast milk, so most bacteria that get with food are lactobacilli and bifidobacteria. They live in the intestines, but still some amount can be and mouth. In addition, in the oral cavity of the child under normal conditions are non-pathogenic species of streptococci, valenol, and some types of fungi. These all bacteria are in the minimum amount in which they can not cause the disease. On the contrary, they play the role of flora, which retards the growth of pathogenic microorganisms. But under certain conditions this balance can be violated, and then pathogenic bacteria or fungi increase in quantity. These processes lead to the development of the inflammatory process of the mucosa, which is a stomatitis. Thus, the pathogenesis of the development of stomatitis is precisely that the amount of pathogenic flora that causes inflammation increases.
The causes of stomatitis in newborns are primarily violations of the population of flora already in the period of newborn. The main reason in this case can be considered a disease of the mother, which breaks the microflora of the genital tract. Such diseases include bacterial vaginosis, vaginitis, inflammatory diseases of the ovaries and genital organs. All these pathologies lead to the fact that the normal flora perishes, and the child contacts at birth with a pathogenic flora. This violates the ratio of bacteria in the mouth of the child, which causes further stomatitis.
Talking about other causes of stomatitis in newborns, one must speak about the etiology of the disease. Stomatitis can be bacterial, viral and fungal. Viral stomatitis is often caused by the herpes virus. This kind of stomatitis in newborns is less common, because the path of infection is contact. Fungal stomatitis is an inflammation of the oral mucosa, which is caused by fungi, more often candida. The cause of such stomatitis can be long-term treatment of the child after birth by glucocorticoids and other drugs. This is due to the fact that any antibiotic kills not only the pathogenic flora, but also the normal flora of the mouth, which leads to active reproduction of fungi. Glucocorticoids by the mechanism of action lead to depression of the immune response, which can also be the reason for the decrease in the reactivity of the oral cavity. Often babies after birth who have breathing problems are on artificial ventilation. This leads to the fact that catheters that are in the mouth of the newborn are risk factors for the propagation of pathogenic flora. And a frequent complication of such treatment is just a stomatitis of a fungal or other etiology.
Bacterial stomatitis in newborns is one of the most common pathologies. The reason for this inflammation in babies is often long-term antibiotic therapy. Such treatment leads to suppression of normal flora growth along the entire gastrointestinal tract, including the oral cavity. Therefore, favorable conditions are created for the growth of pathogenic bacteria, which leads to the development of stomatitis. Most often among pathogens one should note pathogenic strains of staphylococcus, hemophilic rod, neyeriyu, bactereroids.
Risk factors
Risk factors, based on the causes of stomatitis, can be identified as follows:
- diseases of the reproductive organs of the mother, which during pregnancy carry the threat of infection and the baby;
- operative or other invasive procedures immediately after the birth of the child (artificial respiration apparatus, esophagus catheterization, meconial aspiration in labor);
- congenital malformations of the gastrointestinal tract, which violate the whole process of digestion;
- dysbiosis in the child;
- congenital immunodeficiencies, which are accompanied by a decrease in immune defense;
- massive antibacterial therapy in the child immediately after childbirth.
Such risk factors must be taken into account before the child's treatment and minimizes the interventions that can lead to such complications.
Symptoms of the stomatitis in newborns
Symptoms of stomatitis in newborns differ slightly depending on the etiology. But there are some similar manifestations and this, in the first place, rashes on the mucous membrane. If the cause of stomatitis is a viral infection, then the rashes on the mucosa have a characteristic appearance. The first signs of herpetic stomatitis are the appearance of rashes in the form of vesicles in a child. These are small bubbles that rise above the surface of the mucosa and are filled with liquid inside. But after a while these vesicles burst and ulcers or aphthae form. This causes very unpleasant sensations in the child and pain. Aphthous stomatitis in a newborn is a process of herpetic etiology, which requires immediate action. Most often, the mother can not notice single rashes, and simply draws attention to the fact that the child began to eat poorly. This may be the first manifestation of stomatitis. This is because the vesicles cause itching and burning at any touch, so the baby can not eat normally. If you look at the mucous membrane, then with viral stomatitis you can see small sores that formed on the site of the vesicles. Sometimes this process is limited only by the mucous membrane of the tongue and cheeks, but it happens that the virus affects the mucous membrane of the lips. In newborns, herpetic stomatitis is less common than other types of inflammation. Clinical manifestations of such pathology have characteristic features, therefore it is not so difficult to recognize the disease of herpetic etiology.
The first signs of bacterial stomatitis in the newborn manifest, as a rule, some time after the start of treatment with antibiotics or glucocorticoids. Mom can see the child's first signs of the disease, when the child refuses to eat. Bacterial stomatitis is characterized by the multiplication of bacteria on the mucosa and its damage in the form of white dots. When these foci merge, it seems that the mucosa of the oral cavity of the child is white. Symptoms of fungal stomatitis have a similar course. Elements of rashes with massive multiplication of fungi also have the color of white dots, which cover the entire mucosa from the inside of the oral cavity. Sometimes such rashes can be located only on the back wall of the baby's throat, and it is very difficult to distinguish from sore throat. Therefore, additional research methods are so important that can accurately establish the etiology of such a process. Fungal stomatitis is more often caused by candida. It is a fungus that is in a small amount in the oral cavity and its growth is inhibited by other beneficial bacteria. But after antibiotic therapy, the process can not be controlled by these bacteria, which causes massive candida growth. Candidial stomatitis in newborns is very common, especially in premature babies, which can also be caused by the immaturity of their own useful flora of the baby.
Other manifestations of stomatitis are an increase in body temperature, rejection of the breast or any other food, as well as the restlessness and moodiness of the baby. Since stomatitis in the body has a viral, bacterial or fungal infection, it is accompanied by an increase in body temperature. Such a rise can have a different value from low-grade figures to high values. All this indicates only the presence of infection in the body. Eruptions in the oral cavity cause itching and burning, so the child can not eat anything and refuses the breast or even just from the nipple. Such symptoms, in the absence of other possible causes of fever, should prompt mom to think about a possible stomatitis.
Complications and consequences
The consequences of stomatitis with long neglect of this problem can lead to violation of the flora of not only the oral cavity, but also the intestine. Then there is a dysbacteriosis, which further disturbs the digestive process. The child refuses to eat and at this time there may be diarrhea, which leads to weight loss and dehydration. If it is a question of viral stomatitis, then on the mucous membrane of the child very quickly ulcers form. They can be the gateway to infection. Complications of stomatitis, which occur in the absence of treatment, are secondary bacterial infections of the oral cavity with the formation of massive ulcers. Such ulcers in the future may threaten with necrosis of soft tissues, as in newborns inflammatory processes spread very quickly.
Diagnostics of the stomatitis in newborns
Diagnosis of stomatitis in newborns is not difficult, and it should begin already at the stage of the appearance of complaints. Mom can not always examine the baby's mouth thoroughly, so at the first rise in temperature, she turns to the doctor. And it is very important to pay attention not only to complaints, but also to detail all the circumstances.
It is very important for the diagnosis, that the mother drew the doctor's attention to the fact that the child stops eating. He is at the same time capricious, because he remains hungry, because he can not normally suck his chest. When examining the oral cavity, you can see the elements of rashes in the form of white dots on the mucosa that rise above the surface. It is important to examine the oral cavity with a spatula or spoon, because at the beginning of the disease rashes can only be on the side of the cheeks or tonsils.
The data of an anamnesis which can testify on advantage or benefit of a stomatitis is a present treatment by antibiotics, glucocorticoids, invasive interventions after a birth of the child.
Analyzes that should be performed with stomatitis are most often used to determine the etiology of the disease. To choose the tactics of treatment it is very important to know what caused stomatitis. Therefore, first of all, it is necessary to take a smear from the mucous membrane and identify pathogenic bacteria or fungi that are there. For this, it is necessary to perform a cytological and bacteriological study of the smear. At the same time, they look at the sensitivity of bacteria or fungi that are sown to antibiotics or antifungal agents, which will determine the further treatment tactics.
Sometimes it is necessary to determine the state of the entire gastrointestinal tract of the baby for the prevention of dysbiosis, then it is necessary to pass an analysis for dysbiosis. This is also important for treatment, since if the child does not have a normal flora in the intestine, then with the oral cavity there may be problems. An analysis of dysbacteriosis is also necessary if the child has problems with a stool. Therefore, the analysis of dysbiosis in stomatitis can be considered mandatory, at least for the purpose of deeper diagnosis.
More often stomatitis occurs in children already previously compromised. But it also happens that stomatitis occurs in a newborn, and then repeats many more times without any reason. In this case, you need to think about what the child may have more difficult problems and it is about immunodeficiency. Then it is necessary to consult an immunologist and possibly an immunogram.
Instrumental diagnostics of stomatitis in most cases is not used, because the problem is "local" and is not bad diagnosed by external symptoms.
Differential diagnosis
Differential diagnosis of stomatitis is necessary first of all in order to determine the treatment. If to differentiate viral herpetic stomatitis from others is not difficult on clinical manifestations, then bacterial and fungal are very similar. They have the same kind of white small film on the mucosa, which are tightly attached to it. But fungal stomatitis merges and forms almost a continuous film, whereas bacterial can be accompanied by mucosal inflammation and white bloom in the tongue. But such differential signs are not very clear, so sometimes they start treatment, but only with its ineffectiveness can we say that the etiology is different.
Treatment of the stomatitis in newborns
Undoubtedly, the treatment of stomatitis must have an etiopathogenetic orientation. And already at the stage of diagnosis, you can say that it is necessary to apply for treatment. Given that the child's body is sensitive to different drugs and in the period of newborns, the use of such drugs should be minimal, for the treatment of stomatitis it is better to use local drugs. But it is also necessary to know that it is not always possible and effective. Medicines that are used to treat stomatitis, can be antiviral, if it is a viral herpetic stomatitis. If it is a question of fungal stomatitis, then only antifungal agents are certainly effective.
Viruses from the herpetic group are sensitive only to a group of drugs that have direct antiviral activity. Therefore, in the case of such stomatitis, the question of using systemic drugs in the form of local treatment is being solved. Most of these antiviral drugs have many side effects and their use is limited in infancy, so the only option is to apply them in the form of local remedies. Acyclovir drugs are most effective in this regard.
- Acyclovir is a drug that has a direct antiviral effect against the herpes simplex virus and other herpetic infections. It acts by inhibiting the introduction of the virus into the cell and its multiplication. For children, the drug can be used in the form of tablets. Dosage is calculated at 20 milligrams per kilogram of the child's body weight. Such dosage should be divided into four doses at equal intervals. Treatment usually lasts five days. Admission of such a drug inside for newborns with herpetic stomatitis is limited to those cases when the child has an immunodeficiency. If viral stomatitis in a child with normal immune status, then the local application of the drug is recommended. To do this, one tablet is divided into four parts and finely grinded. After dissolving the tablet in boiled water, it is necessary, if possible, to be applied to the mucous membrane of the oral cavity. Do this procedure five times a day. But you need to consider that there may be additional traumatization. Side effects of the drug in systemic application can be in the form of fever, tremor, vomiting, diarrhea, allergic rashes.
- Novirin is an antiviral drug that is highly effective against many viruses, including the herpes group. The active substance of the drug is a compound of inosine pranobex, which affects the viral particle by inhibiting its reproduction. It has a wider application in pediatrics and is less dangerous than direct agents in the form of acyclovir. Allowed for children from 1 year, but for newborns can be used in certain cases. Produced in tablets, which are dosed at 50 milligrams per kilogram. For the treatment of stomatitis it is better to apply in the form of local remedies. Adverse reactions with local treatment are minimal - there may be digestive disorders when the drug is absorbed.
- Laferobion is an antiviral with a wide range of efficacy. The active substance is an interferon that helps fight viral infections through the natural immune defense that is in the human body. The drug is released in the form of candles, so it is convenient to use it in newborns and it is allowed in this group. Dosage of the drug - 150 thousand units of a candle twice a day for five days. With viral stomatitis this drug is effective enough, especially if there are other systemic manifestations of pathology. Side effects can be in the form of allergic manifestations and disorders of the intestine.
- Nystatin is an antifungal drug that is used to treat stomatitis of fungal etiology. The active substance of this drug is nystatin, which is synthesized by a fungus that has antagonistic properties against pathogenic fungi. A medicine is used to treat candidal stomatitis in the form of local remedies. To do this, you need to divide the tablet into parts and lubricate the baby's mouth. Side effects are rare due to topical application. Precautions - do not use the drug for systemic treatment of fungal infections of another etiology.
- Stomatidin is a medicine for local treatment of stomatitis, which can be used for any etiology. The active substance of the drug is hexetidine, which is an antiseptic. The use of such a preparation as a rinse leads to the death of many bacteria, fungi and viruses. Dosage for newborns should not exceed the amount that the child does not swallow the drug. You can use it by wetting a bandage in a solution and wiping the mouth cavity several times a day. Side effects can be in the form of a burning sensation, to which the baby will immediately react, so if there are ulcers, the drug should not be used.
Physiotherapy treatment of stomatitis is not used, but vitamins can be very useful, because any infection weakens the body, while vitamins fill with useful substances. It is necessary to use vitamins, which are allowed for newborns.
Agvantar is a vitamin that contains the metabolically active substance levocarnitine. It promotes the assimilation of biologically useful substances and accelerates the metabolism in cells, which accelerates the recovery of the child and increases the immune status after the infection. The drug is available as a syrup. One milliliter of syrup contains 100 milligrams of the substance, and the dosage is 50 milligrams per kilogram. The drug can be used even in premature babies. Side effects can be in the form of tremors, diarrhea, drowsiness of the child. Apply one month after the transferred stomatitis.
Alternative treatment for stomatitis
Alternative methods of treatment of stomatitis in newborns can be used only locally, because nothing else except breast milk or a mixture in this period should the child receive. There are many alternative medicine tools that work at the expense of local antiseptic and anti-inflammatory properties.
- Cabbage juice has pronounced wound healing properties and contributes to the death of many microbes and fungi in the oral cavity. For treatment, you need to squeeze fresh cabbage juice and wipe the baby's mouth several times a day. For a better effect, you can add a few drops of liquid fresh honey to the juice, then the solution will become more pleasant to the taste and the baby will hold it longer in the mouth.
- Juice made from fresh sea-buckthorn berries also has good anti-inflammatory and antifungal properties. For the medicine you need to take a hundred grams of berries, grind them to kashitsi, add as much boiled water. The solution is acidic by itself, so that there is no burning, you also need to add a little honey. It is necessary to rinse the mouth well, and for the newborn to wipe with a napkin soaked in a medicine several times a day.
- Aloe and Kalanchoe juice is known for its antiseptic and wound healing properties. For treatment, you also need to lubricate the mucosa several times a day with fresh aloe and calanchoe juice in a one to one ratio. After such treatment it is not recommended to give food for 20 minutes, so that the medicine works better.
- Propolis is a known useful remedy that is widely used to treat many wounds and cuts. In the treatment of stomatitis it is also a very effective remedy. For treatment, you must first treat the mucosa with an antiseptic, by lubricating with hydrogen peroxide or hexetidine. After this, you need to prepare a tincture of propolis, fill it with boiled water to half a liter jar. This solution should be applied to the affected areas of the mucosa. Propolis forms a film over the inflamed areas, which protects against the entry of bad microbes and thus faster and better passes healing.
Herbal treatment is also widely used for stomatitis, but mainly uses herbal infusions for local rinsing.
- Chamomile, string and sage are known for their antiseptic and antibacterial properties. To prepare medicinal tinctures, you need to take thirty grams of each herb and pour hot water. After the infusion of half an hour - you can use to wash the mucosa.
- The infusion from the oak bark also has antiseptic properties and promotes the healing of wounds, especially with the formation of ulcers on the mucous membrane. To prepare the infusion, you need to take 50 grams of bark and pour 250 water. After the solution is infused for two hours, you can add a few drops of aloe and wash the mucous.
- It is necessary to take one hundred grams of calendula flowers and fifty grams of grass of a blue-head, fill them with water and this solution should be infused for two hours. After that, the water must be drained and again poured as much with pure boiled water. This solution should be washed several times a day for the mucous membrane.
Homeopathic treatment can be used both in an acute period and at the time of recovery to prevent the recurrence of a fungal or viral infection.
- Borax is a homeopathic preparation of plant origin, which is used in the treatment of stomatitis. It is especially effective against stomatitis, which is accompanied by the formation of ulcers on the mucosa and their bleeding. Dosage of the drug for newborns can be three granules, which must first be dissolved in boiled water and the first week to apply three times a day, and then again for three weeks - once. Side effects are in the form of redness of the skin of the face, which indicates the need to reduce the dose.
- Potassium muriatikum is a homeopathic remedy of organic origin, the main element of which is potassium. The drug is used to treat stomatitis, which is accompanied by the formation of white raids with pronounced systemic manifestations - an increase in body temperature, an increase in lymph nodes. Therefore, the systemic use of the drug is recommended, and if the mother is breast-feeding, it is recommended that the mother is recommended. The drug is applied to the mother in a dose of one pellet six times a day. Side effects can only be with mum's intolerance, and a newborn can have problems with a stool.
- Creosotum is a homeopathic remedy that is used to treat stomatitis, which is accompanied by inflammation of the gums and their redness. This is a frequent complication when local immunity is disturbed in stomatitis and the pathogenic flora propagates, which causes inflammation of the gums. In this case, this particular drug is indicated. For treatment, take two tablets of the drug and dissolve in 50 grams of water. Lubricate the mucosa needs to be gently several times a day, and for best effect, the mother can take the drug one tablet once a day. Side effects are rare.
- Carbo vegetalis is a known homeopathic remedy that is used in the treatment of stomatitis of bacterial etiology, as well as with problems with the intestines. The drug is effective in cases where stomatitis is accompanied by the formation of a white coating on the tongue. Dosage is one pellet per day, which can be used for the newborn in its pure form. To do this, you just need to grind the granule into a fine powder and give the baby that he keeps in his mouth. It dissolves quickly, so problems should not arise. Side effects can be in the form of darkening of the gums or staining them in a bluish tint, which quickly passes by itself.
Homeopathic methods of treatment and alternative means can be effective in the treatment of stomatitis, but it should be remembered that this is a newborn baby and it is necessary to consult a doctor.
Prevention
Prevention of stomatitis in a child is primarily a planned pregnancy with a thorough examination. After all, a healthy mother with normal pregnancy and physiological birth can give the child good immunity and a good microflora that protects his body from such problems. Primary preventive measures also include the use of any medication in the newborn only on strict indications, especially antibiotics and glucocorticoids. If the baby is premature and needs ventilation of the lungs or other invasive interventions, you need to take care of it to avoid complications such as stomatitis.
Forecast
The prognosis for recovery with stomatitis is positive, because the pathology is well amenable to correction. Relapses in healthy children are very rare, which also indicates a good prognosis.
Stomatitis in newborns is not so rare, especially if the baby is premature and has risk factors. This pathology can be caused by bacteria, viruses, but more often it's still a fungus. A child with stomatitis can not eat normally, which is the main symptom and main problem. But the treatment is not difficult, and with its timeliness is successful.
Medical expert editor
Portnov Alexey Alexandrovich
Education: Kiev National Medical University. A.A. Bogomolets, Specialty - "General Medicine"
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