Dry and wet cough in a newborn: drug treatment

Cough in the newborn can appear due to many reasons, and given that the baby is very small, this can be a serious problem for him. First of all, you might think that the child is sick, and only then think about other reasons. Therefore, you need to pay attention to other symptoms, and be sure to consult a doctor.

[1], [2]

Epidemiology

Statistics of cough in newborns testify to the infrequent prevalence of this symptom as a sign of the disease. In 76% of children cough is not the first symptom because of the peculiarities of the structure of the respiratory system. More than 40% of the causes of cough in a newborn are caused by problems with pregnancy and childbirth, and only 26% of newborns have inflammatory diseases of the respiratory tract. This indicates the importance of proper management of pregnancy and childbirth and the importance of the process of giving birth to a future mother.

[3], [4], [5], [6], [7], [8], [9], [10],

Causes of the cough in a newborn

Cough in a newborn has a slightly different character than that of an older child. This is due to incomplete development of receptors in the airways, low voice of the child and inactive respiratory muscles. Therefore, it is not always possible to determine exactly what the newborn coughs, because sometimes it resembles a strong crying. Therefore, you need to understand exactly where the crying, and where already cough. In any case, the cough in the child occurs when the receptors are irritated, which are in the throat, larynx, trachea and bronchi. When these receptors are irritated, the impulses come to the medulla oblongata, where the cough center is located. This forces the muscles to intensively contract to evacuate the irritating factor from the respiratory system. Thus cough fulfills its main protective role.

The neonatal features of the respiratory tract is an uneven distribution of cough receptors, so cough does not always correspond to the nature and type of stimulus. This should be taken into account when conducting differential diagnosis.

The main causes of cough in a newborn can be in the form of several groups of factors:

1. inflammatory infections of the respiratory tract;
2. mechanical stimuli of the receptor apparatus;
3. congenital malformations of the respiratory system.

The reasons are named in the measure of decrease in prevalence of these factors, considering a small age of the child.

Among the infectious pathogens of respiratory tract diseases are viruses and bacteria. Among bacteria, the most common cause of respiratory tract diseases can be the cause most often: hemophilia rod, pneumococcus, streptococcus, staphylococcus, mycoplasma. Among the viruses, there are many pathogens of the respiratory tract - the influenza virus, parainfluenza, adenovirus, respiratory syncytial virus. In the newborn, the main role in the development of the respiratory tract infection process is played by bacteria in the first two weeks after birth, and viral agents in the future. This is due to the fact that immediately after birth or during this time there is a greater risk of infection with bacteria, and subsequently increases the risk of epidemiological danger of a viral infection, when the child begins to visit relatives and contact him.

If a cough appears immediately after birth or a few days later and it has a deep intense nature, then the cause of this can be pneumonia - pneumonia. Pneumonia can be congenital early and late, depending on the duration of the symptoms. This condition has a number of other symptoms other than cough, so you need to carefully assess the condition of the baby. Not so often pneumonia occurs in newborns, so you need to identify the risk factors that can lead to such a pathology. Pregnant women with chronic inflammatory diseases of the ovaries have a risk of becoming infected with the baby even in utero. Also, the risk factors include complicated pregnancy and childbirth, meconial contamination of amniotic fluid, pregnancy retention, premature birth. All these factors increase the risk of infecting the baby still in utero or during childbirth.

Talking about other inflammatory diseases of newborns that can cause the appearance of a cough, viruses often affect the upper respiratory tract. In such children, a common cold can often cause many problems and cause a cough due to the simple flow of mucus in the back wall of the pharynx.

Among the mechanical stimuli in newborns, the cause of coughing may be getting water during bathing or some of the toys. Of course, newborns have a low risk of swallowing a foreign body, but if there are little brothers or sisters who so want to play with the baby, then one should not exclude the foreign body of the respiratory tract as a possible cause of coughing.

Not so often, but the real cause of coughing can be congenital malformations of the respiratory tract. Unfortunately, this is a serious problem, the severity of which affects the clinical course and prognosis. The pathogenesis of the appearance of cough with congenital malformations depends on the type of defect. In the case of broncho-pulmonary dysplasia or lung agenesis / aplasia, the symptoms of a cough appear from the first days and are accompanied by other serious problems. It is very important to diagnose congenital malformation on time, because sometimes an early correction plays a big role in the further normal development of the baby.

[11], [12],

Symptoms of the cough in a newborn

Cough is rarely the only symptom of the disease, especially if it is an infection of the respiratory tract. If it is a question of pneumonia, in a newborn child it always has a two-sided nature, therefore the first symptom can be considered the appearance of pronounced dyspnea. The child lies on the back and creates the feeling that he is moaning, because the degree of the defeat of the respiratory tract does not allow him to breathe normally. You can see that the inhalation of the area over the clavicles or muscles between the ribs, which indicates a pronounced dyspnea. This is usually the first symptom of pneumonia. A mandatory manifestation of the disease is a pronounced intoxication syndrome. The child refuses the breast, is capricious, does not sleep, the body temperature rises. At what, the newborns should not expect an increase to 39 degrees or higher, and the figure 38 is already considered a serious increase in body temperature. This is due to the fact that such a child does not fully develop a thermoregulatory center, so this reaction is considered high.

Cough appears after a while already against the background of dyspnea and intoxication, when a sufficient amount of mucus accumulates in the alveoli. Therefore, the temperature and cough in a newborn are serious symptoms of anxiety about the development of pneumonia.

Speaking of a viral infection, it is always accompanied by catarrhal phenomena, and in the children of the first month of life it often rhinitis. The disease begins acutely when the child becomes restless and soon a mucous liquid discharge appears from the nose. The child refuses the breast, because when breastfeeding he has nothing to breathe. When a child sleeps at night, the horizontal position helps the mucus flow into the back wall of the pharynx. It can reflexively cause a cough, so a runny nose and a cough in a newborn can be considered a manifestation of a viral infection, which simplifies the diagnosis.

Another manifestation of infectious disease of the respiratory tract is acute bronchitis. A wet cough in a newborn can be a symptom of an acute process in the bronchi. In small children, the pathological process can quickly spread to the lower respiratory tract, which causes the development of inflammation. Bronchitis is accompanied by inflammation of the bronchi and a large amount of sputum accumulation. She gradually withdraws from the respiratory tract, which causes the appearance of a cough. But the kid can not completely cough up the whole secret because of the constant horizontal position and insufficient muscle contractions. Therefore, cough is low-intensive, but at the same time moist, with a feeling of "bubbling" in the baby's chest. There are other symptoms - shortness of breath, fever, anxiety, but they are less severe than with pneumonia.

At the child of the first 28 days of life it is very difficult to talk about the topic of the defeat of the respiratory tract, since the inflammatory process very quickly spreads to several departments. Therefore, by the nature of the cough, one can only assume which department is affected more. A dry or barking cough in a newborn can indicate a lesion of the upper respiratory tract, and if there are no changes in the bronchi, it is more likely that it is a viral process.

Dry or barking cough in newborns without a rise in body temperature, and cough during feeding should always be alerted to congenital malformations. Features if cough occurs immediately after birth or after a while and has a monotonous permanent character. There are a lot of congenital malformations of the respiratory system, but the most common ones are cystic fibrosis, underdevelopment of the lungs, congenital stenosis of the larynx and congenital tracheobronchomalacia.

Cystic fibrosis is a disease of a hereditary nature, which consists in the violation of the ion channels of the glands of exocrine secretion, including the glands of the broncho-pulmonary system. Pathology is characterized by the fact that a newborn child literally starts from the first days of severe pneumonia, and already during the first month of life it can happen again. This disease in the bronchi develops a chronic inflammatory process, which is maintained by the persistent persistence of highly pathogenic bacteria. This is manifested by a frequent wet cough in a child with very viscous sputum. Pancreas with symptoms of digestive function may also be affected.

Given the completeness and variety of the clinical picture of pathologies that cause a cough in a newborn, the importance of timely and correct differential diagnosis between these pathologies is explained.

[13], [14], [15]

Complications and consequences

Speaking about the consequences of coughing in such a small child, one must say that everything depends on the cause. If the cause of the cough is pneumonia or bronchitis, then literally in six to twelve hours the child's condition can become very heavy. This threatens the development of severe respiratory failure and intoxication-toxic shock. Complications of the cough itself with congenital defects of the broncho-pulmonary system can be in the form of pneumothorax - a rupture of the bronchus or alveoli and air ingress into the pleural cavity. If the child coughs due to a cold, then often it can be a consequence of acute otitis. This is due to the slight ingress of pus from the nose through the auditory tube in the eye and the development of inflammation there. If rhinitis is not treated, then during coughing mucus from the back of the pharynx can flow through the esophagus into the stomach, which easily causes diarrhea in newborns. This dehydrates the baby's body and there can be serious problems in the future until the death.

[16], [17], [18]

Diagnostics of the cough in a newborn

Diagnosis of any disease in a newborn baby should be timely, since all processes in the baby's body develop very quickly and can lead to complications. Therefore, it is necessary to carefully examine the baby, paying attention not only to the disease, but also to the physiological condition that should be present in a child of this age.

It is necessary to interview my mother and clarify when a cough appeared, whether it is related to feeding, whether there are any other symptoms. When examining a child with a cough, special importance should be given to the respiratory system. You need to calculate the number of breaths per minute to determine if there is shortness of breath. For the newborn, more than 60 breaths per minute are considered to be shortness of breath. It is necessary to pay attention to the respiratory muscles and to exclude its participation in the act of breathing. If the symptoms of dyspnea are absent, you can go on to a thorough examination of the child. With auscultation of the lungs under normal conditions, in such a child, breathing is close to vesicular and is carried out on all areas of the lungs. If cough is caused by bronchitis, then with auscultation, breathing will be hard or wheezing will be determined. Diagnostic sign of pneumonia can be considered weakened breathing, crepitation and local wet rales. Even on the basis of a simple examination, a preliminary diagnosis can be established. If there are no changes in the auscultation of the lungs and examination, then the upper respiratory tract should be examined. Inspection of the pharynx in a newborn should be done in the last place, always using a spatula. There may not be changes, if it's a simple cold. But there may also be hyperemia of the posterior pharyngeal wall and may mucus from the nasopharynx into the oral cavity, which can be considered the cause of the cough.

Analyzes for a newborn child are difficult to conduct. If there is a suspicion that the cough is caused by pneumonia or bronchitis, then necessarily the child is hospitalized for further investigation. In a hospital, the child undergoes general clinical research methods. A general blood test is needed solely for the purpose of differential diagnosis of cough viral and bacterial etiology. If the etiology is viral, the number of lymphocytes will be increased, and if bacterial - there will be an increased number of leukocytes and stab neutrophils (shift of the formula to the left). If a certain bacterial infection is suspected, a blood test is performed to determine the antibodies to one or another type of bacteria. But you need to consider the principle of minimal intervention in the body of such a young baby.

Instrumental diagnosis of cough can be carried out only in case of suspected pneumonia. Then it is necessary to conduct a radiography of the lungs in order to confirm the diagnosis. To minimize the dose of radiation for such a small child, ultrasound can be used to monitor the condition and determine the effectiveness of treatment in the future. This method allows you to see the condition of the bronchi and lungs, and determine the remnants of the inflammatory process.

If the symptoms of coughing occur against the background of other clinical signs or external manifestations of violations of the structure of the respiratory system, then there is a suspicion of birth defects. In order to diagnose vices, it is often necessary to perform bronchoscopy - a study of the respiratory tract with the help of a special endoscope, which is carried out under general anesthesia. This allows you to see the structure of the bronchi, lungs, as well as the location and anatomical structure of the larynx.

[19], [20], [21], [22], [23], [24], [25]

Differential diagnosis

Differential diagnosis of coughing must necessarily be done at the prehospital stage in order to exclude conditions that threaten the life of the newborn. Therefore, it is first of all necessary to differentiate pneumonia and aspiration of a foreign body. If there are no symptoms of anxiety, then further it is possible to examine the child more carefully. It is also important to diagnose a cough symptom between the pathology of the respiratory and cardiovascular system. Many congenital heart defects manifest themselves in the first month of life in the form of a cough. But cough of cardiac etiology is combined with shortness of breath and cyanosis, in contrast to the pathology of the lungs and bronchi. But in any case, for accurate differentiation, it is necessary to conduct electrocardiography and ultrasound examination of the heart at the initial stage.

Treatment of the cough in a newborn

Treatment of a child's cough for the first 28 days of his life should necessarily be done, as it disrupts the normal state of the child and quickly leads to hypoxia. But it must be taken into account that many drugs are not used in children for up to a month, so when approaching treatment, you should carefully choose the drugs.

If the cough is caused by bronchitis or pneumonia, in a newborn baby this is an indication for the appointment of an antibiotic. In newborns, unprotected penicillins or cephalosporins are predominantly used. If the child is hospitalized, then the treatment is parenteral.

1. Ampicillin is an antibiotic from the group of unprotected penicillins that have activity against gram-positive and some gram-negative microorganisms that play a key role in the development of inflammatory diseases of the respiratory system in newborns. The drug is active against staphylococcus, pneumococcus, E. Coli, hemophilic rod. The action of the drug is carried out due to the violation of the cell wall and its easy lysis, which leads to the death of the parasitic microorganism. The method of application of the drug intravenous, which accelerates the effect and action of the substance in the focus of infection. The dosage of the drug is calculated at 50 milligrams per kilogram of the child's weight in four divided doses. Side effects can be frequent in the form of allergic manifestations, as well as effects on the nervous system.
2. Ceftriaxone is a beta-lactam antibiotic, especially effective against gram-positive and gram-negative flora. The drug has a bactericidal effect on possible anaerobic pathogens of respiratory tract infection, taking into account the spectrum of possible pathogens in newborns. Dosage of the drug - from 50 to 100 milligrams per kilogram of weight per day, not less than ten days. 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.
3. Given the fact that the use of cough syrups in newborn babies is limited, inhalations for better sputum discharge are one of the main treatments.

Pulmicort is a remedy from the group of glucocorticoids, which reveals its bronchodilator effect with a pronounced cough in children. The dosage of the drug is 0.1 milliliters per kilogram of the child's body weight. For a newborn, the dose should not be more than 0.3 milliliters. The method of application inhalation after dilution with a solution - by 0,3 medicines you need to take 0.6 saline solution. Side effects can be with prolonged use in the form of stomatitis, gingivitis and the formation of erosions of the mucous membranes of the oral cavity.

Ventolin is a drug from the group of beta-adrenomimetics, the active substance of which is salbutamol. The drug expands the small bronchi, one hundred relieves spasm and improves breathing. Treatment with this drug in newborns can be done only if there are special indications, such as severe obstructive syndrome. The dosage of the drug is 0.5 milliliters with dilution in physiological saline 2: 1. The method of application - at least two times a day and at least three days. Side effects can be in the form of local allergic phenomena.

1. If the child has a cough caused by a viral pathology - acute rhinitis or rhinopharyngitis, then it is necessary to use antiviral agents in the treatment of this cough. In newborns in the acute period of the viral disease, preparations of the group of interferons are used.

Laferobion is a drug that contains recombinant human interferon, which increases the activity of antibodies in the fight against viral infections. The drug can be used in the first three days of treatment of viral infection in newborns. Dosage of the drug for children under one year - 150 000 IU twice a day in the form of candles. Treatment takes three or five days. Side effects are possible: itching at the injection site, redness, and also allergies.

1. Symptomatic cough treatment can be used in newborns only with an active inflammatory process and the doctor's prescription. Sometimes, in some patients, recovery without the use of expectorants is very delayed. Therefore, there is a need to use such medications, priority is given to ambroxol.

Ambroxol is a drug that acts on the respiratory tract by increasing the secretion of the bronchial glands and enhancing the synthesis of the surfactant. The intake of syrup for newborns can only be prescribed by a doctor, given age limits. The way of application of the drug in the form of a syrup, also there are ampoules for inhalations. The dosage of syrup for children under two years is 1.25 milliliters two times a day. Side effects can be in the form of distortion of taste.

Vitamins in the treatment of newborns have limited application, as this can cause allergic reactions. Mom can take vitamin remedies, if there are no special contraindications.

Physiotherapeutic treatment in sputum and improving the nature of cough is very important. For newborns it is recommended to apply a drainage massage, the simplicity of which allows it to be performed even by the mother. The main principle of such massage is the improvement of sputum evacuation by smooth massaging movements towards the lymph nodes and along the course of the bronchial tree.

Alternative treatment of cough in newborn babies

Treatment of cough by alternative means in such small children is not recommended, however, if the mother feeds the baby, she can use hypoallergenic alternative medicines. As for the child, some methods can be used, for example in viral infections.

1. If the child has acute rhinitis and mucus leakage causes a cough, then the cough treatment is to treat rhinitis. The main thing is evacuation of mucus and washing of the child's spout. It is also possible to wash the spout using alternative means. To do this, you need to boil half a liter of water, cool it a bit and add half a tablespoon of sea salt. With a warm solution, you need to instill a baby's nose with a pipette four times a day, one drop.
2. Milk with honey is known for a long time, as a cough remedy. To make a more useful medicine, you need to boil the milk and add two teaspoons of honey, twenty grams of butter and a few drops of olive oil to a cup of milk. You need to drink milk to your mother for the night, this improves the quality of breast milk and the child can feel the improvement.
3. Crushed viburnum with honey has many beneficial properties, including stimulates the defenses of the child's body and reduces cough. For the medicine, the mother should take 20 grams of such medicine every day. It can be prepared by grinding the berries with a blender, and then adding a teaspoon of honey. Treatment should be started with a half dose to assess the reaction of the baby.

Herbal treatment can also be widely used by the mother, or you can humidify the air in the room with the addition of some herbs. Any cough is accompanied sooner or later by the dryness of the mucous membrane of the respiratory tract. Therefore, if the child has a viral or bacterial pathology, then it is necessary that the air in the room is periodically moistened. To do this, use herbs that have a beneficial effect on the respiratory system.

1. To humidify the air in the room after a slight airing, you need to put a saucepan with steamed herbs. To do this, take three liters of water for ten grams of chamomile and the same alteika, steam and put the lid half open. This moistening should be in the opposite corner from the baby's crib and not more than half an hour. The room should not be all wet from the amount of steam, but only to slightly feel the moisture from the water with herbs.
2. Broth from herbs of plantain and althae has a high antiviral activity. These herbs have an anti-inflammatory effect and dilute the secret in the bronchi, which improves the sputum and improves breathing. For broth you need to take 20 grams of each herb and make tea. Given that the baby is a newborn, first you need to make tea from plantain and take it throughout the day, given the child's reaction. If there are no allergic manifestations, then the next day you can add an alteum.
3. The leaves of mother-and-stepmother are also known for properties that improve breathing and reduce the severity of cough. For therapeutic tea, you need to take 50 grams of herbs, make tea from two liters of water and drink in small sips throughout the day. You can add ivy with a dry cough character.

Homeopathy in the treatment of neonatal cough can be used by the mother, which has no less effect than other medications. This is due to the fact that all means have the ability to accumulate in one way or another in milk and be passed on to the baby. Therefore, breastfeeding plays a priority role in the early recovery of the newborn.

1. Agnus compositum is an organic homeopathic preparation, which includes herbs. Used to treat a cough that is caused by a viral infection and marked by catarrhal manifestations. Method of oral administration in the form of grains for mum. Dosage - one pellet twice a day. Side effects are possible in the form of increased salivation and nausea. Precautions - do not use in combination with honey.
2. Flu-compositum is an organic homeopathic preparation, which includes many medicinal herbs. Used to treat a cough that is caused by a viral infection with marked reddening of the throat, conjunctivitis and intoxication. The method of application is in the form of drops for the mother. Dosage - three drops twice a day. Side effects are possible in the form of hyperemia of the skin of hands and feet, as well as sensation of heat.
3. Althea-heel is a plant that is used to treat a cough of bacterial etiology against a background of pneumonia with difficulty in sputum discharge and in children with concomitant diseases. The method of administration of the drug has three steps. Dosage starts with three pellets every three hours on the first day for admission by the mother, then you need to take three granules every six hours the next day, and from the third day, three pellets twice a day. Prophylactic dose can be started in a half dose of medication after contact with infectious patients. Side effects can be on the first day of admission in the form of redness of the conjunctiva of the eyes.
4. Actinaria is a homeopathic remedy of plant origin, which is effective in treating cough in the third dilution in newborns, especially those born in winter. The preparation has very strong antiseptic properties and is used as a tincture. Dosage - three drops per glass of juice every day for mom. Side effects can be manifested by impaired bowel function in the baby or a slight yellowing of the skin.

Answering the question that you can give a cough to a newborn, you can say that any appointments must come from the doctor. And even alternative medicine because of their safety can be used on the recommendation of a doctor.

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

Prevention

The main measures for preventing a cough in a newborn baby are proper care for the baby and avoidance of close contacts in this period. After all, in the first month of life the child is most vulnerable to different factors. A very important element of prevention is exclusive breastfeeding, which prevents many infections by transmitting antibodies from the mother.

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

Forecast

The prognosis is favorable with timely and correct treatment tactics.

Cough in a newborn is caused more often by infectious diseases, but there is no need to exclude other reasons. And the sooner such a cough appears, the more likely it is to congenital pathology or genetic disease. Treatment of cough as an isolated symptom is not carried out, only an integrated approach to treatment is used. In any case, disease prevention has advantages over any treatment.

[33], [34], [35], [36]