Congenital pneumonia in newborns

Congenital pneumonia in a newborn is inflammation of the lungs, which develops immediately after the birth of the child or during three days. The disease develops equally in term infants and premature babies, but the severity of the course and the consequences are slightly different. Such inflammation should be recognized immediately when the first symptoms appear, so knowing these symptoms is very important for proper diagnosis.

[1], [2], [3], [4], [5]

Epidemiology

Statistics of the occurrence of congenital pneumonia indicate that the most common disease develops in women with a history of infection with infection during pregnancy. In premature infants and in children with aspiration, pneumonia occurs 1.5 times more often than in infants born on time.

[6], [7], [8],

Causes of the congenital pneumonia in a newborn

Congenital pneumonia in a child is called such because infection and inflammation occurs precisely during pregnancy or childbirth, and external factors play a minor role in this disease. The cause of this pneumonia is an infectious agent that is in the body of a woman and can become more active during pregnancy, or the pathogen is activated during labor. Therefore, all congenital pneumonia in terms of development time can be divided into antenatal (those that develop in utero to the time of delivery) and intranatal (develop during childbirth). In each case, the cause may be its own microorganism or virus, which is important for proper diagnosis and treatment.

The causes of antenatal pneumonia are often viruses, because it is during this period that the child is vulnerable to their action. To develop an infectious process in the lungs, it is necessary that the virus begin to act in the last trimester, and if earlier, it can cause congenital malformations. The most frequent reasons for the development of congenital pneumonia in utero include the TORCH group. These include toxoplasmosis, rubella, cytomegalovirus and herpes virus, as well as some others. Each such causative agent has its own characteristics of structure and development, and, accordingly, treatment.

Toxoplasmosis is a disease caused by toxoplasm of gondii, which is the simplest microorganism. The causative agent is transmitted through cats that are its carriers, or through poorly roasted meat. Infection can occur during pregnancy at the latest terms, then it will cause pneumonia in the child. If infection occurs before pregnancy, then a woman may not know about the presence of such an antigen in her body, since the clinic is nonspecific.

Rubella is an acute viral disease that is transmitted by airborne droplets and carries a potential threat to the fetus in the early stages due to the development of congenital malformations. The virus can provoke the development of pneumonia in a child, if the mother is infected before the very birth.

Cytomegalovirus infection is a disease that can be transmitted by airborne, sexual and contact. More than 60% of people are affected by this virus, but not everyone develops the disease. When a pregnant woman is infected, the virus can penetrate the placenta and induce the development of the inflammatory process in many organs - the lungs, the liver, the brain.

Herpes is a virus that has a tropism for the nervous system, but it can also cause pneumonia with the same frequency. There are two main types - herpes labial, which is transmitted by airborne and by contact, as well as genital herpes, sexually transmitted. The first virus is important in the development of antenatal pneumonia, and the second - intranatal, because infection occurs when contact with the affected genitals.

Infections from the TORCH group are dangerous in terms of pneumonia when infected at the latest time or before the birth. For other reasons, they can also be an etiological factor.

The cause of congenital pneumonia can also be bacteria - chlamydia, mycoplasma, listeria, ureaplasma, candida, trichomonas. Their role in the development of congenital pneumonia in a child is important already at the stage of infection before the very birth or during them. Ureaplasmas and trichomonads are related to sexual infections, which can not often cause pneumonia in an absolutely healthy child. Such infections, including Candida, infect the already sensitive organism of a premature or immunocompromised child. Chlamydia and mycoplasmas are intracellular microorganisms that play a primary role in the development of congenital pneumonia of bacterial etiology. They can cause an infection of the respiratory tract in the child already at birth or in the first hours afterwards, subject to appropriate conditions.

Summarizing the above reasons for the development of congenital pneumonia, it can be said that viruses can be the most common cause of this, but at the same time, bacteria play a role in the development of inflammation. The pathogenesis of pneumonia in a newborn does not depend so much on the etiologic factor. Any pathogen for the development of the infectious process first enters through the feto-placental barrier. Whether it's a virus or a bacterium, it has tropism to the lung tissue and gets with the blood flow into the lungs. Features of the pulmonary tissue of the newborn are such that the alveoli are not opened and can become a substrate for the development of infection. There is inflammation, which at birth is detected by symptoms due to insufficient lung function, because it is after birth that the lungs should work at full strength. Therefore, the inflammatory process is further activated with a first sigh and symptoms appear.

[9], [10], [11], [12]

Risk factors

There are babies who have a higher risk of developing congenital pneumonia than others. Risk factors include:

1. pathology of pregnancy and mother's disease lead to a violation of the formation of a normal protective barrier - the placenta;
2. infectious diseases of the mother, especially from the TORCH group, increase the risk of infection through the placenta and the development of infection;
3. prematurity increases the risk of infection due to the weakness of the immune defense;
4. birth conditions and external interventions increase the risk of infection.

[13]

Symptoms of the congenital pneumonia in a newborn

Congenital pneumonia is characterized by the fact that the symptoms begin to manifest immediately after birth or in the early postpartum period. If the clinical picture develops within 72 hours of birth, this also applies to the concept of congenital pneumonia, but the intranatal route of infection already plays a role here. If pneumonia is caused by intrauterine infection with a specific virus, then often, along with the symptoms from the respiratory system, there are manifestations from other systems. This should be taken into account when diagnosing congenital pneumonia, since approaches to treating pneumonia of viral and bacterial etiology differ slightly.

The first signs of the disease appear immediately after birth. The general condition of the child can be severe due to severe respiratory disorders. A child is born with a cyanotic or pale gray complexion, there may be a petechial rash against a background of intoxication. The child has a weak cry and depressed congenital reflexes on the background of hypoxia of the central nervous system in case of infection. Therefore, the evaluation of a child on the Apgar scale may be low, which does not allow immediate contact with skin. Sometimes babies with congenital pneumonia need reanimation measures immediately after birth, and sometimes the degree of respiratory disorders is not so pronounced. Manifestations of pneumonia are respiratory disorders that are clinically determined by shortness of breath. Dyspnea, depending on the severity, is characterized by the retraction of the intercostal spaces and areas above and below the clavicles, the sternum occlusion during breathing. Against the background of a violation of breathing, tachypnea and palpitations are determined. All this indicates a clear pathology of the respiratory system and requires immediate further verification.

If pneumonia is caused by a virus from the TORCH group, there may be other symptoms of generalized infection. For example, cytomegalovirus has tropism to the brain of the child and liver, so when exposed to the fetus, this infection causes severe brain damage in the form of ischemic lesions and cysts, as well as an enlarged liver and severe jaundice with bilirubin encephalopathy. Therefore, pneumonia against these symptoms may be a specific manifestation of this virus.

Congenital pneumonia, caused by the rubella virus, can manifest as a characteristic rash on the body of a child with symptoms from the respiratory system.

Bacterial pneumonia has flow characteristics, since the inflammatory process is purulent. Most often they develop during the first two days, when the condition of the baby worsens dramatically. On the background of severe shortness of breath, there are symptoms of intoxication - the body temperature of the baby rises, or if it is a premature baby, hypothermia most likely develops. The newborn refuses the breast, loses weight and becomes restless. All this, together with respiratory symptoms, should lead to the thought of pneumonia.

[14], [15], [16],

Stages

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).

[17]

Forms

Types of pneumonia in a newborn can be classified by causative agent into viral and bacterial, as well as to specific and non-specific ones, which is very important in the choice of treatment.

[18], [19], [20]

Complications and consequences

Complications of congenital pneumonia depend on the type of pathogen and can be immediate or delayed. If the pathogen quickly causes destruction of the lung tissue, then complications in the form of infection spread. 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 fatal. Other systemic complications may include hemorrhagic syndrome, DIC syndrome, hemodynamic disorders, persistent fetal communications and, in view of this, acute cardiovascular insufficiency.

Among pulmonary complications, it is possible to develop pleurisy, atelectasis, pneumothorax.

The consequences of pneumonia may be more severe in the systemic nature of lesions. If pneumonia is viral, then there may be lesions of other organs and systemic manifestations - congenital malformations, chronic forms of infections and intellectual disabilities.

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

Diagnostics of the congenital pneumonia in a newborn

Diagnosis of congenital pneumonia is always complicated by the fact that there may be many options for insufficiency of the respiratory system and it is necessary to differentiate these states. If the diagnosis of congenital pneumonia is confirmed, it is important to diagnose the type of pathogen, since the tactics of treatment are different. Therefore, it is necessary to start the diagnosis with anamnestic data from the mother about the course of pregnancy and childbirth. It is very important to find out whether the mother has an infection and whether the study was conducted on the TORCH group, because these are the most serious pathogens.

A feature of congenital pneumonia, mainly in a premature baby, is an unclear objective picture. The auscultation data does not usually give a clear picture of pneumonia, since a bilateral process can testify equally to pneumonia and respiratory distress syndrome. Therefore, the main diagnostic methods can be considered additional laboratory and instrumental methods of investigation.

Analyzes in a newborn have their own peculiarities due to physiological reasons - the number of blood cells is increased to ensure normal cellular respiration, 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 benefit of pneumonia can be indicated by the growth of the number of white blood cells in the dynamics and the absence of leukocyte crossings on the fifth day of the child's life. This indicates a bacterial infection, and you can exclude the viral etiology of pneumonia or think about the association of viruses and bacteria.

Sometimes, against the background of the treatment of pneumonia, the child does not manage to achieve results, then a mother is examined to determine a specific pathogen. After all, the mother in this case is the main source of infection for the child, while the child's antibodies are not yet formed and can not be determined. To do this, a serological examination of the mother's blood is conducted to determine the antibodies to these or other infections. The level of antibodies of the class of immunoglobulins G and M is determined. Special reagents are used, which allow to determine the level of these antibodies to a special infection. If there is an increase in the level of immunoglobulin G, then this virus can not participate in the development of pneumonia in the child, since it indicates only the old infection. But if immunoglobulins M are found, then this indicates an acute infection, that is, there is a high probability that the fetus is also infected. Among special tests for suspected sexual infections, a smear from the vagina is also performed. This is necessary for bacterial pneumonia, when it is possible to accurately identify the pathogen and its sensitivity to antibacterial agents.

Instrumental diagnosis allows you to accurately determine the diagnosis of lung damage and clarify the localization of the process. X-ray signs of congenital pneumonia of a newborn are a bloating of the lungs and an increase in the vascular pattern at the initial stages of the disease, and then there are inflammatory-infiltrative changes in the draining character. But if the child is premature, the radiograph does not allow for a precise diagnosis between pneumonia and hyaline membrane disease, since the changes are identical in both pathologies. Therefore, there is a need for additional measures of treatment.

[24], [25],

Differential diagnosis

Differential diagnosis of congenital pneumonia should be performed with hyaline membrane disease primarily in prematurity, as well as with aspiration syndrome, congenital malformations of the lungs, diaphragmatic hernia, cardiac pathology and CNS trauma, which are accompanied by respiratory failure. The disease of hyaline membranes is a pathology of premature babies, which develops against the background of the lack of surfactant in the lungs. Pathology is characterized by similar changes in radiography in the form of "cotton" lungs, so these children need to introduce an exogenous surfactant.

Congenital malformations of the respiratory system may also manifest as respiratory disorders, so it is necessary to exclude them. With regard to congenital heart defects, the clinic manifests itself at a later time, and precisely differentiate the ultrasound of the heart. Some "critical" heart defects can manifest in the first hours, in which case there will be an appropriate anamnesis for revealing the defect yet in utero.

Treatment of the congenital pneumonia in a newborn

Treatment of congenital pneumonia should begin immediately after diagnosis. The approach to treatment is complex, taking into account many links of pathogenesis and conditions for nursing a child. 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 a child with congenital pneumonia should be continued with breast milk, the total calorie need to be limited but with increasing frequency of feeding. 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 to correct the act of breathing, then connect special oxygen supply devices with a constant positive pressure in the airways or if necessary.

Only after such measures it is possible to speak about other medicamentous therapy.

If the causative agent of pneumonia is accurately established, the treatment should be as specific as possible. Of course, if the causative agent of a viral etiology, then antibiotic therapy is used together with antiviral therapy. In the event that congenital pneumonia is caused by cytomegalovirus with systemic damage to organs and systems, then therapy is performed with special agents from the group of interferons.

1. Viferon is an antiviral drug that contains recombinant human interferon, is active against most viruses from the herpes group. It acts on cytomegalovirus, hepatitis virus, and also some bacterial infections by immunomodulatory action. The drug is available in the form of ointments, gels, suppositories. For the treatment of newborns it is recommended in the form of rectal suppositories. Dosage of the drug - 500 000 IU twice a day, and then under a special scheme with the child's blood tests for specific antibodies in the future. Side effects are possible: thrombocytopenia, itching at the injection site, redness, and also allergies. Precautions - not recommended for children with severe congenital immunodeficiency.
2. In case of confirmation of toxoplasm, as manifestations of pneumonia and generalized infection, specific treatment is carried out.

Spiramycin is an antibiotic from the macrolide group, which is the drug of choice for the treatment of toxoplasmosis. It has the highest activity against toxoplasma, inhibiting the synthesis of its wall proteins, but it has no teratogenic effect. Dosage of the drug is 6-9 million IU per day. Side effects of spiramycin - paresthesia, violations of skin sensitivity, numbness of hands and feet, tremor, violation of the outflow of bile, as well as severe jaundice in a child.

1. 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: 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.

Netromycin is an antibiotic of the aminoglycoside group, the active ingredient of which is netilmicin. The drug 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.

Tsefpyrom is an antibacterial agent of the 4th generation of the group of cephalosporins. The drug has a bactericidal effect 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. The drug has no pronounced effect on the organs of the newborn, so it can be used for treatment. Adverse events are possible in the form of diarrhea in a baby or a violation of the development of the intestinal biocenosis, so treatment is carried out together with probiotic drugs.

1. Probiotics must be used in such children in order to correct the violations of the bacterial composition of the intestine.

Acidolac - a drug that has in its composition lactobacilli, which form lactic acid and do not allow the reproduction of pathogenic bacteria. Due to this, the preparation forms favorable conditions for the development of useful intestinal microflora. Lactobacillus reuteri, which is part of the drug is completely resistant to antibiotics, so it can be used in the complex treatment of precisely such pathologies. 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. Mom can take vitamin means during the feeding of the child even after his recovery by the courses, which will improve the prognosis for the baby.

Alternative treatment of congenital pneumonia

Treatment with alternative means can be used only by the mother, and the appointment of any herbs or infusions to the child is contraindicated. If the mother determines any infection, then you can use alternative drugs in combination with medication.

1. High efficiency in the treatment of infections that are chronic in the mother and can cause disease in the child, show therapeutic herbs. To make medicinal tea, you need to take 25 grams of mint, 50 grams of licorice and the same number of leaves of a rosemary, it should be boiled over a slow fire for five to ten minutes and then filtered. To drink such tea you need three times a day for half a cup.
2. Decoction of althea grass, sabelnik, and dog rose is especially effective against cytomegalovirus infection. It is necessary to make tea from a liter of water and these herbs and drink in small sips throughout the day. The course of treatment is four weeks.
3. Tea from the leaves of chamomile, oak bark and anise cortex has antiviral and antibacterial activity. For its preparation, all the ingredients need to be filled with water and boiled. Take half the pile in the morning and evening.

Homeopathic preparations can also be successfully applied to mothers, which improves the child's response to medical therapy and accelerates his recovery.

1. Antimonium Tartaricum is a homeopathic remedy of natural plant origin. Used in the treatment of pneumonia in children with severe wet rales in the sixth breeding. 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.
2. Gepar Sulfur is an inorganic homeopathic preparation. Used in premature babies with breathing problems and lack of surfactant. Method of application of the preparation in capsules. Dosage of the drug two capsules three times a day. Side effects are possible in the form of hyperemia of the skin of hands and feet, as well as sensation of heat. Precautions - do not use in combination with sorbents.
3. Veratrum virida is a homeopathic remedy that has a composition of organic substances and promotes the activation of the body's natural defenses, including in the fight against viral agents. The drug is used for pneumonia with severe heart failure in a child. Dosiruetsya four drops twice a day for half an hour before meals at the same time. The course of treatment is three months.
4. Aconite is a homeopathic remedy of natural plant origin, which is recommended to be used in an acute period in the third dilution, with the subsequent transition to the same dosage of Briogne. Dosage - three drops per fifty grams of water for the mother three times a day. The first drug takes two weeks, and then switch to the next one. Side effects - tremor of the fingers or chin of the child.

It must be taken into account that alternative and homeopathic remedies are not a priority in treatment and can only be used according to the doctor's recommendations.

Surgical treatment of congenital pneumonia is used very rarely, only in certain cases of complications. Then, with bacterial destruction of the lungs, there may be interventions to install drains or sanitize the bronchial tree.

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

Prevention

Prevention of any infection in the child should begin even at the stage of early diagnosis and examination of the mother during pregnancy. In Ukraine, before pregnancy and already during pregnancy, a test for the TORCH group is not necessary, but it is always recommended by the doctor and the woman herself decides whether to conduct it or not, as this is a very expensive examination. But taking into account possible risks, it is necessary to emphasize the high importance of this study for timely diagnosis and treatment. If a woman has not been sick for certain infections in childhood and she does not have antibodies, then specific immunization should be carried out. Given the risk factors for congenital pneumonia, the main prevention measures can be considered a normal pregnancy and the birth of a healthy child on time.

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

Forecast

The prognosis of pneumonia can be favorable at the beginning of treatment on time and adequate organization of care for the baby by both the mother and the doctors.

Congenital pneumonia in a newborn is often seen against the background of infection of a child or mother during pregnancy. This proves the high need for the study of pregnant women and the thorough diagnosis of dangerous infections. The birth of a child with signs of respiratory failure should lead to the idea of a possible pneumonia and immediate adequate therapy, which improves the prognosis of such children.

[33], [34], [35], [36], [37],