Inflammation of the lungs is a dangerous disease. In a newborn, pneumonia is especially severe. The disease develops either immediately after the birth of the baby, or during the first month of his life. The peculiarity of inflammation in such crumbs is that the pathological process is rapidly spreading to both lungs, and therefore the condition of the newborn is getting worse every minute. Complications of this pathology can be very serious and affect the future life of the child. Therefore, it is so important for new parents to know about the characteristic symptoms, principles of treatment, causes and consequences of pneumonia in newborns.
It is believed that pneumonia is most often diagnosed in children born from pathological pregnancy and difficult childbirth. In addition, the predominant number of mothers are carriers of viral andbacterial infections, which the baby’s weak immunity is not yet able to fully resist. According to statistics, pneumonia is most often diagnosed in newborns after caesarean section and premature babies.
Main causes of disease
Acute inflammatory process that occurs with damage to the lung tissue, accompanied by a concentration of exudate inside the alveoli. As a result of this pathological phenomenon, symptoms from the respiratory system develop. Pneumonia in newborns, despite their early age, is as common as in older babies. This is attributed to many factors.
For the development of pneumonia in infants, a prerequisite is the penetration of pathogenic microflora into the body. Success in the treatment of pneumonia in newborns largely depends on the timely determination of the type of pathogen and the selection of an antibiotic sensitive to it.
In the first months of life, children are diagnosed with congenital or neonatal pneumonia. In the first case, we are talking about intrauterine pneumonia in newborns, which manifests itself within the first three days after birth. Viruses that cross the placenta are capable of provoking the development of this disease even in the perinatal period. The main causative agents of intrauterine pneumonia in newborns are microorganisms that cause infections from the TORCH group. These include:
- rubella;
- cytomegalovirus;
- herpesvirus;
- toxoplasmosis;
- syphilis.
As a rule, all pregnant women undergo examination for the presence of TORCH viruses in the body at the antenatal clinic. If the mother became ill with an infection in the first trimester, pneumonia was probably one of the complications of transplacental infection. Severe pregnancy and diseases suffered by a woman can lead to a partial destruction of natural protective barriers.
Pneumonia in newborns can be caused by infection with pathogenic bacteria before birth or during passage through the mother's birth canal. The causative agents of the disease in this case can be:
- chlamydia;
- mycoplasmas;
- candida;
- listeria;
- ureaplasma;
- Trichomonas.
Cause neonatal pneumonia, which is distinguished by the timing of occurrence (early - up to 7 days, later - from 7 to 28 days), opportunistic microorganisms are also capable. These include staphylococcus aureus, streptococcus, E. coli, Pseudomonas aeruginosa, Klebsiella.
Late pneumonia occurs, as a rule, after arriving home. Early forms of the disease can be caused by stationary flora. Usually, infection occurs in the delivery room or in the neonatal unit during the event for artificial ventilation of the lungs. Other reasons for the infection of a child in the hospital are:
- Difficult childbirth. Pneumonia in a newborn after a cesarean section or obstetrical forceps is a very common consequence.
- Chronic or acute maternal infectious diseases affectinggenitourinary system.
- Meconium aspiration during childbirth.
- Resuscitation, including mechanical ventilation.
- Profound prematurity.
- Injuries during childbirth.
- Inconsistency of the situation in the delivery room with sanitary and hygienic standards.
Pathogenesis of disease
Pneumonia in a newborn develops against the background of the immaturity of the respiratory system, which increases the risk of infection and the reproduction of pathogenic microflora. With an intensive blood supply, pathogens that penetrate the body reach the lungs with lightning speed. In this case, inflammation first arises in the alveoli. Pathological changes entail disturbances in the gas composition of the blood, therefore, pronounced hypoxia is observed - the cells are sorely lacking oxygen. Its deficiency can affect the functioning of the brain, and then the internal organs. Without treatment, the child will become intoxicated throughout the body.
Baby symptoms
It is impossible to say exactly how much pneumonia is treated in a newborn. In many ways, therapy depends on the severity of the course of the disease and the severity of the clinical picture of the disease. The first symptoms of congenital pneumonia in a newborn can occur immediately after the birth of the baby, just a few hours later. Manifestations of this dangerous disease for a child can be seen by his condition:
- baby is born with pale gray skin;
- may have a rash due to intoxication of the body;
- baby is weak, unable to scream loudly;
- innate reflexes are depressed;
- heavy breathing;
- retraction of intercostal spaces;
- retraction of the sternum when inhaling;
- palpitations;
- body weight below the norm for newborns;
- baby refuses breast offered by mother;
- high body temperature.
When the symptoms increase, which happens quickly enough, the child may have convulsions. The congenital form of pneumonia is particularly severe in infants. Every minute matters, without treatment the baby will die.
For neonatal inflammation caused by community-acquired flora, a milder course is characteristic, since by this time the baby has already managed to gain a little weight, feeding on mother's milk, and acquire additional immune protection against pathogens. The symptoms of neonatal pneumonia are similar to those of congenital pneumonia, but are less pronounced. The newborn becomes restless, capricious, loses appetite. Due to pulmonary inflammation, severe shortness of breath occurs.
Features of the disease in infants
Bilateral pneumonia in newborns is quite common. This is due to the fact that the baby's body is not yet able to fight the inflammatory process within the boundaries of one area, as in adults and older children. In addition, the constant recumbency and rather wide bronchi with small alveolar septa allow the infection to spread faster toother segments. Therefore, there is no need to talk about focal pneumonia in newborn babies.
In the initial stages of the disease in infants, a unilateral form most often appears. In the predominant number of cases, this is exactly what happens with late neonatal pneumonia. The first hearth appears on the right side. This is due to the fact that the right bronchus is wider and slightly shorter than the left one - this is a “standard” physiological feature. However, the inflammatory process quickly affects the left lung, therefore, having lost a couple of days, bilateral pneumonia will have to be treated.
What could be the consequences
It's no secret that the immunity of a newborn child has not yet had time to get stronger. Accordingly, the baby's body is practically not able to fight the infection. If you do not start treatment on time, complications develop rapidly, within the first hours or days. All the possible problems that pneumonia can lead to are conditionally divided into pulmonary and extrapulmonary. The first group includes:
- pleurisy (inflammatory lesion of the pleura);
- atelectasis (collapse of lung particles);
- pneumothorax (air concentration in the sternum, leading to compression of the respiratory organs from the outside).
Such effects of pneumonia in newborns can occur as early as the second day. Extrapulmonary complications are the result of hematogenous transmission of infection. These include otitis media, hemorrhagic syndrome, hemodynamic disturbances, sepsis. Any bacterialdefeat carries a risk for the child, since bacteremia (infection in the bloodstream) threatens the baby with a fatal outcome.
Some time after pneumonia, a newborn may experience complications in the cardiovascular system, and there is also a chance of developing rickets, severe anemia.
Diagnosis of disease
Basic information about the disease of the newborn doctors draw from the history of the mother, the history of pregnancy, childbirth, the results of laboratory and instrumental studies. Next, an objective examination of the child is carried out.
In inflammation of the lungs, percussion of the chest is accompanied by a short muffled tone. In newborns with pneumonia, weakened breathing is expressed, as a rule, without moist rales and crepitus. It is impossible to rely only on the external manifestations of the disease and visual changes from other systems. Laboratory and instrumental studies play a key role in the diagnosis of pneumonia in infants:
- clinical blood test (increased leukocyte counts);
- urinalysis;
- chest X-ray (determining the degree of thoracic involvement).
By the way, without an x-ray on the hands, no specialist will determine the diagnosis. Radiography allows you to find out the localization of the pathological process. Signs of pneumonia in a newborn in the picture are deflation of the lungs, the severity of the vascular pattern (especially in the initialdisease stages). Later, inflammatory-infiltrative changes occur.
Treatment of pneumonia in newborns
Pneumonia in a newly born child requires serious thorough treatment and is urgent. Therapy for pneumonia in infants involves taking into account etiological, pathogenetic and symptomatic factors. Even air temperature matters: for a weakened baby, the slightest overheating or cooling can cause a sharp deterioration in the condition. If the baby was born prematurely, the incubator mode is the most suitable for him - this is the only way doctors can set the most comfortable temperature for him and provide oxygen support.
The duration of treatment for pneumonia is on average 2-3 weeks - it all depends on the severity of the disease. The main drugs are antibiotics. It should be noted that the treatment is carried out in a complex, with the help of two antibacterial medicines. Drugs are administered only parenterally (more often intramuscularly).
Cefuroxime
This is a beta-lactam antibiotic used for its bactericidal properties. The active substance inhibits the activity of many extracellular opportunistic and pathogenic microorganisms. In the treatment of pulmonary inflammation, this drug is injected. The daily and single dosage is determined by the doctor, but usually it is no more than 100 mg per kilogram of the child's weight for 24 hours.
Like anyoneanother antibacterial drug, "Cefuroxime" brings a number of adverse reactions. Most often, against the background of the use of the drug, intestinal dysbacteriosis occurs, which is manifested by bloating, colic, and impaired stool. If the baby's mother or close relatives are prone to an allergic reaction to penicillin drugs, this remedy should not be used.
Amicacin
An antibiotic from the aminoglycoside group, which leaves no chance of staphylococcal infection, E. coli, Klebsiella and other bacteria that can affect the lungs in the prenatal period. The optimal daily dosage for infants is 15 mg/kg of baby weight. The drug is administered to the child twice a day for a week. Among the side effects, it is worth noting the likely sleep disturbance, intestinal dysbacteriosis. Do not use Amikacin for kidney damage.
Vancomycin
The drug is a representative of a group of glycopeptides that are effective against most gram-positive and anaerobic bacteria. This drug is an alternative to Cefuroxime, as it can be used for allergies to penicillin antibiotics. The dosage for newborns is 10-15 mg / kg of the child's weight. The daily amount of the drug is divided into two doses. However, when prescribing this drug, the doctor must take into account that Vancomycin can cause inflammation of the vein at the injection site. The process of parenteral administrationantibiotic requires caution and slowness.
Probiotics in the treatment of pneumonia
The drugs that help restore the microflora disturbed by antibiotics are of great importance - these are drugs containing lacto- and bifidobacteria. These include "Laktovit", "Bifiform", "Florin Forte" and many other means that create favorable conditions for the restoration of normal intestinal microflora. The dosage for the baby is determined by the attending physician. Some drugs are allowed to be dissolved in breast milk and given to the baby before direct feeding.
No self-treatment
It is unacceptable to give a child any antibiotics on their own. Realizing the danger of the disease, it is urgent to show the child to the doctor. Heavy breathing, persistent fever, palpitations - all these symptoms indicate the need for qualified medical care for the baby.
When treating pneumonia in newborns, first of all, doctors are guided by the severity of shortness of breath and the results of the examination. The effect of treatment is assessed by experts 2-3 days after the start of therapy. If there is no even minimal result, therapy is built according to a different scheme, which involves changing the antibiotic.
The prognosis of the disease is favorable if the treatment was started on the first day. Otherwise, the chances of recovery and the absence of complications are melting every day. This is confirmed by the high mortality rates from pneumonia among newborns, especiallyborn prematurely.
