Modern medicine is developing rapidly, but despite this, there remain problems that cannot be solved with the help of scientific achievements and new technologies. One of them is sepsis in children. Symptoms of this pathological process are detected in 0.8% of newborn babies. However, it is worth noting that in full-term infants, sepsis develops in 0.1% of cases, in premature infants - in 1% of cases. In deeply premature babies , this pathology is even more common - in 30-33% of cases. What is sepsis, symptoms in children, a photo of this process?
What is sepsis?
Humanity has known about this state since ancient times. Hippocrates mentioned sepsis in his writings. Then this word was understood to mean rotting of blood. Currently, the term "sepsis" experts designate a pathological process, which is based on a systemic inflammatory reaction to an infection of a viral, fungal or bacterial nature.
The baby can be infected with sepsis in the antenatal (during prenatal development), intrapartum (during childbirth) and postnatal (after childbirth) periods. Before birth, the infection is transmitted to the fetus from a woman. During childbirth and in the postnatal period, the source of infection is the mother, medical personnel, and the environment.
Causes and factors causing the pathological process
Sepsis in children, the symptoms of this serious condition arise due to the ingress of bacteria, fungi, viruses and protozoa into the body. In most cases, bacterial sepsis is observed. It is diagnosed in 85-90% of cases. Sometimes a combination of several different pathogens is detected. Statistics show that this is typical for 10-50% of cases.
Sepsis in children, whose symptoms are diverse, is caused by several factors. These include:
- inadequate antibiotic treatment;
- the use of drugs that lead to a decrease in the immune response;
- long-term full parenteral nutrition;
- the use of invasive diagnostic and treatment methods;
- immunodeficiency conditions and severe premorbid background.
Classification of sepsis
Depending on the time of onset of clinical symptoms, congenital and late sepsis in young children is distinguished . The first type of pathological process is characterized by the appearance of signs in the first 72 hours after birth. As a rule, with early sepsis, infection occurs in utero. There is no primary focus of infection. Late sepsis appears after 3 days of life. Infection with this type of serious condition occurs during childbirth or after them. Possible causes of the onset of infection are pneumonia, meningitis, peritonitis, etc., since in these diseases foci of pathogens and their development are noted.
With the course of sepsis is lightning fast, acute and subacute. There is also a classification based on the division of a serious condition into species according to the primary or leading focus of infection:
- umbilical sepsis;
- cerebral;
- pulmonary;
- intestinal;
- cutaneous.
Clinical picture
Manifestations of the pathological process can be varied. The list below includes the early and late symptoms of sepsis in a newborn baby:
- severe general condition;
- violation of thermoregulation (in full-term infants there is a fever, and in premature infants - progressive hypothermia);
- discoloration of the skin (the body acquires a dirty gray or dirty pale shade);
- violation of the functional state of the central nervous system;
- spontaneous bleeding;
- rapidly growing jaundice;
- respiratory failure (in the absence of inflammatory changes in the x-ray);
- dysfunction of the gastrointestinal tract, deviation of the size of the liver and spleen from the norm upwards.
In newborns with sepsis, symptoms such as vomiting and diarrhea are also observed. Infants refuse breast, rapidly lose weight. Often determined suppuration in the navel, abscesses of various localization are found.
Diagnosis of sepsis
Sepsis, symptoms in children (photos of this pathology do not give a complete picture of the disease) are not the only topics that need to be considered. Attention deserves the diagnosis of a serious condition - conducting emergency research. They include:
- general analysis of blood with platelets;
- coagulogram (a set of indicators by which blood coagulability can be estimated);
- determination of blood group and Rh factor;
- blood chemistry;
- acid-base blood condition (CBS: pH and arterial blood gases);
- radiography of the internal organs of the chest;
- electrocardiography;
- microscopy and inoculation of biological material (feces, urine, or mucous membrane of the oropharynx);
- blood culture
Emerging signs of sepsis in children may be inherent in other diseases. That is why differential diagnosis is important. Sepsis should be distinguished from generalized forms of bacterial infections. The diagnosis will be determined by preventive and anti-epidemic measures, specific antibacterial therapy. Differential diagnosis of sepsis and generalized forms of viral infections is also needed. When confirming their presence, specific antiviral therapy is performed.
Tasks and methods of treating sepsis
This serious condition that occurs in children requires immediate treatment, because it is very dangerous and leads to death when progressing. Therapy for sepsis is carried out simultaneously in 2 directions. One of them is etiotropic treatment. It includes the rehabilitation of foci and antibiotic therapy.
The next direction in the treatment of sepsis is pathogenetic therapy. Its tasks are to restore changes in homeostasis (including the correction of immune status disorders and organ disorders).
Etiotropic therapy
The most important action in the treatment of sepsis is the rehabilitation of the septic focus. Only thanks to this measure, therapy in serious condition becomes effective. At this stage, specialists perform surgical intervention - they perform an autopsy or puncture and drainage of purulent cavities, necratomy, etc.
If symptoms of sepsis are observed in children, antibiotic therapy is prescribed (before determining the causative agent). The doctor chooses the medicine. When selecting drugs, the time of the onset of the condition (during intrauterine development, during childbirth or after birth), the conditions of occurrence (hospital or community-acquired), and the localization of the septic focus are taken into account. All this information suggests the causative agent that caused sepsis. After clarifying the nature of the microflora, antibiotic therapy is adjusted. If necessary, the drug used is replaced by another.
Some treatment regimens
Unfortunately, there is no specific medicine that could eliminate sepsis in children, the symptoms of this pathological process. However, there are recommended treatment regimens. For example, antibiotic therapy for congenital neonatal sepsis can be as follows:
- Ampicillin in combination with aminoglycosides (either Amikacin, or Gentamicin, or Netilmicin);
- 3rd generation cephalosporins (either Ceftriaxone or Cefotaxime) in combination with aminoglycosides.
In late neonatal sepsis, one of the antibiotic therapy regimens is similar to the latter (combination of III generation cephalosporins with aminoglycosides). In the pulmonary form, “Vancomycin” and aminoglycosides are prescribed. With catheterization sepsis, Vancomycin is used. An alternative treatment regimen is Linezolid.
The use of probiotics and antifungal drugs
Antibacterial therapy is quite long in this pathological process. Such a long and intensive treatment of sepsis in children can provoke dysbiosis. For its prevention, probiotics (Linex, Bifiform, Bifidumbacterin) and Fluconazole are prescribed along with antibiotics.
An important role is played by proper feeding. Young children should be fed breast milk. In its absence, pediatricians recommend the use of special mixtures, which include bifidobacteria or probiotics.
Pathogenetic therapy
The named direction in the treatment of sepsis includes several elements:
- immunocorrective therapy;
- restoration of electrolyte and water balances and correction of acid-base disturbances;
- detoxification therapy;
- antishock therapy;
- restoration of the functions of affected systems and organs.
The measures included in the pathogenetic therapy are as follows.
| Immunocorrective therapy | Means and methods of immunocorrection are diverse. They include: - exchange blood transfusion;
- hemosorption;
- plasmapheresis.
Currently, with antibacterial therapy, IgG preparations are administered to children. They are effective at the beginning of sepsis. At the 3-5th week of the pathological condition, these drugs no longer give the expected result |
| Recovery of electrolyte and water balances, correction of acid-base disturbances and detoxification therapy | Correction of the acid-base state is ensured by the use of oxygen therapy. Detoxification treatment includes infusion therapy using glucose-salt solutions and freshly frozen plasma, albumin |
| Antishock therapy | Speaking about how sepsis manifests itself in children, it is worth noting that septic shock is a serious consequence of this pathological process. To reduce the likelihood of its occurrence, anti-shock therapy is performed. It includes the introduction of Ig, "Hydrocortisone." Anti-shock therapy includes daily transfusion of freshly frozen plasma in combination with Heparin. |
| Correction of cardiovascular disorders | With systemic arterial hypotension, cardiotonics are prescribed (either "Dopamine" or "Dobutamine"). With a decrease in cardiac output, cardiac glycoside (Digoxin) is administered to children |
Evaluation of the effectiveness of treatment
Antibacterial therapy plays a major role in the treatment of sepsis. Thanks to her, pathogens are killed in the body. That is why experts evaluate the effectiveness of treatment. Antibiotic therapy is considered effective if, after 72 hours from the start of taking the drugs:
- the general condition of the child improves;
- body temperature normalizes or decreases;
- tachycardia decreases;
- shortness of breath decreases;
- laboratory indicators are normalized.
Effective antibiotic therapy lasts for 3 weeks (minimum). Then it is canceled by a specialist. After 4-6 weeks from the start of treatment, the functions of internal organs and systems are fully restored, the pallor of the skin disappears.
In conclusion, it is worth noting that sepsis (photos in children of this pathological process do not give a complete picture of this disease) is a dangerous condition that can occur in any newborn baby. Despite the rapid development of medicine, children continue to die from sepsis. Statistics show that out of 1 thousand newborns, 4-5 infants die from this pathology.