Pneumonia in premature infants: symptoms, treatment methods, prognosis

The clinical picture of pneumonia in premature babies deserves special attention, since the consequences of this inflammatory process can be very different - from persistent respiratory dysfunction to developmental delays: ZPR, mental retardation. In ICD-10, pneumonia in premature infants is listed under the code P23. Consider what causes this disease, what are its symptoms, what treatment methods exist.

Features of the course of pneumonia in premature infants

Parents and other adults caring for the baby should be very careful about the following aspects of the physical condition of the child:

1. Lethargy, irritability, tearfulness, shortness of breath. Early signs of the disease are reflected in the autonomic nervous system. The baby begins to be capricious without external reasons, sleeps poorly, refuses to take his chest, breathes heavily. Often with prolonged feeding, you can notice the turning of blue lips, skin integument. These alarming calls should be the first reason for contacting the local pediatrician, who will send the baby for a comprehensive examination to a specialized institution (hospital, perinatal center).
2. Change in the weight of the child, which is caused by swelling, constant crying, severe blue skin, frequent burping, respiratory failure and many other typical signs of the inflammatory process. These manifestations characterize the second stage of the development of the disease, in which all the symptoms become pronounced. The child should be hospitalized immediately, since failure to provide urgent medical care in 99% leads to hypoxia (oxygen starvation) and a complex developmental delay, which will be difficult or simply impossible to overcome in the future. Also, the child has multiple malfunctions in the work of internal organs, liver failure, cholestasis.
3. An increase in body temperature, sometimes to a febrile state. A sharp loss of body weight, the development of a hollow chest, a significant increase in liver volume, persistent visible cyanosis of the skin, constant drowsiness and lethargy. This condition is a consequence of an advanced disease. The child is constantly experiencing a lack of oxygen, he is pale, does not eat at all, refuses water. He hardly screams and does not cry, as he has no physical strength for the manifestation of emotions. The processes of defecation and emptying of the bladder are greatly extended over time. Parents of such a child should take emergency measures, otherwise the baby may die.

What causes the disease

The causes of pneumonia in newborns contributes to the appearance of parasites or viruses. Their penetration into the respiratory tract of a child provokes certain factors. Among them, immaturity of the lungs, acute respiratory viral infections, aspiration during childbirth, infections during fetal development. Alveoli in the lungs of a premature baby are often not sufficiently straightened, and the surfactant is mostly poor-quality or not mature enough. Also, after premature birth in babies in the lungs, metabolic processes and circulatory problems occur.

In premature babies, the airways are poorly protected. If bacteria get into them, then pneumonia begins to develop. There are also certain causes that are called predisposing to this disease. Causes of pneumonia in newborns:

1. The pregnant woman suffered from infectious diseases, because of which her respiratory or genitourinary system was affected.
2. The presence of pathologies of the respiratory system.
3. The presence of pathologies of the central nervous system of the baby.
4. Injuries during childbirth.
5. The presence of malformations in the child.
6. Poor care of the baby (a long stay of the child in one position, rare airing of the room where the baby is, overheating or hypothermia of the baby).

Symptoms

At the very beginning of the development of the disease, certain signs significantly prevail. The condition of the child becomes worse, even a strong change in the weight of the baby due to edema is possible.

How can pneumonia be recognized (in ICD-10 code P23)? The following symptoms indicate the appearance of this pathology:

• The presence of subfebrile or too low temperature.
• The baby is noticeable inhibition.
• When eating, the appearance of vomiting, frequent regurgitation.
• Bad sucking.
• Intestinal cramps.
• The baby has drowsiness, lethargy.
• The appearance of shortness of breath.
• The child becomes irritable.
• The baby's skin takes on a pale tint.
• Bloating occurs.

An important fact is breathing problems. It becomes noticeably quicker in the child, the nose wings swell, the baby begins to wheeze, apnea attacks occur, the child also begins to cough, there is periodic breathing, coughing, the gap between the ribs becomes noticeable, heart contractions increase, foamy mucus may even appear from the mouth. This disease with proper treatment lasts about 30 days.

Kinds

Pneumonia or pneumonia develops against the background of infection, low temperatures, and other provoking factors. It should be noted that it can occur haphazardly, including the patrimonial and postpartum moment of adaptation. The most susceptible to the onset of pneumonia are preterm and low birthweight babies whose anthropometric epicrisis does not coincide with the actual normative indicators.

Forms of pneumonia in newborns:

1. Transplacental. It differs from other species by the intrauterine mechanism of development and transmission. Viruses that are in the mother's body freely penetrate the placental barrier, affect the fetus and its immature pulmonary system, create an unfavorable environment for the further development and formation of the embryo. If this happened at a later date, closer to the natural birth - a woman undergoes a procedure called "earlier obstetrics" - artificially cause contractions, remove the baby from the womb for further treatment in the "intensive care unit for newborns". If the virus or bacteria penetrated the fetus in the early stages (1 trimester), the question arises of abortion, since the fetus in 90% of cases is simply not viable.
2. Antenatal Infection of the newborn occurs through the amniotic fluid at the time of birth. If the mother has complex sexually transmitted diseases that were not detected and treated on time, the newborn at the first inhalation absorbs the microbes remaining on the face, lips and other skin integuments.
3. Intranatal. It occurs in the form of complications during obstetric measures (cesarean section). The infection is introduced at the time of dissection of the skin.
4. Postnatal pneumonia in premature infants occurs a few weeks after birth. The virus, fungus, bacteria can get into the respiratory tract, on the mucous membranes in the maternity ward, on the street, at home, or when you are in a public place (store, pharmacy). With this scenario, the infection for a long time does not make itself felt, the symptoms of pneumonia occur sharply. It can be very difficult to bring down the temperature, as it rises again very quickly. The only way to get rid of negative consequences and complications is emergency hospitalization in the nearest clinical institution.

Diagnostics

Bilateral pneumonia in a premature baby is diagnosed on the basis of examinations.

A huge role is played by the x-ray data of the newborn. On it, various forms of pathology are noticed. Radiography is also needed for early detection of possible complications.

It is necessary to differentiate congenital pneumonia in premature infants and pneumopathy, natural malformations of the lungs, heart, and other lesions that cause respiratory distress.

The local changes over the lungs in the form of shortened tympanitis in the basal areas or the shortening of percussion sound in the lower parts of the lungs, a lot of small-bubbling, creaking rales help to make a diagnosis. Tachycardia, dull heart sounds. The temperature is normal or reduced. The condition of children is gradually aggravated. The qualities characteristic of this or that intrauterine infection are found.

The formation of the disease is confirmed by a rapid decrease in hemoglobin, thrombocytopenia, stab progression in the blood, often leuko- and neutropenia, toxic granularity of neutrophils, an increase in the content of YgM and YgA, an increase in the content of C - reactive protein in blood serum.

Treatment

Nursing of premature infants with pneumonia is carried out only in a hospital, in the neonatal pathology department, where there are intensive care wards. Mom stays with the baby and helps to organize a medical and protective order. Many are interested in how much pneumonia is treated in premature babies. It all depends on the severity of the disease and the baby’s immune system.

The organization of a rational regime is considered important: temperature and humidity suitable for the patient’s age (twenty-five in a room, thirty in couves, for children weighing less than one and a half kilos - up to thirty-five in couves with a moisture content of sixty-five percent). It is necessary to beware of overcooling and overheating, to carry out systematic ventilation and quartzization of rooms. You need “free” swaddling or a robe that does not hamper the movements of children (a baby's undershirt and a blouse with protective sleeves, sliders with ties, a deep hat, woolen socks), a change in the body position of children in bed throughout the day.

Feeding

The amount and type of food are determined, according to the age of the baby, the tolerance of the gastrointestinal tract to food, the presence or absence of intestinal and metabolic disorders. Feeding must be provided with native breast milk. Entering food is carried out using a probe or drip method. In the absence of breast milk, it is required to feed with adapted milk mixtures, specialized for premature babies (Alprem, Neonatal, Humana-O, etc.). When improving the condition of children, they transfer to self-nutrition a little, first from the nipple or from a spoon, and then from the mother's breast also a little.

The amount of nutritional deficiency is compensated for by the liquid that is given inside between small doses by pipette or through a probe.

For the prevention of aspiration, they attach a vertical position after feeding. When regurgitation should raise the head end of the bed, put the premature on the side.

It is necessary to eliminate pathologies of airway patency. For this purpose, mucus retention, the use of electro- and ultrasonic aerosols using sodium bicarbonate solutions are recommended. Short-term sessions of the drainage position in combination with percussion or vibration massage are advisable.

Ozone therapy

One of the significant factors in the treatment of newborns is considered to be the correct treatment with ozone, which is part of nursing care for pneumonia. The procedure is prescribed, depending on the level of respiratory disorders and pathologies of gas homeostasis. It is carried out in the form of dosed administration of 35% of air through a mask, catheter, oxygen tent, antennae, Martin-Boyer bag. In severe cases, AIVL is used.

A mandatory circumstance is moisturizing and heating the inhaled oxygen consistency to 32-34 ° , monitoring the indicators of blood saturation with oxygen or partial tension of oxygen and carbon dioxide in the blood.

If the baby does not have pronounced shortness of breath, it can be placed in a couvez at an oxygen concentration in it of about 40-45%. With improved health, the oxygen concentration is reduced to 30-35%. In the absence of improvement or with an increase in shortness of breath, the oxygen concentration can be brought to the limit by placing a cap over the head.

An indication for mechanical ventilation is the inability to achieve normalization of blood pO2 on the background of DPSAP and manifested shortness of breath.

Immunization

Nursing care for pneumonia certainly includes conducting therapy with drugs that help strengthen the body's defenses (Immunoglobulin, plasma). Significant immunoglobulin efficacy for parenteral administration was noted. In addition to administering drugs to a small patient, a nurse monitors the condition of the child - his temperature, respiration, nutrition, and the body's response to the treatment.

In the treatment of cardiovascular failure, Digoxin is used. Cardiac glycosides reduce hypertension in the pulmonary circulation and improve myocardial contractile function.

Intravenous administration of Eufillin lowers the signs of pulmonary hypertension and improves the contractile function of the right ventricle.

When purulent processes use "Gordoks", "Kontrikal".

In the presence of premature obstructive syndrome with bronchopneumonia and bronchopulmonary dysplasia, developing against the background of mechanical ventilation, aerosols with orcipremaline sulfate are indicated.

A major role is played by the renewal of the beneficial flora of the intestinal tract, since dysbacteriosis often occurs with pneumonia. Substances used:

• "Bifidumbacterin."
• "Lactobacterin."
• Bactisubtil.

Effects

Premature babies very often suffer from pneumonia. This disease in such infants is fraught with complications in the form of various pathologies of the lungs. In addition, it is often observed:

• Otitis.
• Hypertrophy.
• Adrenal insufficiency.
• Bleeding.
• Sepsis. This is the most serious complication of pneumonia in a premature baby.

Those who have experienced the disease may also experience the consequences of pneumonia in a newborn, such as rickets, thrush, and anemia. Often such children have bronchopulmonary dysplasia, leading to permanent diseases of the lungs and bronchi.

The prognosis for pneumonia in preterm infants is often favorable. But this is subject to all the recommendations of doctors.

As a prevention of pneumonia in an infant, it is recommended that you follow these tips:

1. During pregnancy, carefully monitor your health and treat any illness with drugs prescribed by your doctor.
2. Observe sanitary requirements. This is especially important for children's clinics and maternity hospitals. If the baby is born with asphyxiation, urgent resuscitation is necessary.
3. After childbirth, it is recommended to immediately apply the newborn to the mother's breast.
4. If the baby appeared prematurely, respiratory distress is observed, childbirth was difficult or the mother had illness during pregnancy, it is better to prescribe an antibiotic to the newborn right away.
5. Carefully monitor the hygiene of the house and the baby, the daily routine of the newborn and observe the necessary microclimate in the room where the baby is.