Inflammation of the lungs is a dangerous disease. In a newborn, pneumonia is especially difficult. 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, treatment principles, causes and consequences of pneumonia in newborns.
It is believed that pneumonia is most often diagnosed in children born from a pathological pregnancy and complex births. In addition, the predominant number of mothers are carriers of viral and bacterial infections, which are not yet able to withstand fully weak baby immunity. According to statistics, pneumonia is most often diagnosed in newborns after cesarean section and premature babies.
The main causes of the disease
An acute inflammatory process that occurs with damage to the lung tissue is accompanied by a concentration of exudate inside the alveoli. As a result of this pathological phenomenon, symptoms develop from the respiratory system. Pneumonia in newborns, despite their very early age, is as common as in babies at an older age. This is associated with many factors.
For the development of pneumonia in infants, a prerequisite is the penetration of pathogenic microflora into the body. Success in treating 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 during the first three days after childbirth. To provoke the development of this disease even in the perinatal period, viruses that penetrate the placenta are capable. The main causative agents of intrauterine pneumonia in newborns are considered microorganisms that cause infections from the TORCH group. These include:
- rubella;
- cytomegalovirus;
- herpes virus;
- toxoplasmosis;
- syphilis.
As a rule, all pregnant women are examined in the antenatal clinic for the presence of TORCH viruses in the body. If the mother contracted the infection in the first trimester, pneumonia was probably one of the complications of transplacental infection. Severe pregnancies and diseases suffered by a woman can lead to the partial destruction of natural protective barriers.
The cause of pneumonia in newborns can be infection by pathogenic bacteria before childbirth or at the time of passage through the birth canal of the mother. The causative agents of the disease in this case may be:
- chlamydia
- mycoplasmas;
- Candida
- listeria;
- ureaplasma;
- Trichomonas.
Conditionally pathogenic microorganisms are also capable of causing neonatal pneumonia, which is distinguished by the timing of occurrence (early - up to 7 days, later - from 7 to 28 days). These include staphylococcus, 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. Typically, infection occurs in the delivery room or in the premature ward during an artificial lung ventilation event. Other causes of child infection in the hospital are:
- Complex birth. Pneumonia in a newborn after cesarean section or the use of obstetric forceps is a very common consequence.
- Chronic or acute infectious diseases of the mother affecting the genitourinary system.
- Meconium aspiration during childbirth.
- Resuscitation measures, including mechanical ventilation.
- Deep prematurity.
- Injuries during childbirth.
- Inconsistency of the situation in the delivery room with sanitary and hygienic standards.
Pathogenesis of the disease
Pneumonia in a newborn develops against the background of the immaturity of the respiratory system, which increases the risk of infection and the multiplication of pathogenic microflora. With intense blood supply, pathogens that enter the body reach the lungs with lightning speed. In this case, inflammation first originates in the alveoli. Pathological changes entail violations 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 begin intoxication of the whole organism.
Symptoms in infants
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 baby is born, literally a few hours later. Manifestations of this disease dangerous for the child can be noticed by its condition:
- the baby is born with a pale gray skin;
- possibly a rash due to intoxication of the body;
- the baby is weakened, unable to scream loudly;
- congenital reflexes are inhibited;
- increased breathing is observed;
- retraction of intercostal spaces;
- retraction of the sternum when inhaling;
- heart palpitations;
- body weight below the norm established for newborns;
- the child refuses the breast offered by the mother;
- high body temperature.
With an increase in symptoms, which occurs fairly quickly, the child may experience cramps. The congenital form of pneumonia is especially difficult 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 had already managed to gain weight by feeding his mother’s milk and acquire additional immune protection against pathogens. Symptoms of neonatal pneumonia are similar to manifestations of congenital, but are less pronounced. The newborn becomes restless, moody, loses his appetite. Due to pulmonary inflammation, severe shortness of breath appears.
Features of the disease in infants
Bilateral form of pneumonia in newborns is quite common. This is due to the fact that the baby’s body is not yet able to deal with the inflammatory process within the same area, as in adults and older children. In addition, a constant lying position and rather wide bronchi with small alveolar septa allow the infection to spread faster to other segments. Consequently, focal pneumonia in babies born is not necessary.
In the initial stages of the disease in infants, a one-sided form most often appears. In a predominant number of cases, this is exactly what happens with late neonatal pneumonia. The first focus appears on the right side. This is due to the fact that the right bronchus is wider and slightly shorter than the left - this is a “standard” physiological feature. However, the inflammatory process quickly affects the left lung, so, having lost a couple of days, it will be necessary to treat bilateral pneumonia.
What could be the consequences
It is no secret that the immunity of a newborn child has not yet managed 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, during the first hours or days. All the probable problems that pneumonia can lead to are conditionally divided into pulmonary and extrapulmonary. The first group includes:
- pleurisy (inflammatory lesion of the pleura);
- atelectasis (decay of a particle of the lungs);
- pneumothorax (air concentration in the sternum, leading to compression of the respiratory organs from the outside).
Such effects of pneumonia in newborns can occur on the second day. Extrapulmonary complications are the result of hematogenous transmission of the infection. These include otitis media, hemorrhagic syndrome, hemodynamic disturbances, sepsis. Any bacterial lesion carries a risk for the child, since bacteremia (infection in the bloodstream) threatens the baby with a fatal outcome.
Some time after pneumonia, the newborn may experience complications in the cardiovascular system, there is also the likelihood of developing rickets, severe anemia.
Diagnosis of the disease
Doctors derive basic information about a newborn’s disease from a mother’s medical history, pregnancy history, childbirth, and laboratory and instrumental studies. Next, an objective examination of the child.
With pneumonia, chest percussion is accompanied by a shortened muffled tone. In newborns with pneumonia, weakened breathing is expressed, as a rule, without wet rales and crepitus. It is impossible to rely only on the external manifestations of the disease and visual changes from other systems. The key role in the diagnosis of pneumonia in infants belongs precisely to laboratory and instrumental studies:
- clinical blood test (increased leukocyte counts);
- general analysis of urine;
- chest x-ray (determining the degree of thoracic lesion).
By the way, without a radiographic image on the hands, no specialist will determine the diagnosis. Radiography allows you to find out the localization of the pathological process. Signs of newborn pneumonia in the picture are flatulence, the severity of the vascular pattern (especially in the initial stages of the disease). Later, inflammatory-infiltrative changes occur.
Treatment of pneumonia in newborns
Pneumonia in a child who has just been born requires serious thorough treatment and is urgent. Therapy for pneumonia in infants involves the consideration of etiological, pathogenetic and symptomatic factors. Even the air temperature matters: for the weakened baby, the slightest overheating or cooling can cause a sharp deterioration. If the child was born ahead of time, the most suitable for him is the mode of the incubator - only this way the doctors will be able to establish for him the most comfortable temperature regime and provide support with oxygen.
The duration of treatment of pneumonia on average is 2-3 weeks - it all depends on the severity of the disease. The main drugs are antibiotics. It is worth noting that the treatment is carried out comprehensively, using two antibacterial medications. Drugs are administered only parenterally (more often intramuscularly).
"Cefuroxime"
This is a beta-lactam antibiotic, which is used due to its bactericidal properties. The active substance inhibits the activity of many extracellular conditionally pathogenic 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 not more than 100 mg per kilogram of the child’s weight within 24 hours.
Like any other antibacterial drug, Cefuroxime brings a number of adverse reactions. Most often, against the background of the use of the drug, intestinal dysbiosis occurs, which is manifested by bloating, colic, and stool disorder. If the baby's mother or his close relatives are prone to an allergic reaction to penicillin preparations, this remedy should not be used.
Amikacin
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 baby weight. The drug is administered to the child twice a day for a week. Among the side effects, it is worth noting a probable sleep disturbance, intestinal dysbiosis. In case of kidney damage, Amikacin is not used.
Vancomycin
The medicine is a representative of a group of glycopeptides that are effective in affecting 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 weight of the child. The daily amount of medication is divided into two doses. However, when prescribing this drug, the doctor should consider that Vancomycin can cause inflammation of the veins at the injection site. The process of parenteral administration of an antibiotic requires caution and unhurriedness.
Probiotics in the treatment of pneumonia
Of great importance are drugs that help restore the microflora disturbed by antibiotics - these are medicines containing lactobacilli and bifidobacteria. These include Lactovit, Bifiform, Florin Forte and many other drugs 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-medication!
It is unacceptable to give a child any antibiotics on its own. Aware of 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, doctors primarily focus on the severity of shortness of breath and the results of the examination. Specialists evaluate the effect of treatment 2-3 days after the start of therapy. If there is not even a minimal result, the therapy is built according to a different scheme, which implies a change in the antibiotic.
The prognosis of the disease is favorable if treatment was started on the first day. Otherwise, the chances of recovery and the absence of complications melt away every day. This is also confirmed by the high mortality rates from pneumonia among newborns, especially those born earlier than term.