Bacterial infections of newborns: diagnosis and treatment. Intrauterine infection dangerous to the fetus: signs, methods of control

Even after a completely successful birth, the baby’s condition can deteriorate sharply during the first weeks of life. Apathy, lethargy, constant regurgitation, lack of appetite, weight problems - this is an approximate list of warning symptoms that most often manifest infections in newborns.

Intrauterine infection in newborns

The female body at different stages of life can harbor pathogens of various diseases, including sexually transmitted infections. This is especially true for employees of hazardous industries and those with chronic pathologies. If the infection attacks a woman during pregnancy, there is a high risk of transmitting it to the child during his intrauterine life. Common blood flow with the mother, ingestion of amniotic fluid are possible routes of infection. In addition, infection often occurs directly during the baby’s passage through the birth canal.

Viral infections provoke diseases such as herpes, rubella, cytomegaly, and influenza. Among the bacterial pathogens known are chlamydia, treponema, streptococci, E. coli, etc. Even fungi and protozoa can cause intrauterine infection in a newborn baby.

Cytomegalovirus infection in newborns

Cytomegalovirus infection in newborns is considered relatively harmless; it extremely rarely provokes developmental pathologies, therefore medications for its treatment are prescribed in exceptional situations. For the expectant mother, the development of cytomegaly occurs completely unnoticed. However, the presence of cytomegalovirus itself in the body of a pregnant woman provokes a weakening of the defenses, as a result of which the immune system cannot properly protect the woman and baby.

The herpes virus is a close relative of the cytomegalovirus, but its activity is much more destructive. If a herpetic infection is detected in the amniotic fluid, the pregnant woman is sent for a planned cesarean section. If the herpes pathogen does attack a child, he will need appropriate therapy, the purpose of which is to minimize the negative impact of the infection on the nervous system.

Staphylococcal infection in newborns

Staphylococci live side by side with humans: they can be found in milk and derivative products, on household items, plants and simply in the air. Of the whole family Staphylococcaceae, only three species are provocateurs of infectious diseases.

The most dangerous staphylococcus is Staphylococcus aureus. The presence of this pathogen in a child’s body can be assumed by purulent inflammations on the skin, including suppuration of the umbilical wound, as well as the formation of boils and impetigo. Staphylococcal infection in newborns can lead to very sad consequences: from meningitis, osteomyelitis and pyelonephritis to sepsis and toxic shock; from laryngitis and pneumonia to epidermal necrolysis.

Of course, with such a large-scale threat to health, you cannot hesitate to see a doctor. It is better to try to get an appointment with a qualified specialist, because an attack of staphylococci requires a worthy response in the form of a whole cocktail of antibacterial agents, vitamins, probiotics and enzymes.

Intestinal infections in newborns

An intestinal infection can rarely take an adult out of their usual rhythm of life (except for a few days), but for a small child, especially a newborn, problems in the intestines can cause death. And we are not talking about some special cases: for a third of children who died before the age of three, the diagnosis of “intestinal infection” became fatal. Poisoning of the body with toxins produced by harmful microflora, as well as dehydration that occurs as a result of the small body’s attempts to remove all unnecessary objects, are destructive factors.

Intrauterine infection often leads to illness in newborns. The clinical manifestation of the disease depends on the pathogen, time and route of infection. There are more infections transmitted from mother to fetus than are included in the traditional acronym TORCH (see Intrauterine Infection).

Cytomegalovirus infection. The clinical picture in newborns is characterized by significant polymorphism of symptoms. Along with the acute course of the disease, manifested by the early appearance of jaundice, hepatosplenomegaly, and hemorrhagic syndrome, cases of an asymptomatic course are identified, which are characterized by only mild neurological symptoms. At the same time, complications such as sensory deafness and severe delay in the neuropsychic development of the child are identified in later periods of life.

In newborns with congenital cytomegalovirus infection, viruses are found in urine, saliva, and cerebrospinal fluid. For diagnosis, it is necessary to collect saliva in a container with a medium for cultivating the virus. Urine and other materials should be sent to the laboratory refrigerated.

For diagnostic purposes, specific CMV antibodies of the IgM class are determined. In addition, electron microscopic examination of saliva, urine sediment or liver tissue is used. The presence of virus particles confirms the diagnosis.

There is no effective specific antiviral therapy. The administration of ganciclovir to newborns did not produce a positive result. To reduce the severity of viremia, it is recommended to use specific anticytomegalovirus immunoglobulin according to the regimen.

Simple herpes. There are 2 known serotypes of herpes simplex: I and II. Clinically, the disease can be asymptomatic (very rare), with localized lesions of the skin or eyes. The disseminated process may manifest itself with signs characteristic of sepsis. Isolated damage to the central nervous system is characterized by fever, lethargy, poor appetite, hypoglycemia, a syndrome of increased neuro-reflex excitability, followed by intractable focal or generalized convulsions.

Vesicular elements on the mucous membranes and skin are important evidence of the disease.

To diagnose the disease, the contents of vesicles or damaged areas of skin are examined in a Tzanck smear to identify giant multinucleated cells or by direct immunofluorescence to detect the herpes simplex virus antigen.

Treatment - for all clinical forms of neonatal herpetic infection, including isolated skin lesions, Acyclovir is prescribed.

For a generalized form, herpetic lesions of the central nervous system or ophthalmic herpes, acyclovir is administered at a dose of 60-90 mg/kg body weight per day intravenously. The daily dose is divided into 3 injections every 8 hours. The course duration is at least 14 days.

For isolated skin lesions - a dose of 30 mg/kg body weight per day intravenously. The daily dose is also divided into 3 administrations. The course of treatment is 10-14 days.

In complex therapy, reaferon is used at a dose of 100-150 thousand IU/kg 2 times a day every 12 hours for 5 days in suppositories, immunoglobulin with a high titer of antiherpetic antibodies.

Determining the level of antiherpetic antibodies in mother and child has no diagnostic value.

Toxoplasmosis. With late infection, when the first symptoms appear after birth, the disease occurs as a generalized process with intoxication, jaundice, and hepatosplenomegaly.

Diagnostics: identification of the pathogen in a native or Romanovsky-Giemsa-stained preparation of cerebrospinal fluid sediment after centrifugation, in peripheral blood, urine, sputum; performing a Sebin-Feldman serological test or a skin test with toxoplasmin.

To treat toxoplasmosis, pyrimethamine is used in combination with sulfonamide drugs.

Sulfadimezine is prescribed in a dose of 1 g 2 times a day, pyrimethamine (chlorophine) - 25 mg 2 times a day. 2-3 courses are carried out for 7-10 days with breaks of 10 days.

Listeriosis. In newborns, the clinical picture of congenital listeriosis is manifested by aspiration pneumonia and cerebrovascular accident. The organ of hearing (otitis), the central nervous system (meningeal phenomena) and the liver are often affected. Often characteristic skin rashes are detected: papules the size of a pinhead or millet grains with a red rim along the periphery, localized on the back, buttocks and limbs. Upon examination, similar rashes can be seen on the mucous membrane of the pharynx, pharynx, and conjunctiva. With bacteriological examination, the infectious agent can be obtained from the contents of skin papules, meconium, urine and cerebrospinal fluid. Treatment is carried out with antibiotics (ampicillin).

Rubella. The diagnosis of rubella in a newborn is made on the basis of clinical symptoms and laboratory data (isolation of the virus from urine and pharyngeal secretions). An important diagnostic test is the detection of specific rubella IgM antibodies in the blood of a newborn. There is no specific therapy.

Infectious diseases of newborns of bacterial etiology. Bacterial infectious diseases of newborns include skin diseases, mastitis, omphalitis, pneumonia, conjunctivitis, sepsis and meningitis, and less commonly, arthritis and osteomyelitis. Sources of infection can be sick mothers, staff, newborns, and poorly processed instruments. Purulent-inflammatory diseases in newborns are characterized by the presence of local signs of inflammation of varying severity, a symptom complex of infectious toxicosis, the presence of changes characteristic of the inflammatory process in general and (or) biochemical blood tests, general urine analysis (for infections of the urinary system), spinal fluids (for neuroinfection), detection of pathology with certain instrumental examination methods (ultrasound, radiography, etc.).

The most common infectious skin diseases are staphyloderma (vesiculopustulosis, pemphigus of newborns, exfoliative dermatitis of Ritter, pseudofurunculosis of Figner, mastitis of newborns, necrotizing phlegmon of newborns).

With vesiculopustulosis, small superficial bubbles up to several millimeters in size appear on the skin of natural folds, head, and buttocks, filled with transparent and then cloudy contents due to inflammation at the mouths of the meracrine sweat glands. The vesicles burst 2-3 days after their appearance, and the erosions become covered with dry crusts that do not leave scars or pigmentation after they fall off.

With pemphigus of newborns, against the background of erythematous spots, bubbles up to 0.5-1 cm in diameter appear, with serous-purulent contents, with a slightly infiltrated base and a rim of hyperemia around the bubble and are in different stages of development. After the bubbles open, erosions form. In the malignant form of pemphigus, phlyctenas appear (bubbles are predominantly large in size - up to 2-3 cm in diameter). The skin between individual blisters may peel off. The general condition of the newborn is serious, symptoms of intoxication are pronounced.

Ritter's exfoliative dermatitis is caused by hospital-acquired strains of Staphylococcus aureus that produce the exotoxin exfoliatin. At the end of the 1st - beginning of the 2nd week of life, redness and weeping of the skin appear, cracks form in the navel, inguinal folds, and around the mouth. Bright erythema quickly spreads to the skin of the abdomen, torso, and limbs, where flaccid blisters and cracks subsequently appear, the epidermis peels off and extensive erosions remain. The general condition of the patients is serious. After 1-2 weeks from the onset of the disease, the entire skin of the newborn becomes hyperemic, and erosions form in large areas due to the accumulation of exudate under the epidermis. Then the epidermis peels off, and symptoms of dehydration appear. With a favorable outcome of the disease, the erosive surfaces are epithelialized without scarring or pigmentation.

Figner's pseudofurunculosis can begin in the same way as vesiculopustulosis, with subsequent spread of inflammation to the entire sweat gland. It is characterized by the appearance of subcutaneous nodes up to 1 - 1.5 cm in diameter of a purplish-red color, in the center of which purulent contents subsequently appear. The most common localization is the skin of the scalp, back of the neck, back, buttocks, and limbs.

Neonatal mastitis usually develops against the background of physiological engorgement of the mammary glands. Clinically manifested by enlargement and infiltration of one mammary gland, hyperemia of the skin over the gland may appear a little later, but without treatment it intensifies; fluctuation occurs. Palpation is painful; purulent contents are released from the excretory ducts of the gland spontaneously or upon palpation.

One of the most severe purulent-inflammatory diseases of newborns is necrotic phlegmon, which begins with the appearance of a red spot on the skin that is dense to the touch. The lesion spreads quickly, while purulent melting of the subcutaneous tissue outstrips the rate of skin changes due to the rich network of lymphatic vessels and wide lymphatic slits. In the alterative-necrotic stage, after 1-2 days, the affected areas of the skin acquire a purplish-bluish tint, and softening is noted in the center. In the rejection stage, necrosis of the exfoliated skin occurs; after its removal, wound surfaces with undermined edges and purulent pockets appear. During the repair stage, the development of granulation and epithelization of the wound surface occurs, followed by the formation of scars.

Among streptoderma, the most common are erysipelas (the appearance of a focus of local hyperemia of irregular shape with scalloped edges, infiltration of the skin and subcutaneous tissue, the demarcation ridge is absent, the altered skin is warm to the touch, the lesion quickly spreads to other areas of the skin) and intertriginous streptoderma ( sharply demarcated hyperemia behind the ears and in natural folds with cracks, conflicts, which are subsequently replaced by pityriasis-like peeling).

Treatment consists of removing pustules with a sterile material soaked in a 70% alcohol solution, local treatment with 1-2% alcohol solutions of aniline dyes, using hygienic baths with disinfectants (potassium permanganate solution 1:10,000), it is advisable to carry out ultraviolet irradiation. If the child’s general condition worsens or infectious toxicosis is present, antibacterial therapy is indicated; if infiltration and fluctuation occur, consultation with a pediatric surgeon is indicated.

Among diseases of the mucous membranes in newborns, conjunctivitis is most often observed. With conjunctivitis, as a rule, there are bilateral lesions with purulent discharge, swelling and hyperemia of the conjunctiva and eyelids. Treatment is determined by the type of causative agent of the infectious process (staphylococci, chlamydia, gonococci, etc.).

Particular attention should be paid to infectious diseases of the umbilical wound. Catarrhal omphalitis is characterized by the presence of serous discharge from the umbilical wound and a slowdown in the timing of its epithelization. Mild hyperemia and slight infiltration of the umbilical ring are possible. In this case, the condition of the newborn baby is usually not disturbed, there are no changes in the blood test, and the umbilical vessels are not palpable. Local treatment: treatment of the umbilical wound 3-4 times a day with a 3% solution of hydrogen peroxide, then a 70% solution of ethyl alcohol and a solution of potassium permanganate, as well as ultraviolet radiation on the area of ​​the umbilical wound.

With purulent omphalitis, the disease usually begins at the end of the 1st week of life with catarrhal changes in the area of ​​the umbilical wound, then purulent discharge from the umbilical wound, swelling and hyperemia of the umbilical ring, infiltration of the subcutaneous tissue around the navel, as well as symptoms of infectious damage to the umbilical vessels appear. With thrombophlebitis of the umbilical vein, an elastic cord above the navel is palpated. In the case of thrombarteritis, the umbilical arteries are palpated below the umbilical ring, and purulent discharge may appear at the bottom of the umbilical wound. In addition to local treatment, antibacterial therapy is mandatory.

The presence of an infectious focus of any localization makes it necessary to exclude sepsis in a given child, while the treatment tactics for a newborn with a localized purulent-inflammatory disease should be comprehensive.

Sepsis is the most severe infectious and inflammatory disease of children during the neonatal period. The frequent development of the septic process in newborns is associated with the anatomical and physiological characteristics of the body, the immaturity of systems and organs, primarily the central nervous system, and the characteristics of the humoral and cellular components of immunity.

Infection of a newborn can occur in the ante-, intrapartum or early neonatal periods. Depending on the duration of infection, intrauterine and postnatal sepsis are distinguished. One of the factors contributing to the development of sepsis in newborns is the implementation of resuscitation measures at birth and in the first days of life. Prematurity and immaturity represent a favorable background for the development of the septic process.

In case of sepsis in newborn children, the entrance gates of infection are most often the umbilical wound, skin and mucous membranes injured at the site of injections, catheterization, intubation, etc., intestines, lungs, less often the urinary tract, middle ear, eyes. If it is impossible to establish the entrance gate of the infection, cryptogenic sepsis is diagnosed.

Based on the clinical picture, neonatal sepsis is sometimes difficult to differentiate from pathological conditions of a non-infectious nature. There is instability in body temperature (hypo- or hyperthermia). Additional signs may be sluggish sucking or the absence of a sucking reflex, regurgitation and vomiting, frequent and loose stools, bloating, apnea, respiratory distress syndrome (signs of respiratory failure), perioral and periorbital cyanosis, hepatosplenomegaly (enlarged liver and spleen), jaundice, marbling of the skin, lethargy, hypotension, convulsions. Bulging, tension of the anterior (large) fontanel and stiff neck in newborns are not reliable signs (obligatory symptoms) of meningitis. The most severe form is fulminant sepsis (septic shock). For premature babies, a subacute (protracted) course of sepsis is more typical.

If sepsis is suspected, you should:

Conduct microbiological studies with culture for sterility and Gram staining of blood, cerebrospinal fluid, urine, discharge from the trachea and infectious foci. Positive blood culture results for infection in a child, with clinical manifestations of a purulent-inflammatory disease, infectious toxicosis, as well as characteristic changes in laboratory parameters and changes identified during instrumental studies, allow the doctor to confirm the diagnosis of sepsis;

Conduct a study of the cerebrospinal fluid: Gram staining, determination of the number of cells, protein content, glucose. The fluid may be cloudy as a result of bacterial cell proliferation in the absence of pleocytosis. The absence of any pathological changes in the cerebrospinal fluid at the first lumbar puncture occurs in less than 1% of newborns with meningitis. Low glucose levels and increased numbers of polymorphonuclear leukocytes are possible with intraventricular hemorrhage. To confirm ventriculitis in children with hydrocephalus, ventricular puncture may be required;

Examine tracheal aspirate. The presence of leukocytes and bacteria in tracheal aspirate in the first hours of life suggests intrauterine infection;

Determine the number of leukocytes and platelets in peripheral blood, leukocyte formula. The absence of changes in these indicators does not completely exclude the diagnosis of sepsis. Leukopenia and neutropenia (increased proportion of juvenile forms) with a ratio of immature forms to the total number of neutrophils of more than 0.2 suggests sepsis, but can also occur in premature newborns from a high-risk group (exposed to severe birth stress). Thrombocytopenia can occur with sepsis both in the case of DIC syndrome and without it. In sepsis, the erythrocyte sedimentation rate may increase by more than 15 mm/h, but this sign is not mandatory;

Take a chest x-ray. The X-ray picture of pneumonia may be similar to that of hyaline membrane disease;

Examine urine: microscopy and culture to determine the sensitivity of the detected microflora to antibiotics;

Perform a limulus lysate test, which allows you to verify the presence of endotoxemia in sepsis caused by gram-negative opportunistic flora, especially in hospital infections that developed after the first week of life.

The tactics of treating a newborn with sepsis is to organize optimal care and feeding, prescribe rational antibacterial therapy (the starting regimen involves the use of second-generation cephalosporins in combination with aminoglycosides in age-specific dosages, then the change of antibiotics is carried out in accordance with the results of microbiological studies and taking into account the sensitivity of the isolated microorganisms to antibiotics; in case of meningitis, it is necessary to take into account the ability of antibiotics to penetrate the blood-brain barrier); carrying out the necessary syndromic therapy - correction of existing syndromes of respiratory, cardiovascular, renal, adrenal, liver failure, hematological disorders (most often DIC syndrome, anemia, thrombocytopenia), neurological syndromes; carrying out adequate hydration therapy for the purpose of detoxification, partial or complete parenteral nutrition, if necessary, to replenish the volume of circulating blood, correct microcirculatory and metabolic disorders. For the purpose of immunocorrection, transfusions of fresh frozen plasma (if the pathogen is identified - hyperimmune), leukocyte mass are most indicated. Maintenance and correction of normal intestinal biocenosis during and after antibacterial therapy is also necessary (prescribe bifidum- or lactobacterin 5 doses 2-3 times a day, and also use polyvalent pyobacteriophage or monovalent bacteriophages - streptococcal, staphylococcal, Pseudomonas aeruginosa, Klebsiella, coliproteus, etc.).

Intrauterine infectious diseases pose a great danger to the health and life of the child, as they lead to delayed fetal development, various defects and diseases.

Intrauterine infection in a newborn is an infectious disease that occurs as a result of infection in the womb or during childbirth. The consequences can be very different - from the formation of congenital defects to the death of the child.

The clinical manifestations of such infections depend on a large number of different factors. For the most part, they depend on acute illnesses of the mother during the prenatal and birth periods. Symptoms are completely different and the clinical picture does not always help identify the presence of the disease. Therefore, proper monitoring of a woman during pregnancy helps either eliminate the risk completely or eliminate all consequences.

In newborns, they occur as a result of infection of the fetus with a pathogen during pregnancy or during childbirth. Most often, a child becomes infected with an infection from the mother. Cases of infection are much less likely to occur with specific types of diagnostics of the mother (invasive prenatal diagnosis), administration of various blood products through the umbilical cord to the child, and other routes.

During the period of intrauterine development of a child, infectious agents most often arise from various viruses (rubella, HIV, herpes, hepatitis B, hepatitis C, cytomegaly) and intracellular microorganisms (mycoplasmosis, toxoplasmosis).

During the birth period, the degree of infection directly depends on the condition of the mother's birth canal. Provided the integrity and healthy functionality of the placenta, the child is inaccessible to the simplest viruses and most harmful bacteria. However, with fetoplacental insufficiency or various injuries, there is a high probability of infection of the child.

The severity of the disease depends on the time of infection and the type of pathogen. Infection during the first ten weeks of intrauterine development guarantees a high probability of spontaneous miscarriage.

Infection with the pathogen in the first fourteen weeks leads to stillbirth and the occurrence of severe malformations and disorders in the development of the child. The disease in the second and third trimesters causes damage to individual organs or extensive infection.

It is possible that the clinical manifestation of the infection in the mother may not coincide with the symptoms or severity of the infection in the child. Low intensity of symptoms or an asymptomatic course of the disease in a pregnant woman often causes severe consequences reflected in the fetus - from pathologies to death.

Symptoms

It is possible to detect intrauterine infection during childbirth. Signs of infection may include:

• unpleasant odor and turbidity of amniotic fluid;
• unsatisfactory condition of the placenta;
• asphyxia in a newborn.

In the future, other manifestations of the disease can be diagnosed:

• enlargement of some internal organs (liver);
• microcephaly;
• jaundice;
• sudden febrile syndrome;
• pyoderma;
• different pigmentation on the skin;
• convulsions.

Manifestations of intrauterine infection may include grayish skin color of the newborn, depression of the central nervous system and excessive regurgitation. In the future, during a protracted period of development, infections can cause the occurrence of osteomyelitis, various types of encephalitis and meningitis.

Congenital toxoplasmosis

Acute manifestations begin in the first days of life after birth and are characterized by the occurrence of inflammation in organs, nephritis, various manifestations of diarrhea, jaundice, and fever. Convulsions and edema syndrome are possible.

The chronic form leads to strabismus, microcephaly, optic nerve atrophy and iridocyclitis. Cases of monosymptomatic and latent forms of the disease occur much less frequently. Late complications entail blindness, epilepsy, mental retardation.

Congenital rubella

The disease of rubella in a pregnant woman at different periods of pregnancy with varying degrees guarantees the possibility of infection of the child. When infected during the first eight weeks, the disease in the fetus is 80% and the consequences have a high degree of risk - up to spontaneous miscarriage. The disease in the second trimester will reduce the risk to 20%, and in the third – to 8%.

A baby with rubella is often born low birth weight or premature. The typical clinical picture includes congenital heart disease, damage to the auditory nerve and eyes. Deafness may develop.

Atypical manifestations and consequences may develop:

• hepatitis
• hydrocephalus;
• microcephaly;
• cleft palate;
• skeletal abnormalities;
• defects of various systems;
• mental or physical developmental delay.

Cytomegaly

Infection with pathogens of cytomegalovirus infection often leads to damage and abnormalities in the development of various internal organs, disruption of the functioning of the immune system, and various complications.

Most often, congenital pathologies are present, which manifest themselves:

• cataracts;
• retinopathy;
• microphthalmia;
• microgyria;
• microcephaly and other serious diseases.

In the future, liver cirrhosis, blindness, pneumosclerosis, encephalopathy, and deafness may develop.

Herpetic infection

This disease occurs in three forms - broad, mucocutaneous and neurological. The broad form of the disease is characterized by toxicosis, jaundice, hepatomegaly, pneumonia, and distress syndrome. Other forms occur with rashes and encephalitis. Sepsis may develop.

Hepatitis can cause defects of varying severity - dwarfism, retinopathy, microcephaly. Later complications include developmental delay, blindness, and deafness.

Diagnostics

For modern medicine, one of the most pressing tasks is in the initial stages. To do this, a wide range of different tests are carried out to identify pathologies - smears and cultures of flora from the pregnant woman’s vagina, PCR diagnostics, specialized laboratory tests for a complex of intrauterine diseases in newborns.

A method often used is to identify specialized markers using widely used ultrasound. This method allows you to determine low and polyhydramnios, turbidity of amniotic fluid, developmental disorders and damage to the placenta, various pathologies of the fetus and disorders in the development of various organ systems of the child.

During the postpartum period, a complex of various laboratory tests is carried out to confirm or refute the presence of intrauterine infections. Tests for microorganisms, viruses and bacteria are widespread. Molecular biological research methods based on DNA, serological and histological analyzes are used.

In the first days of life, if an infection is suspected, the child should be examined by specialists in various fields - cardiology, neurology, ophthalmology and other areas. It is recommended to carry out various studies on the reactions of the child’s body.

Treatment

Treatment of intrauterine infections is a complex of multidirectional therapies that together help cope with the disease. The main types of treatment are aimed at ridding the body of pathogens, restoring the full range of functioning of the immune system, and restoring the body after an illness.

To strengthen the immune system, immunomodulators and immunoglobulins are prescribed. Most antibiotics intended for newborns and pregnant women help fight viruses and bacteria. Restoring the body consists of getting rid of residual symptoms of intrauterine infections.

Prevention

First of all, preventive examination of partners at the stage of pregnancy planning will help to avoid the occurrence of intrauterine infections. Vaccination is often used to prevent the occurrence of herpes viruses.

An important element of prevention is complete and unconditional adherence to the rules of personal and general hygiene, maintaining a healthy lifestyle, and regular examinations for various infectious diseases.

– a group of diseases of the fetus and newborn that develop as a result of infection in the prenatal period or during childbirth. Intrauterine infections can lead to fetal death, spontaneous abortion, intrauterine growth retardation, premature birth, the formation of congenital defects, damage to internal organs and the central nervous system. Methods for diagnosing intrauterine infections include microscopic, cultural, immunoenzyme, and molecular biological studies. Treatment of intrauterine infections is carried out using immunoglobulins, immunomodulators, antiviral and antibacterial drugs.

General information

Intrauterine infections are pathological processes and diseases caused by antenatal and intrapartum infection of the fetus. The true prevalence of intrauterine infections has not been established, however, according to generalized data, at least 10% of newborns are born with congenital infections. The relevance of the problem of intrauterine infections in pediatrics is due to high reproductive losses, early neonatal morbidity, leading to disability and postnatal death of children. Issues of preventing intrauterine infections lie in the area of ​​consideration of obstetrics and gynecology, neonatology, and pediatrics.

Causes of intrauterine infections

Intrauterine infections develop as a result of infection of the fetus in the prenatal period or directly during childbirth. Typically, the mother is the source of intrauterine infection for the child, i.e., there is a vertical transmission mechanism, which in the antenatal period is realized by transplacental or ascending (through infected amniotic fluid) routes, and in the intranatal period by aspiration or contact routes.

Iatrogenic infection of the fetus occurs less frequently during pregnancy when a woman undergoes invasive prenatal diagnostics (amniocentesis, cordocentesis, chorionic villus biopsy), the introduction of blood products to the fetus through the vessels of the umbilical cord (plasma, red blood cells, immunoglobulins), etc.

In the antenatal period, infection of the fetus is usually associated with viral agents (rubella, herpes, cytomegaly, hepatitis B and Coxsackie viruses, HIV) and intracellular pathogens (toxoplasmosis, mycoplasmosis).

In the intranatal period, microbial contamination more often occurs, the nature and extent of which depends on the microbial landscape of the mother’s birth canal. Among the bacterial agents, the most common are enterobacteria, group B streptococci, gonococci, Pseudomonas aeruginosa, Proteus, Klebsiella, etc. The placental barrier is impermeable to most bacteria and protozoa, however, if the placenta is damaged and fetoplacental insufficiency develops, antenatal microbial infection can occur (for example, with the causative agent of syphilis ). In addition, intrapartum viral infection cannot be ruled out.

Factors in the occurrence of intrauterine infections are a burdened obstetric and gynecological history of the mother (nonspecific colpitis, endocervicitis, STDs, salpingophoritis), unfavorable course of pregnancy (threat of miscarriage, gestosis, premature placental abruption) and infectious morbidity of the pregnant woman. The risk of developing a manifest form of intrauterine infection is significantly higher in premature infants and in cases where a woman is primarily infected during pregnancy.

The severity of clinical manifestations of intrauterine infection is influenced by the timing of infection and the type of pathogen. So, if infection occurs in the first 8-10 weeks of embryogenesis, pregnancy usually ends in spontaneous miscarriage. Intrauterine infections that occur in the early fetal period (before 12 weeks of gestation) can lead to stillbirth or the formation of gross malformations. Intrauterine infection of the fetus in the second and third trimester of pregnancy is manifested by damage to individual organs (myocarditis, hepatitis, meningitis, meningoencephalitis) or a generalized infection.

It is known that the severity of the manifestations of the infectious process in a pregnant woman and in the fetus may not coincide. An asymptomatic or minimally symptomatic course of infection in the mother can cause severe damage to the fetus, including its death. This is due to the increased tropism of viral and microbial pathogens towards embryonic tissues, mainly the central nervous system, heart, and organ of vision.

Classification

The etiological structure of intrauterine infections suggests their division into:

To designate the group of the most common intrauterine infections, the abbreviation TORCH syndrome is used, combining toxoplasmosis, rubella, cytomegalovirus, and herpes simplex. The letter O (other) denotes other infections, including viral hepatitis, HIV infection, chicken pox, listeriosis, mycoplasmosis, syphilis, chlamydia, etc.).

Symptoms of intrauterine infections

The presence of intrauterine infection in a newborn may be suspected already during childbirth. Intrauterine infection may be indicated by the outpouring of turbid amniotic fluid, contaminated with meconium and having an unpleasant odor, and the condition of the placenta (plethora, microthrobosis, micronecrosis). Children with intrauterine infection are often born in a state of asphyxia, with prenatal malnutrition, enlarged liver, malformations or stigmas of dysembryogenesis, microcephaly, hydrocephalus. From the first days of life, they experience jaundice, elements of pyoderma, roseolous or vesicular rashes on the skin, fever, convulsions, respiratory and cardiovascular disorders.

The early neonatal period with intrauterine infections is often aggravated by interstitial pneumonia, omphalitis, myocarditis or carditis, anemia, keratoconjunctivitis, chorioretinitis, hemorrhagic syndrome, etc. During instrumental examination, congenital cataracts, glaucoma, congenital heart defects, cysts and calcifications may be detected in newborns brain

In the perinatal period, the child experiences frequent and profuse regurgitation, muscle hypotension, central nervous system depression syndrome, and gray skin color. In the later stages, with a long incubation period of intrauterine infection, the development of late meningitis, encephalitis, and osteomyelitis is possible.

Let us consider the manifestations of the main intrauterine infections that make up the TORCH syndrome.

Congenital toxoplasmosis

After birth in the acute period, intrauterine infection manifests itself as fever, jaundice, edematous syndrome, exanthema, hemorrhages, diarrhea, convulsions, hepatosplenomegaly, myocarditis, nephritis, pneumonia. In the subacute course, signs of meningitis or encephalitis dominate. With chronic persistence, hydrocephalus with microcephaly, iridocyclitis, strabismus, and optic nerve atrophy develop. Sometimes monosymptomatic and latent forms of intrauterine infection occur.

Late complications of congenital toxoplasmosis include mental retardation, epilepsy, and blindness.

Congenital rubella

Intrauterine infection occurs due to rubella during pregnancy. The probability and consequences of fetal infection depend on the gestational age: in the first 8 weeks the risk reaches 80%; The consequences of intrauterine infection can include spontaneous abortion, embryo- and fetopathy. In the second trimester, the risk of intrauterine infection is 10-20%, in the third – 3-8%.

Babies with intrauterine infection are usually born premature or at low birth weight. The neonatal period is characterized by a hemorrhagic rash and prolonged jaundice.

Congenital herpetic infection

Intrauterine herpes infection can occur in a generalized (50%), neurological (20%), mucocutaneous form (20%).

Generalized intrauterine congenital herpetic infection occurs with severe toxicosis, respiratory distress syndrome, hepatomegaly, jaundice, pneumonia, thrombocytopenia, hemorrhagic syndrome. The neurological form of congenital herpes is clinically manifested by encephalitis and meningoencephalitis. Intrauterine herpes infection with the development of skin syndrome is accompanied by the appearance of a vesicular rash on the skin and mucous membranes, including internal organs. When a bacterial infection develops, neonatal sepsis develops.

Intrauterine herpes infection in a child can lead to the formation of developmental defects - microcephaly, retinopathy, limb hypoplasia (cortical dwarfism). Late complications of congenital herpes include encephalopathy, deafness, blindness, and delayed psychomotor development.

Diagnostics

Currently, prenatal diagnosis of intrauterine infections is an urgent task. For this purpose, in the early stages of pregnancy, smear microscopy, bacteriological culture of the vagina for flora, PCR examination of scrapings, and examination for the TORCH complex are performed. Invasive prenatal diagnostics (chorionic villus aspiration, amniocentesis with examination of amniotic fluid, cordocentesis with examination of umbilical cord blood) are indicated for pregnant women at high risk for the development of intrauterine infection. detects signs.

Treatment of intrauterine infections

General principles for the treatment of intrauterine infections involve immunotherapy, antiviral, antibacterial and syndromic therapy.

Immunotherapy includes the use of polyvalent and specific immunoglobulins, immunomodulators (interferons). Targeted antiviral therapy is carried out mainly with acyclovir. For antimicrobial therapy of bacterial intrauterine infections, broad-spectrum antibiotics (cephalosporins, aminoglycosides, carbapenems) are used; for mycoplasma and chlamydial infections, macrolides are used.

Syndromic therapy of intrauterine infections is aimed at relieving individual manifestations of perinatal damage to the central nervous system, hemorrhagic syndrome, hepatitis, myocarditis, pneumonia, etc.

Intrauterine infections Localized and generalized purulent infection: causes and epidemiology Omphalitis, pyoderma, mastitis, conjunctivitis: clinical picture Treatment of localized purulent diseases Sepsis of newborns: etiology, pathogenesis, clinical picture, diagnosis, treatment, prognosis Prevention of purulent-septic diseases

Intrauterine infections

Intrauterine infections of newborns(IUI) are infectious diseases in which pathogens from an infected mother penetrate to the fetus during pregnancy or childbirth.

In newborns, IUI manifests itself in the form of severe damage to the central nervous system, heart, and organs of vision.

The time of infection of a pregnant woman, as well as the type and virulence of the pathogen, the severity of infection, the route of penetration of the pathogen, and the nature of the course of pregnancy are important in the development of the disease.

Infection of the mother occurs from Toxoplasma-infected domestic animals and birds (cattle, pigs, horses, sheep, rabbits, chickens, turkeys), wild animals (hares, squirrels). The mechanism of transmission is fecal-oral through unwashed hands after contact with soil contaminated with animal feces, consumption of unpasteurized milk, raw or undercooked meat; hematogenous - during transfusion of infected blood products. A person infected with toxoplasmosis for others not dangerous.

Infection from mother to fetus is transmitted through the placenta only once in a lifetime, if she was infected for the first time during this pregnancy. During a subsequent pregnancy or in the event of an illness before pregnancy, the fetus is not infected. This is due to the fact that the mother’s body has already developed high immunological activity to this pathogen.

Damage to the fetus in the first trimester of pregnancy leads to miscarriages, stillbirths and severe organ damage. When infected in the third trimester of pregnancy, the fetus is less likely to become infected, and the disease manifests itself in a milder form. Toxoplasmosis can be asymptomatic for a long time and can be detected in children at an older age, even at 4-14 years of age.

There are acute, subacute and chronic phases of the disease. Clinical symptoms of an infectious disease are varied and not always specific. For acute phase(generalization stage) is characterized by a general serious condition, fever, jaundice, enlarged liver and spleen, maculopapular rash. Possible dyspeptic disorders, interstitial pneumonia, myocarditis, intrauterine growth retardation. Damage to the nervous system is characterized by lethargy, drowsiness, nystagmus, and strabismus. The fetus becomes infected shortly before the birth of the child, and a severe infection that begins in utero continues after birth.

IN subacute phase(stage of active encephalitis) a child is born with symptoms of central nervous system damage - vomiting, convulsions, tremors, paralysis and paresis, progressive micro-, hydrocephalus are detected; changes in the eyes are observed - vitreous opacities, chorioretinitis, iridocyclitis, nystagmus, strabismus.

IN chronic phase Irreversible changes in the central nervous system and eyes occur - micro-, hydrocephalus, calcifications in the brain, delayed mental, speech and physical development, epilepsy, hearing loss, optic nerve atrophy, microphthalmia, chorioretinitis. Infection of the fetus occurs in the early stages, the child is born with manifestations of chronic toxoplasmosis.

Treatment. IN pyrimitamine preparations are used in treatment (chloridine, daraprim, tindurine) in combination with sulfonamides ( bactrim, sulfadimezin). Combination drugs are used fansidar or Metakelfin. Effective spiramycin (rowamycin), sumamed, rulid. For active inflammation, corticosteroids are indicated. Multivitamins are a must.

To prevent toxoplasmosis, it is important to carry out sanitary educational work among women of childbearing age, identify infected women among pregnant women (screening test at the beginning and end of pregnancy), and prevent contact of pregnant women with cats and other animals;

Wash your hands thoroughly after handling raw meat. Identified infected women are treated in the first half of pregnancy spiramycin or terminate the pregnancy.

Congenital cytomegalovirus infection. The causative agent of the disease belongs to DNA viruses from the herpes family. The disease is characterized by damage to the salivary glands, central nervous system and other organs with the formation of giant cells with large intranuclear inclusions in their tissues.

The source of infection is only a person (patient or virus carrier). The virus is released from an infected body in urine, saliva, secretions, blood, and less often with feces. Shedding the virus in urine can last for several years. The transmission mechanism is predominantly contact, less often airborne, enteral and sexual.

The source of infection for newborn children is mothers who are carriers of the cytomegaly virus. Viruses penetrate to the fetus through the placenta, ascending or during childbirth, to the newborn - with infected milk, through transfusion of infected blood. Infection during childbirth occurs through aspiration or ingestion of infected amniotic fluid or secretions of the mother's birth canal.

Signs of the disease may be absent in pregnant women. asymptomatic form). If a latent infection is activated in a pregnant woman, a less intense infection of the placenta is observed. Due to the presence of specific IgG antibodies in the mother, less pronounced damage to the fetus is observed.

Damage to the fetus in early pregnancy leads to miscarriages and stillbirths. A child is born with malformations of the central nervous system, cardiovascular system, kidneys, lungs, thymus, adrenal glands, spleen, and intestines. Organ damage is fibrocystic in nature - liver cirrhosis, biliary atresia, kidney and lung cysts, cystic fibrosis. Viremia and release of the virus into the external environment are not observed, since it is in a latent state.

If infection occurs shortly before birth, during labor, the child is born with generalized form disease or it develops soon after birth. It is characterized by clinical symptoms from the first hours or days of life, involvement of many organs and systems in the process: low birth weight, progressive jaundice, enlarged liver and spleen, hemorrhages - petechiae, sometimes resembling “blueberry pie” on the skin, melena, hemolytic anemia, meningoencephalitis and small cerebral calcifications around the ventricles. Chorioretinitis, cataracts, and optic neuritis are detected. When the lungs are affected, children experience persistent cough, shortness of breath and other signs of interstitial pneumonia.

Localized form develops against the background of isolated damage to the salivary glands or lungs, liver, or central nervous system.

Diagnostics. Laboratory diagnosis is based on the results of cytological, virological and serological studies. The virus is isolated in urine sediment, saliva, and cerebrospinal fluid. Serological methods - RSK, PH, RPGA - confirm the diagnosis. ELISA, PCR and D NK hybridization are used.

Treatment. During treatment, you should make sure that there are no pathogens in the mother's milk. A specific anti-cytomegalovirus 10% immunoglobulin solution is used - cytotect, sandoglobulin(IgG). Use pentaglobin - IgM, KIP, antiviral drugs (cytosine arabinoside, adenine arabinoside, iododeoxyuridine, ganciclovir, foscarnet). Syndromic and symptomatic therapy is carried out.

It is important to observe the rules of personal hygiene when caring for newborns with jaundice and toxic-septic diseases. All pregnant women are examined for the presence of cytomegaly.