Generic pathology in newborns. Pneumonia or pneumonia in infants: signs, treatment, complications Inflammation of the lungs at birth

• Bilateral pneumonia in newborns
• Treatment of pneumonia in newborns

Pneumonia in a newborn is an inflammation of the lung tissue of an infectious nature. This disease is considered deadly for every baby. According to statistics, in 15% of cases, premature babies are exposed to it, while only 2% of full-term babies suffer from pneumonia.

Pneumonia is of several types:

• transplant centric - congenital pneumonia in newborns;
• antenatal;
• intranatal;
• postnatal.

Factors that cause the disease: toxoplasmosis, rubella, herpetic eruptions, streptococcal and staphylococcal infections of various groups, listeriosis, the presence of bacterial, viral and fungal infections.

The causes of lung inflammation can be very different. Quite often, the disease appears as a complication of acute respiratory diseases and sepsis. A special role can be played by the underdevelopment of the organs of the respiratory system in infants, in which pneumonia manifests itself much more often. Pulmonary inflammation can be caused by prenatal bleeding, premature discharge of amniotic fluid, the presence of diseases in the mother with acute or chronic course.

In medical practice, pathology occurs when pneumonia begins to develop in utero, that is, until the birth of a child. The causes of pneumonia are usually attributed to the illness of the expectant mother during childbearing. Viruses and infections enter through the blood and amniotic fluid. In some cases, the occurrence of pneumonia occurs under the influence of not one, but several factors at once. At this stage, it is possible to distinguish two ways of infection:

• bronchogenic method;
• hematogenous way.

The first method involves the entry of pathogenic microflora through the lungs, which occurs most often during childbirth. As for the second way, the infection occurs directly through the blood from mother to child.

Signs of pneumonia in newborns

Usually, with any degree of pneumonia, there are pronounced symptoms. These include the occurrence of shortness of breath, cough, fever in infants, while the skin color becomes pale gray. A sick baby may vomit right during feeding, there are intestinal cramps, bloating, loose stools, lethargy in behavior, fatigue from breast sucking, obvious disorders of the cardiovascular plan, severe diaper rash. Inflammation of the lungs in infants has a severe course with a high probability of mortality. Babies during this period have not yet fully formed the immune system, because the respiratory system is considered unprotected. Pneumonia is the cause of active inflammatory processes and severe damage to the lung tissue. At the same time, infants always fall into the risk group for the development of complications and various pathologies in the respiratory system.

The occurrence of intrauterine pneumonia in newborns is detected almost immediately after their birth.

In addition, after discharge, a doctor and a nurse will constantly visit the mother and the newborn for a month. If any abnormalities are found in the child's behavior, they should be reported immediately. The baby is shown in the first days of life to regularly measure body temperature, so even a slight increase should not go unnoticed. Signs of pneumonia of any form in very rare cases are latent and usually appear immediately when infection occurs.

Pneumonia in infants involves the diagnosis of the disease. The doctor makes a conclusion based on a direct examination of a sick child in the presence of pronounced clinical manifestations. In this case, one of the mandatory procedures is an X-ray examination. Children with congenital heart disease, pulmonary pathologies and pneumopathy require a special approach.

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The development of bilateral pneumonia in newborns is characterized by the most complex form of the course and a high probability of mortality. The occurrence of serious consequences is due to an underdeveloped immune system, pulmonary hypertrophy and prematurity.

In some cases, in the absence of the effect of drug therapy, the only method of treatment is to conduct an open sanitation of the formations by surgery. The operation is rather difficult for children, but it is a necessary measure. A complete cure can only be guaranteed if the disease is detected at an early stage. In premature infants, the following complications are observed with bilateral pulmonary inflammation: a violation of cardiovascular activity, a decrease in the level of hemoglobin in the blood, a change in the acid-base balance, pneumocystosis and chlamydia.

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The treatment of pneumonia in newborns is given as much time as is necessary for a full recovery. The acute course of the disease after the start of the complex of therapeutic measures lasts approximately 14 days, after which there is a decrease in respiratory failure, the child's appetite increases and the nervous system stabilizes.

Further treatment is prescribed taking into account the possibility of increasing immunity and stopping all concomitant causative factors. With inflammation of the lungs, complications may develop in the form of abscesses, pleurisy, respiratory system disorders, cardiac pathologies, insufficient weight gain in the child, and acid-base imbalance.

For therapeutic purposes, in this disease, antibiotics with a wide spectrum of action are prescribed in almost every case. In addition, the child during the treatment should be under close supervision. It is impossible to allow hypothermia or overheating of the baby, it is necessary to ensure that the baby maintains hygiene and cleanliness of the skin, change the position of the body in time. In this case, feeding should be carried out through a probe in order to facilitate the process and save the child's strength. Only in the case when the baby's condition is considered satisfactory, in the absence of the slightest signs of intoxication and respiratory pathologies, breastfeeding can be allowed.

In addition to antibiotics, the child is pierced with vitamins B1, B2, B3, B6, B15 and C, a number of physiotherapeutic procedures are prescribed, such as electrophoresis, microwave, hot wraps with and without mustard. In severe cases, blood and plasma transfusions may be performed. Inflammation of the lungs is treated exclusively in stationary conditions under the vigilant supervision of doctors. In this situation, at any time it is possible to correct appointments and procedures.

It should be taken into account that pneumonia, especially bilateral, greatly weakens the child's body and requires increased attention and control of the child's condition. That is why recovered children can get sick again. In order to prevent this, children may be prescribed a course of vitamin therapy lasting 4 months. At the same time, for another whole year, the child should be observed by a specialist.

Pneumonia in newborns

Pneumonia of the lungs in newborns - an infectious inflammation of the lung tissue - is one of the most common infectious diseases. It is dangerous for any baby, especially when it comes to bilateral pneumonia in newborns. Unfortunately, the statistics for today is as follows: pneumonia in newborns is diagnosed in 1% of full-term and 10-15% of premature babies.

Types and causes of pneumonia in newborns

In medicine, the following types of pneumonia are distinguished depending on the cause of the disease:

• congenital transplacental (the pathogen enters the baby through the placenta from the mother);
• intrauterine antenatal, caused by pathogens that have penetrated from the amniotic fluid into the lungs of the fetus;
• intranatal, occurs when the baby passes through the birth canal of the mother, infected with microorganisms;
• postnatal pneumonia, in which infection occurs after birth in a maternity hospital, in the neonatal pathology department (nosocomeal), or at home.

The most common causes of pneumonia in newborns are:

• infections of toxoplasmosis, listeriosis, rubella, herpes (with congenital transplacental pneumonia in newborns);
• streptococci of groups B and O, gestal mycoplasmas, tuberculosis and Haemophilus influenzae (with antenatal and intranatal pneumonia);
• group B streptococci, cytomegaloviruses, chlamydia, fungi of the genus Candida and type II herpes virus (with intranatal pneumonia);
• Klebsiella, Pseudomonas aeruginosa, Intestinal Yuchka, Proteus, Staphylococcus aureus (with nosocomeal aspiration pneumonia in newborns);
• mixed bacterial-bacterial, viral-bacterial.

Acquired home pneumonia most often occurs against the background of SARS (acute respiratory viral infection) caused by adenoviruses.

Secondary pneumonia, which is a manifestation or complication of sepsis, aspiration syndrome, is often caused in newborns by streptococci, staphylococci or gram-negative flora.

Symptoms of pneumonia in newborns

In the case of intrauterine infection, doctors will detect signs of pneumonia in a newborn even before discharge, because often the first signs of pneumonia begin to appear immediately after the birth of the child.

If a mother with a child was discharged home, during the first month a doctor must come to their house for patronage. He will monitor the condition of the baby, and he needs to talk about all the alarming symptoms, for example, lethargy of the child, frequent regurgitation and loose stools, refusal of the breast, and rapid fatigue when sucking.

If the child has a fever, do not wait for the next visit of the doctor. Urgently call an ambulance. Coughing in babies can be mild, but coughing is important to pay attention to right away. Also alert should be the appearance of nasal discharge in a child and shortness of breath. Shortness of breath leads to blue-tinged symptoms on the feet, face, and hands. In a sick child, diaper rash appears faster.

There is no need to be afraid to miss pneumonia in your child, because signs of the disease rarely occur without fever. And it needs to be measured periodically for prevention purposes.

The doctor, regularly examining and listening to the child, can easily detect pneumonia.

What is the treatment for pneumonia in newborns?

Broad-spectrum antibiotics are always used to treat pneumonia. Careful care is needed for the child to avoid hypothermia and overheating. It is important to monitor the hygiene of his skin, often change the position of his body, feed exclusively from the horn or with a tube. Doctors will allow putting a sick baby to the chest only if he is in a satisfactory condition, namely, when intoxication and respiratory failure disappear.

In addition to the listed treatments, physiotherapy (microwave and electrophoresis), vitamins C, B1, B2, B3, B6, B15, the use of immunoglobulins, mustard and hot wraps twice a day, blood plasma transfusions are also prescribed.

Consequences of pneumonia in newborns

Children who have had pneumonia (especially bilateral pneumonia in newborns) are prone to recurrent illnesses. After discharge, they should repeatedly undergo vitamin therapy courses, give bioregulators (aloe and eleutherococcus extract) for 3-4 months. And within 1 year the child will be under dispensary observation.

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Pneumonia in newborns: prognosis, symptoms, causes, treatment

Pneumonia in newborns occurs when infected with pathogenic bacteria in utero or during childbirth. Until a few decades ago, this condition caused high mortality among children, but the pharmaceutical industry has created effective drugs. Modern anti-pneumonia drugs are capable of destroying most pathogens of congenital lung inflammation within a short time.

Congenital pneumonia is diagnosed in 10-15% of children. Very often, the disease can be traced in preterm infants and with fetal malnutrition.

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The prognosis for the life of the child depends on the correctness of the treatment tactics and the timeliness of the detection of pathology. The problem is relevant enough to leave its causes without attention, so we invite readers to read the article to the end.

Lung pathology in preterm infants

The causes of the disease in preterm infants can be divided into the following categories:

• Transplacental - when the pathogen penetrates the mother's placenta if she has bacterial or viral infections;
• Antenatal - bacteria infect the respiratory tract of the fetus by penetrating from the amniotic fluid;
• Intranatal - microorganisms enter the lungs when a child passes through the birth canal or from the environment when a cesarean section is performed on a pregnant woman;
• Postnatal - infection in the maternity ward or at home.

Pneumonia in newborns is caused by a special spectrum of microorganisms, which requires the appointment of a special group of antibiotics in the treatment of the disease. With viral infections, the prognosis of the course of the disease in newborns depends on the state of the baby's immune system and has specific features, which we will consider below.

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Risk of illness after caesarean section

After a caesarean section, congenital pneumonia occurs when infected with the following microorganisms:

• Herpes, rubella, toxoplasmosis, listeriosis viruses;
• Bacterial pathogens: mycoplasmas, streptococci, chlamydia;
• Mushrooms of the genus Candida.

With a long course, congenital pneumonia is caused by combined flora, which is difficult to treat, which in ancient times led to high mortality in newborns.

Inflammation of the lung tissue that occurred after a cesarean section in the mother is due to streptococcus. The causative agent causes purulent foci and sepsis (bacterial infection of the blood) with rapid reproduction, even against the background of antibiotics.

Home types of pneumonia in preterm infants occur against the background of respiratory infections, adenovirus lesions, streptococcal infections.

Pathogenetic signs in newborns

When a baby is born healthy, it does not mean that he has a strong immune system. Some bacteria are antagonists to other pathogens of the respiratory tract. So, Proteus is able to destroy gram-negative bacteria.

Doctor's advice for pneumonia

In premature babies, there is an underdevelopment of the protective factors of the alveolar tissue: defects in the surfactant are traced, there are no alveolar macrophages (cells that destroy microbes in the alveoli), the bronchial wall is weak. Against the background of such changes, it is difficult to assume that a meeting with infectious agents will not cause inflammatory reactions. The only salvation is the struggle of some representatives of the microbial world with others.

With bacterial contamination of the respiratory tract by Proteus, pneumonia caused by gram-negative rods is not traced for several months. Proteus is a pathogenic bacterium and is capable of independently causing pneumonia in infants.

Interaction in the microbial world is a complex mechanism that has not been reliably studied by man. Obviously, the widespread use of antibiotics is not rational. Features of the appointment of these drugs require control of the dosage and course of therapy. Due to the violation of the scheme of treatment of infections with antibacterial agents, many bacteria have developed resistance, which complicates the process of their therapy.

What forms a negative outlook

A negative prognosis for pneumonia in newborns is formed by the following symptoms:

• Hypoxia of the brain with a slowdown in motor function and mental activity;
• Violation of the depth of respiratory movements and disorders of its rhythm;
• Irregularity of heart contractions;
• Enhanced respiratory acts (Cheyne-Stokes);
• The accumulation of toxins in the blood and the appearance of secondary changes in other organs.

If at least one of the above symptoms appears, the child is placed in the intensive care unit, as mechanical ventilation may be necessary.

Pneumonia in premature babies has its own characteristics, unlike infants and infants under 1 year old:

1. The predominance of respiratory symptoms and toxic reactions. With the accumulation of large amounts of carbon dioxide, swelling of the periorbital tissues appears. Over time, hypercapnia leads to depression of the central nervous system, the appearance of Cheyne-Stokes respiration;
2. Increased temperature reaction and pulmonary complications - pneumothorax, atelectasis, pleurisy;
3. Extrapulmonary complications - intestinal paresis, ear inflammation, blood clots, adrenal insufficiency;
4. Premature babies often develop aspiration pneumonia, as they are prone to regurgitation;
5. A typical picture of the formation of pathological changes in the lung tissue: disseminated blood coagulation syndrome, sepsis;
6. Unstable clinical condition of patients with fluctuations in laboratory and clinical tests.

Suffering from pneumonia?

The above signs of pneumonia in newborns depend on the cause of the pathology. If the inflammation is caused by pneumococcus, the likelihood of complications or death is high. With this form, inflammatory foci quickly penetrate from one lung to another.

Congenital pneumonia in newborns is a dangerous condition. If the doctor does not prescribe antibiotics, the child quickly develops the following symptoms:

• respiratory failure;
• Accumulation of carbon dioxide in the blood;
• Damage to brain tissue;
• Imbalance of water-salt metabolism;
• Heart overload;
• Increased heart rate.

The list of changes that pneumonia causes in premature newborns is endless. The final stage of the pathology is death (without adequate treatment).

How does congenital pneumonia occur in full-term babies?

Pneumonia at birth in term infants is benign. Its duration is 1-2 weeks, and then the patient's condition gradually improves. Signs of respiratory failure rarely require relief with mechanical ventilation.

In a full-term baby, the acute period of inflammatory changes in the lungs lasts 5-7 days. After the use of antibiotics, resorption of infiltrative foci in the alveolar acini is observed, which provides a favorable prognosis.

Segmental pneumonia at birth in premature babies is at best cured after 4 weeks. Due to this course of the disease, it is obvious that the fetus should be preserved in utero until the time of physiological birth, but this is not always possible.

Morphological symptoms

Symptoms of pneumonia in premature newborns can be divided into the following morphological types:

1. Transplacental - the consequences of widespread infection with bacteria. Clinical symptoms of the disease occur due to a generalized infection. Children with pathology are born with asphyxia, cyanosis, respiratory failure;
2. The intranatal type of pneumonia manifests itself in 2 variants. The disease can occur due to intracranial birth trauma, leading to respiratory failure. The second option is accompanied by the presence of a "light gap". The child is born healthy, but after a few days he has bouts of cyanosis, frequent regurgitation, nervous excitement. There may be diarrhea, the appearance of foam from the mouth;
3. Early neonatal - observed in the first days after birth. This type can be determined by the following signs: respiratory failure, lethargy, cyanosis of the skin;
4. Late neonatal - begins with manifestations of inflammation of the upper respiratory tract: fever, anxiety, rhinitis, regurgitation. Over time, other symptoms of inflammation of the lung parenchyma appear: fever, cough, vomiting.

Does the sputum come out badly?

For a quick recovery, it is important that sputum is expectorated and excreted from the body, as Tolbuzina E.V., a pulmonologist, tells how to do this.

In premature babies, any of the above forms progresses rapidly and can cause death, so it is necessary to identify and treat the pathology at an early stage.

The degree of danger of pneumonia

Bilateral pneumonia in preterm infants has a dangerously high mortality rate. Serious consequences also occur against the background of primary immunodeficiency, severe malnutrition and prematurity.

The risk of respiratory failure increases in the presence of infiltrative fluid in the lungs, foreign bodies, liquid sputum (against the background of cystic fibrosis). To empty purulent foci with the ineffectiveness of antibiotics, open sanitation of formations by the operative method is necessary. Surgical intervention in premature babies is very difficult, but it is a necessary measure to save the life of the child.

With bilateral pneumonia in preterm infants, the following complications are often observed:

• Pneumocystosis;
• Chlamydia;
• Violation of cardiac activity;
• Change in acid-base balance;
• Decreased levels of hemoglobin and serum iron;
• Increasing the acidity of the blood.

The consequences of the disease in premature babies are too serious. Only with early detection of signs of infiltrative changes in the lung parenchyma and the absence of provoking factors can a complete cure of the pathology be guaranteed.

Terms of treatment for infants

Congenital pneumonia is treated as long as there are pathogenetic symptoms of the disease. The acute period of the disease lasts about 2 weeks, after which the phenomena of respiratory failure decrease. With the improvement of the condition in premature babies, the appetite increases, the state of the central nervous system is restored. The resolution stage lasts 1-2 weeks.

The prognosis for pneumonia in preterm infants depends on the state of the child's immune system, the presence / absence of provoking factors, and the treatment tactics used.

The development of secondary pathological changes in the lung tissue complicates the course of the pathology:

• Abscesses;
• Pleurisy;
• Respiratory and cardiovascular insufficiency;
• Hypotrophy of premature babies (lack of body weight);
• Violation of the acid-base balance of the blood.

Neonatal pneumonia is a dangerous pathology that requires constant analysis of the baby's condition and immediate medical correction. It can only be treated in a hospital setting.

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Pneumonia in a newborn child: causes, symptoms, consequences

Pneumonia in a newborn baby can occur due to infection with pathogenic microorganisms in utero or during childbirth. This disease used to be a cause of high mortality among infants, but today there are effective drugs that have significantly reduced the mortality rate.

A fairly common problem is congenital pneumonia in newborns, the causes of which are caused by infection with herpes viruses, toxoplasmosis, streptococci, chlamydia, etc. This disease is diagnosed in 10-15% of children.

Causes of pneumonia in newborns

With the transplacental route of infection, the pathogen passes through the maternal placenta. In the antenatal variant of pneumonia, the source of bacteria is amniotic fluid.

The intranatal route involves the entry of microorganisms into the lungs of a child when passing through the birth canal or from the environment (in the case of a Caesarean section). The postnatal variant of pneumonia is caused by infection either in the maternity ward or already at home.

Signs of pneumonia in a newborn

The clinic of the disease that developed in the prenatal period is noticeable immediately after childbirth. Symptoms are most pronounced if the pregnancy lasted less than 37 weeks, as well as in case of asphyxia. If a child was born with pneumonia, the following phenomena take place:

• very weak first cry;
• bluish tint of the skin and mucous membranes (this is very noticeable on the limbs, lips and tongue);
• intermittent noisy breathing with moist rales;
• in term-born children, the temperature is about 40 degrees, and in premature babies - about 35 degrees;
• swelling of the lower extremities is possible;
• weight loss, delayed falling off of the remainder of the umbilical cord, there are cases of inflammation of the umbilical wound;
• frequent regurgitation, vomiting is possible.

If there is pneumonia in a newborn that occurs during childbirth, symptoms appear after about two days. These include an increase in temperature up to 40 degrees, a decrease in appetite, cyanosis of the lips and paranasal region, and drowsiness. In full-term babies, breathing is noisy and frequent, while in premature babies, breathing is weak and rare.

Prognosis of congenital pneumonia in newborns

It is necessary to take into account a complex of factors, including the state of the child's immunity and the applied treatment tactics. Pneumonia in a newborn is treated as long as pathogenetic symptoms persist. The acute period lasts about two weeks, after which the phenomena of respiratory failure decrease. The improvement is accompanied by an increase in appetite. The duration of the resolution stage is usually 1-2 weeks.

The terms of treatment of pneumonia in a newborn child are delayed in the presence of secondary changes in the lung tissue. These include pleurisy, abscesses, respiratory failure. When there is congenital pneumonia in newborns, the consequences are the smaller, the more qualified the doctors.

A competent specialist takes into account the differences in the course of the disease in full-term and premature babies and chooses the appropriate treatment tactics. So, if pneumonia is diagnosed in a newborn, the consequences will not necessarily be severe, so parents should not panic ahead of time. If the disease developed at home, then the main thing is to see a doctor as soon as possible.

Inflammation of the lungs in newborns has a negative prognosis in the presence of factors such as cerebral hypoxia, increased respiratory acts, irregular heartbeats, and accumulation of toxins in the blood. Such symptoms are an indication for placing the child in the intensive care unit, as there may be a need for mechanical ventilation.

In a full-term infant, the duration of the acute period is usually 5-7 days. After the use of antibacterial drugs, resorption of infiltrative foci occurs, which provides a favorable prognosis.

Bilateral pneumonia in newborns

With such pneumonia, the risk of death is high. The situation is especially dangerous if the disease develops against the background of prematurity, severe malnutrition, and primary immunodeficiency.

The risk of respiratory failure is high if foreign bodies, infiltrative fluid, and liquid sputum are present in the lungs. If antibiotics do not give an effect, the emptying of purulent foci is performed by the surgical method. A premature baby is very difficult to tolerate surgery, but this is the only way to save his life.

Among the common complications of bilateral pneumonia in prematurely born babies are chlamydia, pneumocystosis, cardiac disorders, increased blood acidity, and a drop in hemoglobin levels.

Treatment of pneumonia in newborns

A necessary condition for recovery is the hospitalization of a sick infant in a specialized hospital with the maintenance of an optimal temperature and humidity regime. In no case should you rush to be discharged, even if it seems that the child is clearly already better. In a hospital, pneumonia in newborns is treated as much as necessary in order to protect them from serious consequences and complications.

Sometimes there is such a problem as distrust of parents to the attending physician. It is quite natural that against the background of a severe course of the disease in a child, the mother and other family members experience severe stress. They are trying to find out from third-party sources how and how much pneumonia is treated in newborns, for some reason trusting anonymous advisers on forums more than medical staff.

It is important to consider that all cases of this insidious disease are individual. Without knowledge of all aspects of the situation, it is impossible to immediately give an unambiguous answer for how long pneumonia in newborns is treated. One child copes with the disease faster, the other takes longer. Do not immediately blame the medical staff for incompetence if the disease is not treated as quickly as worried parents would like.

Treatment includes measures such as regular monitoring of breathing and body temperature, full fractional nutrition (best of all - breastfeeding), detoxification therapy, oxygen therapy.

Detoxification therapy is carried out by intravenous administration of physiological solutions and diuretics to the infant. This is done in order to speed up the filtration of blood by the kidneys.

Oxygen therapy consists in supplying a sick baby with humidified oxygen through a mask. This is necessary to normalize breathing and oxygen content in the blood. To stimulate the immune system, vitamin therapy is prescribed (large doses of vitamin B and C).

Use folk methods of treatment for pneumonia in newborns should not be. Sometimes honey is recommended as the most effective and safe remedy, but any experiments are unacceptable when it comes to the health of such young children.

Prevention of pneumonia in newborns

The mother of the child can take some steps to reduce the chance of developing this dangerous disease. Preventive measures include:

• planned pregnancy management, including testing for the diagnosis of congenital diseases;
• treatment of foci of chronic infection;
• exclusion of contact with infected patients;
• a well-thought-out diet, the basis of which is fruits, vegetables and herbs;
• fractional nutrition;
• walk in the fresh air for at least 2 hours a day;
• night sleep - at least 8 hours;
• giving up alcohol and smoking.

Prevention of pulmonary pneumonia in newborns is ensured by compliance with sanitary and epidemiological standards in maternity hospitals. In addition, after discharge from the hospital, parents must properly care for the baby. To do this, follow the recommendations of the doctor and protect the child from contact with sources of infection.

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A newborn child does not yet have strong immunity, its organs and tissues in the first month of life adapt to environmental conditions. Any infection that enters the baby's body at this time can lead to a serious illness and consequences, sometimes fatal. The infectious process in pneumonia, including intrauterine, is dangerous because it affects not only the lung tissue, but can also spread throughout the body. Knowing the causes, manifestations and preventive measures of the disease, you can avoid serious complications.

What is neonatal pneumonia

Pneumonia of the newborn (pneumonia) is an infectious disease of lung tissue in children in the first 28 days of life with characteristic symptoms of intoxication and changes in the respiratory system.

With inflammation of the lungs, the alveoli are filled with a secret and cease to perform their functions.

At risk are:

• premature babies (born at a gestational age of less than 38 weeks);
• children with intrauterine growth retardation (body weight less than 2500 g);
• children born by caesarean section.

In addition, a number of factors significantly increase the likelihood of developing the disease in crumbs, for example:

• fetal hypoxia (oxygen starvation). Occurs as a result of a lack of oxygen in the blood of the mother, placental insufficiency (lack of oxygen supply to the fetus through the vessels of the placenta);
• aspiration syndrome, when part of the amniotic fluid enters the child's respiratory tract during inhalation;
• birth trauma;
• hypoxia in childbirth - a long anhydrous period (more than 24 hours);
• infectious diseases of the genitourinary and respiratory systems of the mother;
• malformations of the lungs (bronchopulmonary dysplasia).

Interestingly, a third of pneumonia in newborns is a secondary concomitant disease against the background of the main one. For example, congenital pneumonia can act against the background of hemolytic disease, severe birth trauma, and sepsis. Such pneumonia often determine the severity of the course of the underlying disease, as well as its outcome.

Types of disease

1. Congenital (or intrauterine) pneumonia. The infection infects the fetus in the womb. They are divided into transplacental, when the infection gets to the baby from the mother through the placenta. Antenatal, when the fetus becomes infected through the amniotic fluid. And intranatal, when the child is exposed to infection during passage through the birth canal. The causative agent of the disease in this case penetrates from the amniotic fluid or from the infected genital tract of the mother (genital tract).
2. Postnatal pneumonia that occurs after the birth of a child. They are divided into hospital (nosocomial) pneumonia, when infection occurs in the maternity hospital or neonatal pathology department, and out-of-hospital, when the newborn catches the disease after discharge from the hospital.

One of the ways of infection of the fetus from the mother with an infection is through the placenta (transplacental route of infection)

In addition, according to the type of causative agent of pneumonia, it is customary to divide into bacterial, viral and fungal.

Causes

In term newborns, the main cause of pneumonia is infection.. All other factors (maternal infections, hypoxia in childbirth, birth trauma, etc.) only increase the likelihood of pneumonia, but are not its cause!

In antenatal infection, the most common pathogens are cytomegalovirus infection, herpes simplex virus, and pneumocystis. The latter becomes the most common cause of the development of the disease in premature babies. With intranatal infection, the child is exposed to microorganisms that inhabit the birth canal of the mother, these are:

• chlamydia;
• mycoplasma;
• ureaplasma;
• streptococci;
• candida (fungal infection).

Streptococcal infection is the cause of pneumonia in 35% of infants in the first month of life.

Hospital infections that provoke nosocomial pneumonia are Klebsiella, enterococci, Pseudomonas aeruginosa and Staphylococcus aureus.

In premature newborns, the main cause of pneumonia, in addition to infection, is the underdevelopment of the respiratory system and the immune system. It is more difficult for such children to fight infectious agents, they are more easily susceptible to infection.

In children after delivery by caesarean section, the main cause of pneumonia is the suction of infected amniotic fluid or mucus from the birth canal. As a result of this, atelectasis occurs (collapse of part of the lung), which contributes to the development of pneumonia.

Ways of infection with pneumonia in newborn children:

• Hematogenous (with blood flow). This is the most common route of infection for intrauterine pneumonia. From the foci of infection of a pregnant woman with a bloodstream, a virus or bacterium enters the fetus. Hence, intrauterine infection of the fetus occurs.
• Bronchogenic. This is the route of infection in postnatal pneumonia, when a child picks up an infection from a sick mother or relatives. Infection occurs by airborne droplets.

Symptoms of the disease

In the clinical manifestation of pneumonia in newborn children, several groups of symptoms are distinguished:

• Intoxication syndrome - occurs as a result of poisoning of the child's body with toxins from viruses or bacteria. First of all, the nervous and immune systems are affected. This is manifested in the weakness of the child, refusal to eat, drowsiness, pallor or grayness of the skin. There may also be frequent regurgitation or bouts of short-term respiratory arrest (apnea).
• Respiratory disorders - occur as a result of lung tissue damage and, as a result, a lack of oxygen. Manifested in an increase in breathing, participation in the act of breathing of auxiliary muscles (retraction of the intercostal spaces, swelling of the wings of the nose). The breath of a newborn becomes groaning, noisy, sometimes wheezing is heard in the distance. The skin around the lips and on the extremities acquire a bluish tint, which is a sign of oxygen starvation.
• Violations of the cardiovascular system are manifested in the form of tachycardia (increased heart rate), lowering blood pressure, and edema.
• Disorders of the nervous system - increased excitability of the child, anxiety, regurgitation, decreased muscle tone.
• Manifestations from other organs and systems - an increase in the liver and spleen, early jaundice (yellowing of the skin before 3 days of a child's life).

Symptoms of pneumonia in newborns - photo gallery

With pneumonia in newborns, breathing is disturbed, wheezing may be heard during auscultation In congenital pneumonia, prolonged jaundice is a common symptom Lack of oxygen in the tissues manifests itself in the form of cyanosis (cyanosis) of the extremities or lips

It is important to know that an increase in body temperature in newborns with pneumonia is an optional symptom. In children of the first day of life, hypothermia (body temperature below 36 degrees) may occur. This indicates a reduced immune reactivity and severe intoxication.

The most common cause of pneumonia in medical institutions is Staphylococcus aureus. A feature of staphylococcal pneumonia is a strong intoxication syndrome (body temperature above 38.5 ° C, respiratory failure). The child quickly develops respiratory failure.

Staphylococcus destroys lung tissue, resulting in the formation of cavities and bullae filled with pus. The inflammatory process often passes to neighboring tissues, and pleurisy develops. Complicated by an abscess or pleurisy, staphylococcal pneumonia is often the cause of death in newborns.

Specificity of congenital pneumonia in infants:

• Clinical and radiological manifestations of the disease occur in the first 72 hours of a child's life.
• The source of infection is the mother - the same pathogenic flora is sown in her as in the baby.
• The child often has infectious foci in organs adjacent to the lungs.
• Characterized by an increase in the liver and spleen from the first day of the baby's life.
• In the placenta after childbirth, inflammatory changes are found.

Features of pneumonia in premature babies

• The onset of the disease with nonspecific signs is poor sucking, increased excitability of the child, pallor or cyanosis of the skin, a decrease in body temperature, sleep disturbance, weight loss or an increase due to edema.
• Late manifestation of respiratory disorders (at 1-2 weeks of life).
• More frequent occurrence of complications of pneumonia than in full-term newborns.
• Foamy discharge from the mouth. This occurs as a result of congestion in the lungs.
• Premature babies are more likely to develop blood poisoning due to pneumonia.

The most common causative agent of pneumonia in premature newborns is pneumocystis. The course of such pneumonia lasts 4–8 weeks and is divided into several stages:

1. Initial manifestations (first 1–2 weeks of illness). Characterized by nonspecific symptoms in the form of sluggish sucking, poor weight gain, rapid breathing when bathing, sucking. Sometimes there is a slight cough, loose stools (diarrhea).
2. The height of the disease (2–4 weeks of illness). Manifested by severe shortness of breath (increase in the number of breaths up to 80–140 per minute), paroxysmal cough, discoloration of the skin (blue, gray). Body temperature rarely rises.
3. The stage of resorption (reparation) is characterized by the slow disappearance of shortness of breath, cough, signs of intoxication.

Video of Dr. Komarovsky's school about pneumonia in children

Treatment

Treatment of newborns continues until the acute period of the disease is relieved (about 2 weeks). During the period of resorption of pneumonia, supportive and restorative therapy is used.

Treatment of pneumonia in newborns is carried out only in a hospital under the strict supervision of a neonatologist!

The main aspects in the treatment of pneumonia in newborns are:

1. Protective mode. Maintaining optimal temperature and air humidity (+24…+26 °C in the ward at 60–70% humidity). For premature babies weighing up to 1.5 kg, the temperature in the incubator is maintained at +34…+36 °C. Overheating is undesirable, as is hypothermia. Regular ventilation is required. It is not recommended to swaddle babies and restrict their movements, it is necessary to change their body position frequently during the day.
2. Feeding. If the child is in serious condition or in deep prematurity, he is fed through a tube or drip method. For this, mother's milk or adapted mixtures are used. With the improvement of the condition and the formation of the sucking reflex, the child is fed with a spoon or breast. In a serious condition, the child is not able to absorb all the necessary amount of food, therefore, between feedings, he is given liquid (glucose, oralitis) through a probe or pipette.
3. Oxygen therapy is the introduction of heated and humidified oxygen through a mask, catheter, into the incubator.
4. Antibacterial therapy - depending on the pathogen and type of pneumonia.
5. Immunocorrective therapy - the introduction of immunoglobulins, blood plasma.
6. Treatment of cardiovascular insufficiency - the use of cardiac glycosides for health reasons, diuretics.
7. With obstructive syndrome (bronchospasm), bronchodilators are used (for example, Alupent).
8. Sanitation of the upper respiratory tract - removal of mucus with the help of an electric suction.
9. Vibration massage - stroking, light tapping, compression of the chest from the sides.

Treatment of pneumonia in newborns - photo gallery

Stronger children are fed from a bottle with a nipple Weakened newborns are fed through a tube It is important for a newborn child to maintain a constant body temperature and humidity level - for this it is placed in an incubator The supply of humidified oxygen to the baby is carried out through a mask or nasal catheter

Combinations of antibiotics for different types of pneumonia - table

Antibacterial therapy is carried out intravenously - jet or drip. Antibiotics should be treated for at least 5 days, sometimes their intake is extended up to 10 days.

Possible complications and consequences

1. Pleurisy is an inflammation of the pleura (the membrane that covers the lungs). Occurs when the infection passes from the pulmonary focus to neighboring tissues.
2. An abscess is a cavity in the lung filled with pus.
3. Sepsis is an infectious infection of the blood and the spread of infection throughout the body with the formation of many foci of infection.
4. Atelectasis - collapse of part of the lung;
5. Pneumothorax - air entering the pleural cavity, normally it should not be there.

Pneumonia in a newborn is usually called an acute disease of an infectious nature (causative agents of the disease are microorganisms), which is characterized by damage to the respiratory (participating in the actual gas exchange) sections of the lungs.

In this case, the child may show symptoms of systemic (affecting not only the site of the introduction of the pathogen) inflammation. Often, the signs of pneumonia in infants are reduced to a respiratory disorder, while the suspicion of pneumonia in a newborn occurs only with an x-ray examination (the image usually shows an area of ​​shading in the lower parts of the lungs - this is the focus).

Since from the very first minutes of life the location of the child is determined by the obstetric or pediatric department, pneumonia in a newborn can be congenital or nosocomial.

Pneumonia in a newborn is usually divided, depending on the microorganism, after the introduction of which inflammation in the lungs occurred, into the following types:

There are factors that predispose a child to develop congenital pneumonia. The latter are fetal prematurity, complicated pregnancy, the consequences of severe strangulation during childbirth, as well as infectious diseases in the mother (then the infection can be transmitted directly from the mother; this is called the transplacental transmission mechanism: through the placenta - the organ through which the fetus is nourished, with blood mother).

An illustration of the trans-placental transmission route in general.

An additional risk is a caesarean section (removing the baby through an incision in the abdominal wall and uterus, respectively). Also, the reasons due to which congenital pneumonia occurs may lie in the violation of the sanitary and epidemiological regime by the hospital staff (for example, insufficient care for the child's respiratory organs). In addition, the introduction of the pathogen into the body of a newborn can occur during a blood transfusion. Unfortunately, such consequences of medical activity are not so rare.

Fundamentally, different causes of pneumonia in a newborn are possible. However, most often the pathogen is in the lungs of the child transplacentally (the consequences of the exchange of blood with the mother), as well as in the case of aspiration (inhalation by the newborn) of the infectious agent along with the amniotic fluid (the fluid that was the habitat for the fetus before birth). That is, congenital pneumonia is the most common.

In the first day of a child's life, if he has inflammation in the lungs, it may be difficult for a doctor to interpret the resulting signs of the disease as symptoms of congenital pneumonia. To understand the true cause of respiratory disorders in a child, you need to know about the indirect signs of inflammation in the lungs. The earliest signs are violations of the function of the gastrointestinal tract, which consist in the growth of food debris in the stomach, mixed with bile.

Symptoms in this case are poor suckling of the breast and constant spitting up during feeding the baby. At the same time, symptoms of general intoxication of the body can be observed: pallor (up to “gray”) skin,

enlargement of the spleen (splenomegaly) or liver (hepatomegaly). And sometimes even pathological jaundice happens - a yellow staining of the skin due to a violation of the processes of bile formation and bile secretion (there is also physiological jaundice: it is usually distinguished from pathological by how much bilirubin was detected in the patient during a biochemical blood test).

But the symptoms of pneumonia, characteristic of an adult patient, such as fever (fever) and cough, are completely uncharacteristic of pneumonia in infants.

If the newborn does not have congenital pneumonia, but acquired (nosocomial), it may be hidden behind conditions that require resuscitation (severe suffocation and other critical respiratory disorders of the child). All these are objective consequences of the natural (until treatment is prescribed) course of lung disease. Often, such a development of events accompanies premature babies, especially if a caesarean section was performed (an additional risk factor for infection).

Diagnostic measures in the detection of the disease

To confirm the diagnosis of pneumonia in a newborn, it is necessary to obtain x-ray data,

and also perform seeding

from the birth canal of the mother and the respiratory tract of the child, in order to understand whether the microflora (microorganisms) is the same in them. Also important signs are an increase in the level of leukocytes in the blood (an indicator of inflammation), an increase in the level of C-reactive protein in the time limit of 72 hours after birth (also confirms inflammation). In addition, there may be the following symptoms: the presence of purulent sputum during the first intubation (the introduction of a respiratory tube into the infant's respiratory tract), a significant increase in the newborn's liver on the first day after birth, as well as inflammation in the placenta, which is detected during its special histological examination (study of the tissue structure ) research. All these signs, especially if several of them are found together, indicate the presence of the disease with a high degree of certainty.

In addition to the above signs, important data indicating the possibility of pneumonia in a newborn may be previous infectious diseases in the mother: respiratory infections during pregnancy, chronic inflammation of the female organs or kidneys. Complications that occur in the mother after pregnancy are also important. They indirectly indicate its not quite favorable course.

At the same time, while listening to the child's lungs, wheezing in them will be detected, as well as weakening of breathing (muting of respiratory sounds).

Listening to the heart will give an increase in the number of its contractions in one minute (this is called tachycardia) and some muffled heart beats.

Basic therapeutic measures

Pneumonia is treated successfully (including the consequences of the disease) if optimal conditions for nursing the patient have been previously created.

Non-drug treatment consists mainly in inhalation (based on inhalation) measures: the newborn is given a humidified air-oxygen mixture. At the same time, the tension (quantity) of oxygen in the blood is controlled. Treatment is often accompanied by the transfer of the child to artificial ventilation of the lungs (the introduction of a tube into the trachea with parallel oxygen supply from a special apparatus).

Drug treatment of the disease usually involves antibiotic therapy. They are usually treated with penicillin antibiotics in combination with aminoglycosides (ampicillin is a broad-spectrum antibiotic). If the causative agent of the disease is established and this is Pseudomonas aeruginosa (Pseudomonas aeruginosa, usually represents a nosocomial, rather than congenital infection), then the disease is treated with cephalosporins (also antibacterial drugs) of the 3rd generation (ceftazidime) with aminoglycosides (netilmicin).

In general, it should be noted that the choice of an antibacterial drug, first of all, depends on how many pathogens were found in the lungs of a particular child, which groups of microorganisms they belong to, and also on what consequences the disease had already caused by the time it was diagnosed. .

If the disease is especially severe, treatment may include drugs that directly target the immune system of the newborn. In children, it is not yet perfect, so it is better to avoid such effects. However, if the condition of the baby is really critical, immune therapy may be necessary.

Summary

If we calculate the percentage of mortality in pneumonia in newborns, figures of about 5-10% will be obtained. At the same time, lethality depends, first of all, on the processes against which the disease occurred, as well as on the degree of maturity of the child (pneumonia in premature infants occurs more often and is accompanied by formidable complications). The prognosis worsens if the disease occurs while the child is in the intensive care unit.

To understand whether a congenital disease or nosocomial, you need to consider how much time has passed from the moment the child was born until the moment when the first symptoms of the disease were noticed.

Maternal behavior during and before pregnancy plays an important role in the prevention of pneumonia in newborns. In addition, it is important to comply with the sanitary and epidemiological regime, use the material once, as well as distribute babies in a ratio of no more than two newborns per nurse in the intensive care unit.

The birth of a child is a joyful event. But sometimes it can be overshadowed by complications and congenital diseases, in particular intrauterine or acquired pneumonia. Inflammation of the lungs is a pathology that becomes a test for both the newborn and his parents. Timely diagnosis and treatment will help to avoid serious consequences.

Features of the disease in newborns

Pneumonia is a disease that causes serious complications and health consequences. In newborns, pneumonia can occur as an independent disease or as a complication after, for example, an acute respiratory viral infection.

Inflammation of the lungs is 10 times more likely to affect premature babies

Premature babies are most susceptible to pneumonia. In them, pneumonia occurs in 10–15% of cases, while among children born on time, pathology is diagnosed in only one child out of a hundred. This is due to the underdevelopment of the respiratory muscles, insufficient regulation of the mechanisms of respiration and gas exchange, and the immaturity of the lung tissue.

Types of pneumonia

All cases of pneumonia can be divided into:

• congenital (intrauterine);
• acquired (postnatal).

They differ in the method of infection, symptoms, severity of the disease and possible consequences for the child.

congenital pneumonia

This type of pneumonia develops in the womb and occupies approximately 10% of all pneumonia in newborns. The disease makes itself felt already in the first minutes or days of the baby's life. Infection can occur in many ways:

• transplacental, i.e., the causative agent of the disease entered the child's body through the placenta. Rare;
• antenatally - through the amniotic fluid;
• intranatally, or during childbirth.

Most often, congenital pneumonia occurs due to infection during childbirth with pathogenic microflora located in the birth canal of the mother, or through infected amniotic fluid. The transplacental method is rare.

Acquired

If the disease occurs after childbirth in the first month of a baby's life, then it is called acquired. Such inflammation of the lungs can be:

• out-of-hospital - the child falls ill at home;
• hospital - the disease developed in a hospital in a maternity hospital, intensive care unit, neonatal pathology department, etc.

Causes

There are many factors that contribute to the development of pneumonia in newborns. They are especially dangerous for premature babies. Often several of them can lead to the disease at the same time:

• diseases suffered by a woman during pregnancy;
• the use of steroid drugs by the expectant mother;
• oxygen starvation and suffocation of the fetus;
• complications during childbirth;
• cesarean section;
• intracranial or spinal injury;
• intrauterine brain damage;
• genetic diseases of the lungs and other internal organs;
• unfavorable environment for the maintenance of the child;
• improper child care.

Normally, a child has a small amount of fluid in the lungs, which is pushed out during natural delivery. With a caesarean section, the organs do not have time to adapt to new living conditions, and the fetal fluid remains in them. This contributes to the development of the so-called fetal (fetal) fluid retention syndrome, which causes the risk of developing respiratory pathology in a child, in particular pneumonia.

In a premature baby, a caesarean section can provoke the development of respiratory distress syndrome, in which there is rapid irregular breathing and an increased risk of developing pneumonia. Such newborns require careful observation, examination and treatment.

Separately, it is necessary to mention aspiration pneumonia. Its cause is often a violation of the feeding regimen of the child, in which milk, formula, water, and vomit can enter the lungs. Especially often this type of pneumonia develops in premature babies due to their predisposition to regurgitation.

causative agents of pneumonia

Inflammation of the lungs is caused by viruses, bacteria, or fungi that can enter the lungs in two ways:

• hematogenous - in utero through the blood;
• bronchogenic - through the lungs.

1. The most common causes of the disease are the following bacteria:
   • streptococcus;
     

     Group B streptococcus is the most common cause of neonatal morbidity and mortality from meningitis, sepsis, and streptococcal pneumonia in developed countries.

   • staphylococcus;
   • Pseudomonas aeruginosa;
   • listeria;
   • gram-negative rods of the family of intestinal bacteria;
   • Klebsiella (Friedlander's stick) and other microorganisms.
2. Viral inflammation of the lungs can be caused by different types of herpes virus, in particular cytomegalavirus, as well as influenza virus, adenovirus and others.
3. Fungal pneumonia is more common in children who have been on mechanical ventilation for a long time, especially premature babies. The causative agents of the disease can be fungi of the genus Candida, less often - Aspergillus, pneumocystis (the average between protozoa and fungi).
   

   Pneumocystis pneumonia, or pneumocystosis, occurs predominantly in premature babies. Infection with this microorganism can occur through contact with a carrier at home or in the hospital. A characteristic feature of this type of disease is the absence of wheezing in the lungs, so the diagnosis is made on the basis of an x-ray.

Pneumonia of newborns in 65–80% of cases is of a mixed nature, for example, when a bacterial infection joins a viral or fungal inflammation of the lungs.

1. Intrauterine pneumonia is more often caused by group B streptococci and gram-negative bacteria - Escherichia coli and Klebsiella (Fridlander's stick), less often - staphylococcus aureus and listeria. It is possible to develop the disease due to infection with cytomegalovirus, herpes simplex virus and fungi of the genus Candida.
2. The most common causative agents of acquired pneumonia are viruses (respiratory syncytial, parainfluenza and others), gram-negative intestinal microflora, staphylococci. Less commonly, community-acquired pneumonia is caused by moraxella (a representative of the normal microflora of the upper respiratory tract) and whooping cough. Pneumococci and influenza or Pfeiffer's bacillus are rarely isolated from newborns.

Symptoms and features of different types of disease

Symptoms and features of the disease depend on whether the child was born full-term or not, as well as on the type of pneumonia.

Intrauterine pneumonia appears immediately after the birth of a child.

Symptoms of intrauterine pneumonia

1. If the disease developed in the womb, then its symptoms are visible immediately after the birth of the child:
   • reduced muscle tone;
   • lack of swallowing and sucking reflexes;
   • impaired circulation;
   • swelling of the legs (sometimes);
   • a large loss of body weight of the child - 15–30%, as well as its slow recovery.
2. Infection during childbirth occurs 1–2 days after birth. At the same time, the symptoms of the disease of intrapartum pneumonia differ from the symptoms of other types of intrauterine pneumonia.

Features of symptoms depending on the method of infection - table

Acquired pneumonia symptoms

Acquired pneumonia with its symptoms resembles SARS. The following signs are noted:

• respiratory disorders;
• runny nose;
• child's anxiety
• lethargy;
• sleep disturbance, feeding regimen;
• increase in body temperature.

Symptoms and course of the disease depend on the pathogen:

1. Inflammation of the lungs caused by respiratory syncytial infection is characterized by difficulty in breathing.
2. When infected with adenovirus, severe wheezing, conjunctivitis, runny nose, and wet cough occur.
3. The flu affects the nervous system.
4. With herpetic infection, bleeding, acute renal and hepatic insufficiency, expressed in an increase in the liver and general intoxication of the body, are observed.
5. When infected with staphylococcus, abscesses (abscesses) of the lungs, pustular lesions of the skin, umbilical wound, osteomyelitis occur.
6. With the defeat of Klebsiella, enteritis, meningitis, pyelonephritis is noted.

Diagnostics

X-ray is essential for diagnosing pneumonia.

In order to diagnose pneumonia in a newborn, the doctor performs the following activities:

1. Collection of anamnesis and analysis of symptoms (through a survey of parents).
2. General examination, during which the specialist reveals:
   • pallor and cyanosis of the skin;
   • hard breathing - inhalation is equal in duration to exhalation, wheezing, etc.
3. Laboratory research:
   • a general blood and urine test, as well as a biochemical blood test;
   • cultures of mucus and sputum from the throat (to determine the pathogen).
4. Instrumental research:
   • chest x-ray (X-ray);
   • echocardiography;
   • CT (computed tomography).

Dr. Komarovsky on methods for diagnosing pneumonia - video

Treatment and its timing

Treatment of pneumonia in newborns is carried out only in a hospital. It includes a number of measures:

An important task of the mother during the period of illness of the child is to maintain breastfeeding. Breast milk strengthens the immune system and contains all the necessary substances that contribute to the recovery of the baby.

Duration and prognosis of treatment

The duration of treatment and the prognosis for recovery depend on the causative agent of the disease, the severity of the baby's condition and concomitant diseases. In most cases, pneumonia is easily treatable. With proper and timely medical care, improvement is observed at 2-3 weeks of illness. It is characterized by a decrease in signs of respiratory failure, restoration of appetite, and normalization of the nervous system.

Inflammation of the lungs caused by pneumocystis takes longer to heal. Its incubation period is from 8 days to 1 month. The total duration of the disease is 7-8 weeks, while in premature babies, only the acute period lasts 4-6 weeks.

But in some cases, the disease can cause dangerous complications and consequences.

Dangerous complications and consequences for newborns

The level of modern medicine is so high that it allows saving babies who have been diagnosed with intrauterine or acquired pneumonia. However, the consequences of the disease are sometimes very serious. They are divided into:

Complications of pneumonia in newborns affect the whole organism as a whole and each organ and system separately.

Children who have had pneumonia have a much higher predisposition to bronchopulmonary diseases. Adhesions and scars called alectases may remain on lung or bronchial tissue. Speaking about the consequences for the health of the baby, it is necessary to mention the increased risk of developing anemia and rickets in premature babies who have had early pneumonia.

Disease prevention before and after childbirth

Measures to prevent pneumonia in a child must be taken both before the birth of the baby and after. A pregnant woman should take care of her health, namely:

• regularly visit the clinic and take all the necessary tests;
• eat right and balanced;
• to refuse from bad habits;
• live a healthy life;
• prevent ARVI, influenza and other infections during pregnancy.

During childbirth, all measures must be taken to avoid fetal asphyxia. After the birth of the baby, it is necessary to organize proper care for him, to prevent hypothermia, contact with sick relatives. Breastfeeding plays an important role in the prevention of pneumonia and other diseases. It enhances the child's immunity and increases resistance to disease.

Although pneumonia in newborns is a very serious and dangerous disease, the level of modern medicine allows us to hope for a positive outcome and a full recovery. Care for the health of the child should not begin after birth, but from the moment of conception.

A newborn child does not yet have strong immunity, its organs and tissues in the first month of life adapt to environmental conditions. Any infection that enters the baby's body at this time can lead to a serious illness and consequences, sometimes fatal. The infectious process in pneumonia, including intrauterine, is dangerous because it affects not only the lung tissue, but can also spread throughout the body. Knowing the causes, manifestations and preventive measures of the disease, you can avoid serious complications.

What is neonatal pneumonia

Pneumonia of the newborn (pneumonia) is an infectious disease of lung tissue in children in the first 28 days of life with characteristic symptoms of intoxication and changes in the respiratory system.

With inflammation of the lungs, the alveoli are filled with a secret and cease to perform their functions.

At risk are:

• premature babies (born at a gestational age of less than 38 weeks);
• children with intrauterine growth retardation (body weight less than 2500 g);
• children born by caesarean section.

In addition, a number of factors significantly increase the likelihood of developing the disease in crumbs, for example:

• fetal hypoxia (oxygen starvation). Occurs as a result of a lack of oxygen in the blood of the mother, placental insufficiency (lack of oxygen supply to the fetus through the vessels of the placenta);
• aspiration syndrome, when part of the amniotic fluid enters the child's respiratory tract during inhalation;
• birth trauma;
• hypoxia in childbirth - a long anhydrous period (more than 24 hours);
• infectious diseases of the genitourinary and respiratory systems of the mother;
• malformations of the lungs (bronchopulmonary dysplasia).

Interestingly, a third of pneumonia in newborns is a secondary concomitant disease against the background of the main one. For example, congenital pneumonia can act against the background of hemolytic disease, severe birth trauma, and sepsis. Such pneumonia often determine the severity of the course of the underlying disease, as well as its outcome.

Types of disease

1. Congenital (or intrauterine) pneumonia. The infection infects the fetus in the womb. They are divided into transplacental, when the infection gets to the baby from the mother through the placenta. Antenatal, when the fetus becomes infected through the amniotic fluid. And intranatal, when the child is exposed to infection during passage through the birth canal. The causative agent of the disease in this case penetrates from the amniotic fluid or from the infected genital tract of the mother (genital tract).
2. Postnatal pneumonia that occurs after the birth of a child. They are divided into hospital (nosocomial) pneumonia, when infection occurs in the maternity hospital or neonatal pathology department, and out-of-hospital, when the newborn catches the disease after discharge from the hospital.

One of the ways of infection of the fetus from the mother with an infection is through the placenta (transplacental route of infection)

In addition, according to the type of causative agent of pneumonia, it is customary to divide into bacterial, viral and fungal.

Causes

In term newborns, the main cause of pneumonia is infection.. All other factors (maternal infections, hypoxia in childbirth, birth trauma, etc.) only increase the likelihood of pneumonia, but are not its cause!

In antenatal infection, the most common pathogens are cytomegalovirus infection, herpes simplex virus, and pneumocystis. The latter becomes the most common cause of the development of the disease in premature babies. With intranatal infection, the child is exposed to microorganisms that inhabit the birth canal of the mother, these are:

• chlamydia;
• mycoplasma;
• ureaplasma;
• streptococci;
• candida (fungal infection).

Streptococcal infection is the cause of pneumonia in 35% of infants in the first month of life.

Hospital infections that provoke nosocomial pneumonia are Klebsiella, enterococci, Pseudomonas aeruginosa and Staphylococcus aureus.

In premature newborns, the main cause of pneumonia, in addition to infection, is the underdevelopment of the respiratory system and the immune system. It is more difficult for such children to fight infectious agents, they are more easily susceptible to infection.

In children after delivery by caesarean section, the main cause of pneumonia is the suction of infected amniotic fluid or mucus from the birth canal. As a result of this, atelectasis occurs (collapse of part of the lung), which contributes to the development of pneumonia.

Ways of infection with pneumonia in newborn children:

• Hematogenous (with blood flow). This is the most common route of infection for intrauterine pneumonia. From the foci of infection of a pregnant woman with a bloodstream, a virus or bacterium enters the fetus. Hence, intrauterine infection of the fetus occurs.
• Bronchogenic. This is the route of infection in postnatal pneumonia, when a child picks up an infection from a sick mother or relatives. Infection occurs by airborne droplets.

Symptoms of the disease

In the clinical manifestation of pneumonia in newborn children, several groups of symptoms are distinguished:

• Intoxication syndrome - occurs as a result of poisoning of the child's body with toxins from viruses or bacteria. First of all, the nervous and immune systems are affected. This is manifested in the weakness of the child, refusal to eat, drowsiness, pallor or grayness of the skin. There may also be frequent regurgitation or bouts of short-term respiratory arrest (apnea).
• Respiratory disorders - occur as a result of lung tissue damage and, as a result, a lack of oxygen. Manifested in an increase in breathing, participation in the act of breathing of auxiliary muscles (retraction of the intercostal spaces, swelling of the wings of the nose). The breath of a newborn becomes groaning, noisy, sometimes wheezing is heard in the distance. The skin around the lips and on the extremities acquire a bluish tint, which is a sign of oxygen starvation.
• Violations of the cardiovascular system are manifested in the form of tachycardia (increased heart rate), lowering blood pressure, and edema.
• Disorders of the nervous system - increased excitability of the child, anxiety, regurgitation, decreased muscle tone.
• Manifestations from other organs and systems - an increase in the liver and spleen, early jaundice (yellowing of the skin before 3 days of a child's life).

Symptoms of pneumonia in newborns - photo gallery

With pneumonia in newborns, breathing is disturbed, wheezing may be heard during auscultation In congenital pneumonia, prolonged jaundice is a common symptom Lack of oxygen in the tissues manifests itself in the form of cyanosis (cyanosis) of the extremities or lips

It is important to know that an increase in body temperature in newborns with pneumonia is an optional symptom. In children of the first day of life, hypothermia (body temperature below 36 degrees) may occur. This indicates a reduced immune reactivity and severe intoxication.

The most common cause of pneumonia in medical institutions is Staphylococcus aureus. A feature of staphylococcal pneumonia is a strong intoxication syndrome (body temperature above 38.5 ° C, respiratory failure). The child quickly develops respiratory failure.

Staphylococcus destroys lung tissue, resulting in the formation of cavities and bullae filled with pus. The inflammatory process often passes to neighboring tissues, and pleurisy develops. Complicated by an abscess or pleurisy, staphylococcal pneumonia is often the cause of death in newborns.

Specificity of congenital pneumonia in infants:

• Clinical and radiological manifestations of the disease occur in the first 72 hours of a child's life.
• The source of infection is the mother - the same pathogenic flora is sown in her as in the baby.
• The child often has infectious foci in organs adjacent to the lungs.
• Characterized by an increase in the liver and spleen from the first day of the baby's life.
• In the placenta after childbirth, inflammatory changes are found.

Features of pneumonia in premature babies

• The onset of the disease with nonspecific signs is poor sucking, increased excitability of the child, pallor or cyanosis of the skin, a decrease in body temperature, sleep disturbance, weight loss or an increase due to edema.
• Late manifestation of respiratory disorders (at 1-2 weeks of life).
• More frequent occurrence of complications of pneumonia than in full-term newborns.
• Foamy discharge from the mouth. This occurs as a result of congestion in the lungs.
• Premature babies are more likely to develop blood poisoning due to pneumonia.

The most common causative agent of pneumonia in premature newborns is pneumocystis. The course of such pneumonia lasts 4–8 weeks and is divided into several stages:

1. Initial manifestations (first 1–2 weeks of illness). Characterized by nonspecific symptoms in the form of sluggish sucking, poor weight gain, rapid breathing when bathing, sucking. Sometimes there is a slight cough, loose stools (diarrhea).
2. The height of the disease (2–4 weeks of illness). Manifested by severe shortness of breath (increase in the number of breaths up to 80–140 per minute), paroxysmal cough, discoloration of the skin (blue, gray). Body temperature rarely rises.
3. The stage of resorption (reparation) is characterized by the slow disappearance of shortness of breath, cough, signs of intoxication.

Video of Dr. Komarovsky's school about pneumonia in children

Treatment

Treatment of newborns continues until the acute period of the disease is relieved (about 2 weeks). During the period of resorption of pneumonia, supportive and restorative therapy is used.

Treatment of pneumonia in newborns is carried out only in a hospital under the strict supervision of a neonatologist!

The main aspects in the treatment of pneumonia in newborns are:

1. Protective mode. Maintaining optimal temperature and air humidity (+24…+26 °C in the ward at 60–70% humidity). For premature babies weighing up to 1.5 kg, the temperature in the incubator is maintained at +34…+36 °C. Overheating is undesirable, as is hypothermia. Regular ventilation is required. It is not recommended to swaddle babies and restrict their movements, it is necessary to change their body position frequently during the day.
2. Feeding. If the child is in serious condition or in deep prematurity, he is fed through a tube or drip method. For this, mother's milk or adapted mixtures are used. With the improvement of the condition and the formation of the sucking reflex, the child is fed with a spoon or breast. In a serious condition, the child is not able to absorb all the necessary amount of food, therefore, between feedings, he is given liquid (glucose, oralitis) through a probe or pipette.
3. Oxygen therapy is the introduction of heated and humidified oxygen through a mask, catheter, into the incubator.
4. Antibacterial therapy - depending on the pathogen and type of pneumonia.
5. Immunocorrective therapy - the introduction of immunoglobulins, blood plasma.
6. Treatment of cardiovascular insufficiency - the use of cardiac glycosides for health reasons, diuretics.
7. With obstructive syndrome (bronchospasm), bronchodilators are used (for example, Alupent).
8. Sanitation of the upper respiratory tract - removal of mucus with the help of an electric suction.
9. Vibration massage - stroking, light tapping, compression of the chest from the sides.

Treatment of pneumonia in newborns - photo gallery

Stronger children are fed from a bottle with a nipple Weakened newborns are fed through a tube It is important for a newborn child to maintain a constant body temperature and humidity level - for this it is placed in an incubator The supply of humidified oxygen to the baby is carried out through a mask or nasal catheter

Combinations of antibiotics for different types of pneumonia - table

Antibacterial therapy is carried out intravenously - jet or drip. Antibiotics should be treated for at least 5 days, sometimes their intake is extended up to 10 days.

Possible complications and consequences

1. Pleurisy is an inflammation of the pleura (the membrane that covers the lungs). Occurs when the infection passes from the pulmonary focus to neighboring tissues.
2. An abscess is a cavity in the lung filled with pus.
3. Sepsis is an infectious infection of the blood and the spread of infection throughout the body with the formation of many foci of infection.
4. Atelectasis - collapse of part of the lung;
5. Pneumothorax - air entering the pleural cavity, normally it should not be there.