Consequences and treatment of intrauterine pneumonia in newborns
Intrauterine pneumonia in newborns, the consequences of which can be very deplorable, is a very common pathology. It is an infectious disease that develops in the first days of a child's life.
The cause of the appearance of this kind of pneumonia is the ingestion of the infected infected amniotic fluid at the time of birth or the hematogenous penetration of the pathogen from the sick mother.
Diagnosis of intrauterine pneumonia
The main diagnostic criteria for intrauterine pneumonia:
- Signs of pneumonia appear from 1 to 3 days of life.
- At delivery of a roentgen on 3rd day of a life of the child focal or infiltrative shadows are taped.
- When the microflora is sown in the mother and child of the first days of life, identical analyzes are observed.
- At a lethal outcome of a newborn on the 4th day, the inflammatory process in the lungs is determined.
Auxiliary diagnostic criteria:
- Histological examination of the placenta can reveal an inflammatory process in the womb of the mother.
- With an increase in the liver and spleen, the pathology in the baby's body is determined.
- Blood tests reveal the presence of inflammation.
Symptoms of intrauterine pneumonia
Symptoms appear on the second or third day after birth. Already during childbirth it is noticeable that the child is sluggish, weak, and the skin is cyanotic. There may be no reflexes of swallowing and sucking, muscle hypotension.
Other symptoms include:
- dry skin accompanied by hemorrhagic rash;
- limbs edematous;
- in full-term children, the temperature rises, in preterm infants, on the contrary, decreases to 34-35 degrees;
- shortness of breath accompanied by dyspnoea;
- on the 2nd-3rd day the rales are audible;
- regurgitation and vomiting;
- lack of body weight;
- possible development of heart failure;
- enlargement of the liver.
Most often, pneumonia can develop due to streptococcal infection in the womb.
With the development of respiratory failure, three phases of its development are distinguished:
- 1 degree - mild frequent breathing, the entrainment of the intercostal spaces is poorly expressed, cyanosis is poorly expressed in a calm state.
- 2 degree - with the help of auxiliary muscles, cyanosis is more pronounced.
- 3rd degree - frequent breathing, arrhythmia, apnea, movement of the head and additional musculature during breathing. Cyanosis is stable both in excitement and in a calm state.
Consequences of intrauterine pneumonia of the newborn and their treatment
Not always the treatment of congenital pneumonia can give a favorable result. Often the consequences of even timely treatment. These include the formation of atelectasis, which is characterized by the areas of the combined tissue of the lungs and the formation of connective tissue in the affected areas of the lungs. In future, with such pathologies, the lungs do not have the ability to fully perform their functions, which leads to emphysema. With such a disease, the child develops toxicosis, which is difficult to treat.
The main therapeutic measures of pneumonia and its consequences:
- Elimination of peripheral circulation and its blockade. This procedure is carried out to eliminate the centralization of blood flow and reduce brain activity, which is also involved in this process.
- Detoxification of the body. This therapy is carried out in order to remove the toxins accumulated in the body, adjust the water-electrolyte and alkaline-acid balance, and saturate the internal organs with good blood supply.
- Elimination of heart failure.
- Prevention of disseminated vascular blood clotting, and when it appears - quality treatment.
- Elimination of pneumonia symptoms.
Consequences of pneumonia in children with a delayed diuresis.
Most often, the effects of this disease are manifested through difficulty urinating. Delay diuresis is treated with diuretics, which should appoint a doctor. It often requires the help of a catheter, which is inserted into the bladder.
The forced diuresis is carried out in three directions, such as:
- Elimination of dehydration.
- Establishment of water-salt metabolism.
- Prevention of excessive fluid in the body.
If suspected of pneumonia, the child is isolated from the mother and transferred to the neonatal department. There he is placed in a cuvette, where a supply of moistened oxygen is provided. A small child is prescribed a course of antibiotics. If the condition worsens, artificial ventilation is used, this process is most often performed in the intensive care unit, where the heavy baby is transferred.If the treatment was not performed correctly, then pneumonia can go to the chronic stage.
Causes of intrauterine pneumonia
The most common pathogens are streptococci from group B, also influenza and parainfluenza viruses, adenoviruses, mycoplasma. Infection of the fetus can occur if a pregnant woman with late gestation is ill with the flu or ARVI.
Other causes of infection include:
- chronic infections of the mother;
- use of steroid drugs during pregnancy;
- hypoxia of the fetus in the womb;
- genetic diseases of the lungs and other internal organs.
A child can become infected with an infection leading to pneumonia in two main ways:
- Bronchogenic, when the infection penetrates through the lungs.
- Hematogenic, when the infection occurs in utero through the infected blood of the mother.
Another way of infection can be when the child passes through the birth canal and swallows the amniotic fluid that is infected. There are cases of infection after the birth of the baby.
Prevention of pneumonia in newborns
Preventive measures of this disease provide for the protection of the body of a pregnant woman in order to prevent infection with her flu or acute respiratory illness, especially in the second half of pregnancy.
Other preventive measures of a pregnant woman include the following actions:
- Timely opening of a registration card, a regular visit to a polyclinic and the delivery of all necessary tests.
- The nutrition of the future mother must be varied and balanced, rich in vitamins and minerals.
- A significant role is played by the rejection of bad habits and the maintenance of a healthy lifestyle.
At delivery, doctors should take all measures to avoid fetal asphyxia. After the baby was born, do not allow the infection to enter the room where it is. It is very important not to overcool the baby during this period. And also the importance of mother's milk in raising the immune system of a child has been proven for a long time.
Causes and treatment of aspiration pneumonia
Aspiration pneumonia is an inflammatory process that develops in the lungs due to the effects of foreign substances from the stomach and nasopharynx that fall into the airway. As a result, the multiplication and spread of harmful microorganisms occurs on the lung tissues.
Aspiration pneumonia is a fairly common disease.
Causes of aspiration pneumonia
The ingestion (aspiration) of tiny food particles to the respiratory organs occurs quite often. Thanks to the mechanisms of body protection, foreign bodies do not enter directly into the lungs and are quickly removed to the outside. If normal protective reactions are violated, particles can enter the lung area, which is a prerequisite for the development of aspiration pneumonia.In the category of persons most susceptible to the emergence of aspiration pneumonia, people get immunity which is weakened by the abuse of alcoholic beverages or medications.
However, this type of pneumonia can affect absolutely healthy people. Nutritional particles can enter the lungs during, for example, vomiting.
We can identify a number of factors that create a favorable soil for the development of aspiration pneumonia:
- CNS diseases in the form of stroke, tumors, Parkinson's disease, multiple sclerosis;
- diseases that provoke disturbances in swallowing processes;
- presence in the mouth and in the upper respiratory tract of microflora pathogenic;
- damage to the upper part of the airways, the causes of which are mechanical and iatrogenic manipulations.
Depending on the reason for the formation, it is customary to distinguish three types of aspiration pneumonia:
- Pneumonia, resulting from mechanical disturbances in the structure of the respiratory tract by foreign bodies of small and medium calibers, penetrating into the bronchial region.
- Bacterial pneumonia (the result of exposure to various pathogens penetrating the lungs).
- Pneumonitis of chemical nature (the consequence of getting into the lungs of gastric juice or other toxic substances).
Symptoms of aspiration pneumonia
The general symptomatology, which indicates inflammation in the area of the bronchial tree, can be presented:
- increased body temperature;
- rapid heart rate;
- difficulty breathing and exhaling, dyspnea;
- painful sensations in the chest, which become more intense during coughing attacks;
- cyanotic coloring of the skin of the patient's face.
Since aspiration pneumonia develops for various reasons, it can also manifest itself in different ways.
For bacterial aspiration pneumonia, the following symptoms are characteristic:
- a significant increase in temperature, which in frequent cases can reach a level of 38 ° C;
- the emergence of a wet cough accompanied by abnormalities of purulent sputum;
- pain in the chest.
With aspiration pneumonia, which was caused by contact with chemicals, the patient has a general intoxication of the body and the following symptoms:
- high body temperature;
- rapid heart rate:
- allocation of sputum having a pink tint;
- signs of cyanosis of the skin due to improper supply of oxygen to the skin.
Aspiration pneumonia, the prerequisites for the development of which is the ingress of a foreign body into the area of the bronchial tree, may be accompanied by the emergence of a reflexive painful cough, after the cessation of which the process of inflammation begins to affect the pulmonary epithelium.Aspiration pneumonia in newborns can develop on the basis of intrauterine infections, immaturity of lung tissue and birth trauma.
In the womb of the mother there is a process of infection of the child in the process of swallowing them with amniotic fluid or mucus that are in the birth canal.
A newborn with aspiration pneumonia is characterized by respiratory failure and the appearance of a gray-pale skin tone.
The process of feeding the baby is accompanied by constant vomiting and regurgitation. There is a sharp decrease in weight followed by a slow set.
Diagnosis of aspiration pneumonia
The presence of aspiration pneumonia is indicated by the presence of an aspiration episode, which can be confirmed with the help of physical, x-ray, endoscopic and microbiological studies.
At the reception the doctor carefully examines the symptoms for the presence of shortness of breath, cyanosis and tachycardia.
With the help of a radiologic examination of the lungs, a specialist can easily determine the presence of infiltrates and the typical localization of foci of the disease.To make an accurate diagnosis, you may also need to study the bacteriological culture of sputum and washing water from the bronchi. For this, bronchoscopy is carried out, aimed at picking up phlegm, taking rinsing water. Examination of sputum is also performed in order to find out which antibiotic should be used to treat the disease.
In order to determine the severity of hypoxemia, it may be necessary to study the gas composition of the blood.
Aspiration pneumonia in children under 2 years is difficult to diagnose. This is due to the fact that during a period with acute symptoms there is a lull in which the disease is difficult to detect even by the results of X-ray studies.
Most often, a specialist can guess the existence of a foreign component in the child's airways only after multiple cases of severe pneumonia.
Treatment of aspiration pneumonia
Treatment of the disease involves the simultaneous use of several antibacterial drugs, which must be taken for 2 weeks.
If abscesses are found in the lungs, then the specialists turn to the drainage, as well as to the vibratory and percussion massages of the chest. In some cases, it may be necessary to perform a second tracheal aspiration of the secretion and sanation bronchoscopy.
The need for surgical intervention arises only in severe cases, which are characterized by large abscesses and pulmonary hemorrhage.
Treatment of aspiration pneumonia is carried out in medical institutions under the close supervision of a doctor.
With a small amount of aspirated substance, timely diagnosis and treatment of the disease can be eliminated without much effort.
Prevention of aspiration pneumonia
Persons belonging to the category of risk should be sensitive to the consistency of the food consumed and the state of their health, timely correcting the concomitant diseases and the main pathological condition. This applies to people in advanced age, as well as suffering from persistent alcohol dependence, neuromuscular disorders, diseases of the central nervous system and the gastrointestinal tract.
For patients prone to aspiration processes, eating food in crushed form and a diet with sparing conditions are recommended.
Treatment of aspiration syndrome in newborns
It is believed that aspiration of meconium almost always can be prevented if appropriate control is carried out in antenatal period, to promote the acceleration of the course of labor, to immediately clear the trachea in the newborn. Doctors conducted a study of clinical-pathoanatomical features in the syndrome of meconium aspiration on the basis of analysis 14 genera with the presence of meconium in waters where meconium aspiration syndrome caused neonatal mortality. In the study group, all women in labor were primiparous. Intranatally, 6 (42.8%) of the fetuses died, in all of these cases the delivery was completed by the imposition of cavitary obstetric forceps and a vacuum extractor. The remaining newborns at birth had an Apgar score of 5 or lower. Immediately after birth, all children were sucked mucus from the upper respiratory tract, used ventilation, In the vein of the umbilical cord injected solutions of soda, glucose, ztimizol, appointed a session of hyperbaric oxygenation.
Despite the ongoing resuscitation, 7 (50%) children died in the first day after delivery from massive aspiration of meconium, the rest - on the 2-4th day of severe aspiration pneumonia. The diagnosis of meconium aspiration was confirmed during autopsy. A typical pathoanatomical picture was the filling of the lumen of the bronchi with a large amount of mucus, elements of amniotic fluid, meconium. The alveoli in all cases were enlarged, in the lumen they were determined a large number of amniotic fluid, the particles of meconium. In three cases there was a rupture of the wall of the alveoli, extensive hemorrhage was found under the pleura.
When meconium thick, in the form of clots, you should try to clear the nose and oropharynx from it even before the thorax comes out of the birth canal. Immediately after birth, if the meconium is thick or the Apgar score is lower than 6, endotracheal intubation should be undertaken to draw off the contents of the trachea prior to the initiation of artificial respiration. If these measures are not performed immediately after birth, the incidence of aspiration syndrome and mortality increase. This procedure is shown even in cases of absence of meconium in the oropharynx (as shown, 17% of newborns having meconium in the trachea, the latter in the oropharynx was not found). Suction of the contents from the trachea with repeated intubation or through a catheter should be repeated until the trachea is completely cleared. Additional procedure in the delivery room - removal of swallowed meconium from the stomach - prevents repeated aspiration.
The newborn should be placed in a block of intensive observation. Continuous monitoring of pulse and respiration rate is important. To confirm the diagnosis and exclude pneumothorax, an X-ray examination is performed; it is repeated if the clinical picture deteriorates. Every newborn who needs a 30% air-oxygen mixture to conserve pink color skin, it is advisable to catheterize any artery to constantly monitor the composition of blood gases. Antibiotics of a wide spectrum of action are recommended, since the cause of hypoxia of the fetus and the release of meconium into the water may be bacterial sepsis. In a number of cases, pneumonia can not be distinguished from meconium aspiration syndrome, and even if meconium is sterile, its presence promotes bacterial growth. There is no evidence of a positive effect of steroids in this syndrome. To remove meconium from the lungs, physiotherapy and postural drainage can be used.
Approximately 50% of newborns with meconium aspiration develop respiratory failure. Artificial ventilation is shown at Ra below 80 mm Hg. Art. on 100% oxygen, Race, over 60 mm Hg. Art. or apnea. Recommended parameters of artificial ventilation: respiratory rate 30-60 / min; inspiratory pressure 25-30 cm of water. p. positive end-expiratory pressure (PEEP) 0-2 cm of water. p. the ratio between inspiration and expiration is from 1: 2 to 1: 4.
With a high risk of hypoxic pulmonary vasoconstriction and low probability of retinopathy in a mature newborn, Ra should be maintained at the upper limit, i.e., 80-100 mm Hg. Art. To reduce Ra, the rapidity of breathing is preferable to increasing the tidal volume by creating a high peak pressure.
A high level of PEEP increases the risk of a decrease in venous return to the heart and, consequently, cardiac output, stretchability of the lungs (which can lead to hypercapnia) and the formation of "air traps" (leading to rupture of the alveoli). However, if Ra remains below 60 mm Hg. Despite the artificial ventilation of the lungs with pure oxygen, one can try to improve blood oxygenation by increasing PEEP up to 6 cm of water. Art. This method should be carried out under close supervision because of possible complications. PEEP should be reduced if systemic hypotension, hypercapnia or air leakage from the lungs occur. Oxygenation improves if artificial ventilation is combined with muscle relaxation. This method is especially recommended if an X-ray examination reveals interstitial emphysema of the lungs, the child is not "synchronous" with the apparatus and the PEEP needs to be increased. Deterioration in the process of such treatment is possible due to the development of pneumothorax or clogging of the endotracheal tube with meconium. The most likely cause of persistent or increasing hypoxemia may be considered persistent pulmonary hypertension.
In conclusion, it should be noted that, according to literary and our data, the lethality in the syndrome of meconium aspiration is 24-28%; in those cases when artificial ventilation was required, the lethality reached 36-53%.
If immediately after birth, before the first breath, the nasopharynx was cleared or the contents of the trachea were exhausted, no death was recorded.
The final prognosis depends not so much on developing lung disease as on perinatal asphyxia. No specific chronic pulmonary dysfunction is described.
Pneumonia in newborns
Pneumonia of the lungs in newborns - 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, statistics today are 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 causative agent penetrates the baby through the placenta from the mother);
- intrauterine antenatal, is caused by pathogens that have penetrated into the fetal lungs from amniotic fluid;
- intranatal, occurs when the baby passes through the mother's birth canal, infected with microorganisms;
- postnatal pneumonia, in which infection occurs after birth in a maternity hospital, in the department of neonatal pathology (nosocomial), 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, tuberculous and hemophilic rods (with antenatal and intranatal pneumonia);
- streptococcus group B, cytomegalovirus, chlamydia, fungi of the genus Candida and herpesvirus type II (with intranatal pneumonia);
- Klebsiella, Pseudomonas aeruginosa, intestinal yucca, proteas, staphylococci (with nosocomial aspiration pneumonia in newborns);
- mixed bacterial-bacterial, viral-bacterial.
Acquired home pneumonia most often occur against the background of 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
Signs of pneumonia in a newborn in case of intrauterine infection doctors will find even before discharge, because often the first signals of pneumonia begin to appear immediately after the birth of the child.
If the mother and child are discharged home, during the first month they must be accompanied by a doctor for patronage. He will look after the state of the baby, and he needs to talk about all the alarming symptoms, for example, about the child's lethargy, frequent regurgitation and liquid stool, rejection of the breast, fast fatigue when sucking.
If the child has a fever, do not wait for another doctor to come. Urgently call an ambulance. Cough in infants may be mild, but it is important to pay attention immediately to coughing. Also, alert the appearance of discharge from the nose in the child and shortness of breath. Shortness of breath leads to symptoms of blue on the feet, on the face and hands. The sick child has a faster appearance of diaper rash.
To be afraid to pass pneumonia at the child it is not necessary, in fact signs of illness or disease rarely arise without rising of temperature. And it needs to be periodically measured for prevention purposes.
The doctor, who regularly examines and listens to the child, can easily detect pneumonia.
What treatment is prescribed for pneumonia in newborns?
Antibiotics of a wide spectrum of action are always used for the treatment of pneumonia. The child needs careful care to avoid overcooling 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 using a probe. Applying to the breast of a sick infant, doctors will be allowed only if it is in a satisfactory state, namely, with the disappearance of intoxication and respiratory failure.
In addition to these treatments, physiotherapy (microwave and electrophoresis), vitamins C, B1, B2, B3, B6, B15, the use of immunoglobulins, mustard and hot wraps twice a day, transfusions of blood plasma.
Consequences of pneumonia in newborns
Children who have had pneumonia (especially bilateral pneumonia in newborns) are prone to repeated illnesses. After discharge for them should be repeatedly conducted courses of vitamin therapy, give bioregulators (extract of aloe and eleutterococcus) for 3-4 months. And within 1 year the child will be under clinical supervision.