Pneumonia in newborns
The content of the article:
- Causes of pneumonia in newborns and risk factors
- Forms of the disease
- Symptoms of pneumonia in newborns
- Diagnostics
- Treatment of pneumonia in newborns
- Possible complications and consequences of pneumonia in newborns
- Forecast
- Prevention
Pneumonia in newborns is an inflammatory disease of predominantly infectious etiology, in which pathological processes in the alveoli and interstitial tissue of the lung usually predominate. Pneumonia in newborns is distinguished into a separate group, which is due to the peculiarities of the etiology, as well as the clinical manifestations of the disease.
Pneumonia is diagnosed in 10-15% of newborns. Intrauterine pneumonia can develop in isolation or be a manifestation of a generalized infectious process.
X-ray of pneumonia in a newborn
Causes of pneumonia in newborns and risk factors
The main causes of pneumonia in newborns include intrauterine infection, aspiration of amniotic fluid and mucus, impaired blood circulation in the lungs, immaturity of lung tissue, a decrease in the lung lobe, and respiratory distress syndrome. As a rule, not one, but a combination of several reasons leads to the development of the disease. Viral-bacterial pneumonia in newborns usually occurs against the background of acute respiratory viral infections. The risk of developing pneumonia in a newborn increases if a pregnant woman has sexually transmitted diseases, fever during childbirth, the development of chorioamnionitis, and premature pregnancy. A baby can become infected while passing through the birth canal, during a cesarean section, and later in the maternity ward (hospital infection) or at home.
Pneumonia in a newborn may be due to intrauterine infection
Premature and debilitated children have a high risk of a secondary bacterial infection joining an already existing inflammatory process.
Forms of the disease
Depending on the origin and time of debut, the following types of pneumonia in newborns are distinguished:
- congenital - due to intrauterine infection (infectious agents are usually herpes simplex virus, cytomegalovirus, ureaplasma, mycoplasma) or intrapartum (i.e., occurring during childbirth) infection with streptococci, E. coli, chlamydia, Klebsiella, opportunistic microscopic mushrooms;
- neonatal, or acquired.
Neonatal pneumonia in newborns, in turn, are:
- the early ones make their debut in the first week of life;
- late - develop from the second week of life.
Depending on the morphological changes in the lungs:
- focal;
- interstitial.
Symptoms of pneumonia in newborns
With congenital pneumonia in newborns, there is a decrease in blood pressure, decreased reflexes (hyporeflexia), or the absence of one or more reflexes (areflexia). The skin takes on a grayish-white or cyantotic hue; during breathing, there is a pronounced tension of the wings of the nose, their swelling. Appetite decreases, when trying to feed, the child has belching or vomiting, with the progression of the pathological process, intestinal paresis may develop, accompanied by a sharp bloating. In addition, symptoms of pneumonia in newborns include crepitus or moist wheezing when listening to the lungs (sometimes they can only be heard with forced inhalation).
With congenital pneumonia in newborns, wheezing is found when listening to the lungs
With pneumonia in newborns, signs of respiratory failure are determined, which is divided into three degrees:
- A slight increase in breathing rate in a calm state, retraction of the intercostal spaces is moderately expressed.
- In the process of breathing, auxiliary muscles are involved, there is pronounced cyanosis in the mouth and around the eyes, and at rest, rapid shallow breathing is noted.
- The frequency of respiratory movements in children exceeds 70 per minute, there is a violation of the rhythm of breathing, prolonged apnea, widespread cyanosis of the skin. There are signs of cardiovascular failure.
In children with insufficient body weight, signs of respiratory failure do not always correlate with the severity of the pathological process.
In the peripheral blood, an increase or decrease in the number of leukocytes occurs, a shift of the leukocyte formula to the left is noted.
Children become drowsy, lethargic, they develop shortness of breath, cough, weight loss (15–30%) and slow recovery. Foamy discharge from the mouth and convulsions may occur. Body temperature rises to subfebrile or febrile numbers, less often remains within normal limits. Usually the duration of the disease is 3-4 weeks.
Aspiration pneumonia of newborns is characterized by the presence of dense particles of aspirated amniotic fluid in the alveoli, alveolar passages and bronchi.
Pneumonia in newborns caused by chlamydia appears during the first months of a child's life. Conjunctivitis can precede the clinical manifestations of the inflammatory process in the lungs, which debuts 1-2 weeks after the birth of the child. Chlamydial pneumonia of newborns is characterized by low-symptom onset, broncho-obstructive syndrome, non-productive cough, normal body temperature, and no signs of general intoxication. A moderate increase in the number of eosinophils is found in the peripheral blood.
With pneumonia in newborns caused by intrauterine ureaplasma infection, clinical manifestations occur within the first two weeks after birth. A persistent cough without sputum is a characteristic feature. Peripheral blood changes are usually absent.
Pneumonia in premature babies has a number of features. In such patients, the clinical picture is dominated by signs of intoxication of the body, periorbital edema, disseminated intravascular coagulation syndrome, and sepsis may occur. The disease can be accompanied by non-pulmonary manifestations: otitis media, thrombus formation, adrenal cortex insufficiency, etc.
Diagnostics
The primary diagnosis of pneumonia in newborns is based on history and physical diagnosis. During auscultation, there is a shortening of the percussion sound over the affected area of the lung, an increase in bronchophonia in the same area; physical changes in the lungs are asymmetric. To confirm the diagnosis, they resort to chest x-ray - the method makes it possible to determine infiltrative changes in the lungs, as well as their localization and nature.
Auscultation and chest x-ray are done to diagnose pneumonia in newborns
From the methods of laboratory diagnostics, general and biochemical blood tests, bacteriological and serological studies are performed.
Differential diagnostics with congenital lung and heart defects, aspiration, pneumopathies, acute respiratory viral infections, bronchitis, bronchiolitis is required.
Treatment of pneumonia in newborns
Treatment of pneumonia in newborns is complex, carried out in a hospital. Regardless of the form of pneumonia, newborns are prescribed antibacterial drugs (oral or parenteral). With chlamydial pneumonia, antibiotics of the tetracyclines, macrolides, fluoroquinolones group are used. The duration of the course of antibiotic therapy is 2-3 weeks.
Medicines for symptomatic therapy are selected in accordance with the clinical picture of the disease. Usually, mucolytic drugs are prescribed, which can be administered by mouth or by inhalation, through a spacer or nebulizer.
Treatment of pneumonia in newborns is carried out in a hospital setting
For newborns with any form of pneumonia, aero- and oxygen therapy is indicated. Aerotherapy is permissible in children over 3 weeks of age with a body weight exceeding 1.7-2 kg. For the purpose of detoxification of the body, infusion therapy is used.
If an asthmatic or toxic syndrome develops, glucocorticoids and appropriate symptomatic treatment are prescribed.
Premature infants with pneumonia are placed in a newborn incubator and supplemented with oxygen. The method of feeding such children is selected depending on the severity of the condition, the presence of concomitant pathologies, the severity of the sucking and swallowing reflexes. Preference is given to breast milk; in the absence of such an opportunity, patients are shown parenteral nutrition.
In the case of a severe course of pneumonia, immunotherapy is indicated, which complements the main treatment and consists in the administration of immunoglobulins.
In case of disturbances in the rhythm of breathing and depth of respiratory movements, accumulation of carbon dioxide in the blood, irregular heartbeats, imbalance in water-salt metabolism, resuscitation measures are required.
Possible complications and consequences of pneumonia in newborns
In severe cases, the consequences of pneumonia in newborns can be: pulmonary edema, edema syndrome, pathological enlargement of the liver, disintegration of lung tissue, pyopneumatorax, cerebral hypoxia.
The consequences of bilateral pneumonia, especially in premature babies, are often pneumocytosis, a decrease in the level of serum iron and hemoglobin, cardiac disorders, abscesses, pleurisy.
Forecast
With timely and correctly selected treatment, the prognosis is usually favorable. It worsens if the patient has primary immunodeficiency, pronounced underweight, as well as in the case of prematurity. With bilateral pneumonia, premature babies are at high risk of death.
Prevention
In order to prevent the development of pneumonia in newborns, timely treatment of diseases in a woman during pregnancy, prevention of toxicosis, as well as asphyxia and aspiration during childbirth, and proper care of the newborn are recommended.
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Anna Kozlova Medical journalist About the author
Education: Rostov State Medical University, specialty "General Medicine".
The information is generalized and provided for informational purposes only. At the first sign of illness, see your doctor. Self-medication is hazardous to health!
