How does pneumonia manifest in a newborn baby? Correct treatment, possible complications. Pneumonia in newborns Pneumonia in infants symptoms

It happens that a newly born baby receives its first diagnosis - pneumonia in a newborn. Parents are perplexed and ask questions about how this could happen, where little man, who barely breathed the air of the new world, could get this serious illness? We suggest you find the answer in this article.

Causes of pneumonia in newborns

Pneumonia in infants, popularly called pneumonia, can be congenital, i.e. received while the baby is in the womb, and acquired when infection occurs after birth. The congenital variant of the disease is a consequence of infection first reaching the expectant mother, and then to the child through the placenta, amniotic fluid or birth canal. For an already born baby, infection is possible within the walls of a hospital or home. In general, the sources of the disease are divided into three groups:

• bacteria;
• viruses;
• fungal infections.

At the same time, the appearance and development of the disease in infants is positively influenced by all possible complications: hypoxia, asphyxia, trauma during childbirth, birth defects heart and lungs, weakened immunity, lack or absence of any vitamins.

Symptoms of pneumonia in newborns

Signs of pneumonia in infants differ depending on the method of infection:

• Intrauterine infection to the baby

1. bluish tint to the skin, tongue, lips, arms, legs;
2. weak, quiet first cry or its absence due to the presence inflammatory processes in the lungs;
3. noisy, uneven breathing with wheezing;
4. increased body temperature (up to 40 degrees);
5. sluggish reflexes;
6. swelling of the legs;
7. frequent regurgitation, vomiting;
8. rapid weight loss;
9. slow healing umbilical wound.

• Illness after childbirth (symptoms become noticeable after two days)

1. high temperature(about 40 degrees);
2. decreased appetite, digestive disorders;
3. blue discoloration of the area around the nose and lips;
4. frequent, noisy breathing;
5. general malaise, weakness.

If other symptoms are added to pneumonia in an infant (hypoxia, developmental defects, birth injuries, etc.), the baby may be sent to the intensive care unit, and artificial ventilation of the lungs may be indicated.

Types of pneumonia and special cases of the disease

Unfortunately, children born ahead of schedule, may also suffer from pneumonia. Pneumonia in premature babies has some distinctive features, not inherent in the disease in older children. Thus, babies born before 37 weeks experience a drop in body temperature of up to 35 degrees, while full-term babies, on the contrary, are characterized by a high temperature. Also, their breathing is weaker and less frequent, and there is a risk of disruption of the functioning of the lung tissue and the reappearance of diseases of the bronchopulmonary apparatus. The tendency to regurgitate and vomit is more pronounced, general condition may be unstable and is sometimes accompanied by other complications (inflammation of the ears, kidney failure).

Another option special occasions The disease in children is bilateral pneumonia. It can involve several segments of one lung or affect both lungs at once. In this case, the baby’s condition is under serious threat, and untimely treatment can lead to a sad outcome.

Infection with pneumonia after cesarean section occurs in newborns after contact with the external environment, i.e. immediately after birth and inhalation of hospital air. The causative agent of the disease can be viruses (herpes, rubella, toxoplasmosis), bacteria (chlamydia, streptococci), as well as Candida fungi.

Treatment of pneumonia in newborns

Pneumonia in infants is subject to immediate treatment, otherwise, the situation threatens to move into a more dangerous stage for the baby’s life. The most difficult period of the disease is the first two weeks, after which respiratory failure gradually decreases, the child develops an appetite and his condition stabilizes.

A mandatory measure for this disease is hospitalization and placement of the baby in a special hospital, where certain conditions will be created for his recovery (temperature and humidity). The newborn’s condition is monitored on a regular basis; doctors measure his body temperature, assess his breathing and general well-being. The baby's mucous membranes and skin require special care. Nutrition is supplied in fractions, and it is desirable that it be mother’s breast milk, which can provide the baby with important protective components. If necessary, treatment is carried out with antibiotics and drugs to enhance immunity, diuretics are administered intravenously and saline solutions. Oxygen is supplied through a special mask, and the air must have a humidity level of at least a certain level. A course of vitamins, in particular C and group B, may be prescribed in order to strengthen the baby’s immunity.

As medical practice shows, with timely treatment, the prognosis for the development of pneumonia in newborns is favorable.

Neonatal pneumonia is an inflammatory process localized in the lungs that occurs within 4 weeks of birth. Unlike childhood pneumonia, this disease has a number of features related to the process of infection, diagnosis and treatment. Considering the danger of inflammation of lung tissue, it is important to know about the nuances of this disease in newborns.

Forms

Pathogens

If the infection occurred in utero, it was caused by viruses that can penetrate the blood-brain barrier. Such provocateurs of the inflammatory process are called TORCH pathogens. In order to minimize the risk of disease in a newborn, the obstetrician usually refers the patient to a blood test to identify:

• herpesvirus;
• cytomegalovirus;
• toxoplasmosis;
• syphilis;
• listeorosis;
• togavirus.

On later pregnancy or directly during labor activity The following microorganisms can enter the child’s body from the mother:

• fungi (candida);
• Trichomonas;
• ureaplasma;
• chlamydia;
• mycoplasma.

In the maternal body they may be present as a result of acute or chronic pathologies of the genitourinary, respiratory or digestive system. Sometimes they can be asymptomatic, which is why it is so important to carefully monitor your health before and during a planned pregnancy.

Causes of pneumonia in newborns

Pneumonia can be classified into 2 categories:

• intrauterine;
• neonatal.

The cause of intrauterine pneumonia is infection of the fetus from the mother's body. In addition to TORCH infection, somatic pathology can be provoked by underdevelopment of lung tissue, which occurs if a pregnant woman, while awaiting childbirth, encounters genitourinary infections. There is also a high probability of illness in a child if a woman has suffered an acute viral or bacterial infection, especially in late pregnancy.

Neonatal pneumonia, which develops after the baby is born, is divided into early and late.

1. The cause of early pneumonia is an infection that occurs when the infant’s body interacts directly with maternity hospital Staphylococcus, Klebsiella, Pseudomonas or coli. Immune cells mothers who protect the newborn's body for up to six months usually prevent infection, but the risk is still high, especially if the baby was born prematurely.
2. Late pneumonia develops outside the walls of the maternity hospital, at home. It occurs after discharge from maternity ward up to 4 weeks. A pathogenic microorganism enters the child’s body, and if the immune system cannot cope with the antigen, it begins to actively develop in the lung tissue, provoking the appearance of signs of a clinical picture of pneumonia.

Features of the course of the disease in newborns

The extent to which the clinical picture of pneumonia in a newborn corresponds to the classic course of the disease depends on a number of factors, the list of which includes:

• full-term baby;
• the degree of maturity of its organs and systems;
• the presence of other pathological processes.

However, as a rule, the clinical picture has a number of features that distinguish pneumonia in a newborn from the course of the disease in an adult or older child.

1. After the inflammatory process occurs in the body, symptoms do not appear immediately, but only after several hours, sometimes several days.
2. Usually, pneumonia in an adult begins with a sharp rise in temperature, but in a newborn the immune system is not yet formed and cannot give the necessary immune response in the form of an increase in body temperature, so the first symptoms of pneumonia in children are weakness and drowsiness.
3. In most cases, children are diagnosed with a small focal type of inflammation, which can be recognized by listening to the organs. chest almost impossible with a stethoscope. Therefore understand that pathological process localized specifically in the lungs, it is possible only after the appearance of appropriate symptoms: cough, shortness of breath, rapid breathing.
4. Any catarrhal phenomena: cough, runny nose, sore throat, are absent in the viral etiology of pneumonia in newborns.

Risk factors

The following factors significantly increase pneumonia in newborns:

Symptoms of pneumonia in a newborn baby

If the infection occurred in utero, no signs of the disease appear before birth, since until the baby is born and takes its first breath, its lungs do not function. After the child is born, the clinical picture of the pathology begins to develop within a few hours.

It is important to know exactly what signs indicate intrauterine pneumonia:

• the baby is weakened, does not cry or the cry is weak;
• hypoxia leads to damage to the nervous system, therefore innate reflexes weakly expressed (nutritional, indicative, protective);
• breathing is frequent and shallow due to the fact that the body wants to compensate for the lack of oxygen in the tissues;
• the heartbeat is rapid, the sternum sinks when inhaling;
• the baby has no appetite;
• body temperature rises quickly, convulsions may occur;
• The baby's skin is pale, grayish.

If infection with the causative agent of pneumonia occurs after birth, the symptoms of the disease are practically no different from congenital:

• the child is capricious and cries a lot;
• body temperature rises;
• shortness of breath occurs.

How exactly pneumonia will develop in a baby depends on the pathogen, but usually intoxication is quite severe and is the prevailing symptom.

Severity

The severity of pneumonia is assessed by clinical signs, and the assessment criteria differ little from the classification of the severity of pneumonia in adults.

Features of pneumonia in premature babies

In premature babies, pneumonia develops much more often than in those born on time, both congenital and neonatal.

The course of the disease in premature newborns has a number of features:

• V clinical picture in the newborn they predominate nonspecific signs diseases: weakness, lethargy, disturbances of the sucking and swallowing reflex;
• inhibition of the sucking and swallowing reflex in an infant leads to a decrease in his body weight;
• During infection in premature patients, body temperature not only does not increase, but often decreases (hypothermia);
• signs of toxicosis predominate in the baby, and only after a few days signs of respiratory failure;
• complications after pneumonia suffered at birth after a premature pregnancy in an infant are very common, especially bronchopulmonary dysplasia.

Diagnosis of pneumonia in newborns

Diagnosis always begins with a history taking. The doctor asks the child’s mother what chronic diseases she is suffering, what is the likelihood that the child was hypothermic or overheated, was near people who could be a source of infection.

During the examination, the doctor performs the following actions:

• assesses the degree of paleness of the baby’s skin;
• listens to the lungs for wheezing;
• taps the lungs to detect the location of inflammation using a shortened sound.

If suspicion of pneumonia is confirmed, the child is immediately hospitalized in a hospital (infectious diseases department). There, the diagnosis of a newborn is carried out using:

• clinical blood test;
• urine analysis;
• culture of mucus from the nasopharynx to identify sensitivity to different groups antibiotics;

Treatment

If pneumonia is suspected, the newborn should be immediately hospitalized in the infectious diseases department. It is strictly forbidden to independently diagnose and treat pathology, since inflammation localized in the infant’s respiratory system can lead to death if treated incorrectly or untimely.

Mode and nutrition

In a hospital setting, the most comfortable conditions are provided for infants: a microclimate is created that prevents either hypothermia or overheating of the child. Patient care includes the necessary hygiene procedures, as well as regularly changing the child’s position.

Nutrition of a newborn with pneumonia is an important topic, because impaired respiratory activity inhibits the baby’s sucking reflex. And until the activity of the bronchopulmonary system is completely restored during proper treatment, the baby must be fed through a tube: with breast milk or a special formula. The calorie content of the daily diet decreases, but the number of feedings per day needs to be increased.

Antibiotic therapy

Taking antibiotics is the main method of treating pneumonia in patients of any age, including newborns. The prescription of a specific medicine depends on the causative agent of the disease, the type of pneumonia (congenital, early, late).

• Until the causative agent of pneumonia is identified, broad-spectrum antibiotics are used: Cefuroxime, Amoxicillin.
• For pneumonia, cephalosporins (Cefotaxime) and macrolides (Erythromycin) have proven effective.

After 72 hours, it will be possible to evaluate the effectiveness of the drug, and if the newborn patient’s well-being has not improved, the prescription will be adjusted taking into account new diagnostic data.

For congenital and early types of pneumonia provoked by group B streptococci, Klebsiella, Listeria, Escherichia coli and Staphylococcus aureus, the following are prescribed:

• Ampicillin plus aminoglycoside (Amikacin);
• Amoxicillin and clavulanic acid (Amoxicav, Augmentin), plus an aminoglycoside (Amikacin);
• Ampicillin and sulbactam (Sultasin, Unazin), plus an aminoglycoside (Amikacin).

This treatment regimen has high degree effectiveness, but in case of low recovery dynamics or in the presence of contraindications, Cefotaxime with Amikacin can be prescribed.

For late pneumonia in newborns, provoked by infection with Pseudomonas aeruginosa, enterobacteria and Staphylococcus aureus, are assigned:

• Ceftazidime or Fortum;
• Cefoperazone or Cephobid;
• antipseudomonas penicillin (Carbenicillin, Azlocillin).

The drugs are also prescribed together with an aminoglycoside.

Only the attending physician can prescribe antibiotics. All medications for newborns are administered by injection.

Detoxification therapy

Intoxication of the body is one of the most dangerous phenomena during pneumonia in a newborn child. The purpose of detoxification is to remove from the body toxins formed as a result of the presence and reproduction of pathogenic organisms in the body.

• With moderate intoxication, newborns only need to maintain water and electrolyte balance, which is ensured by constant administration of fluid intravenously or through a nasogastric tube.
• In case of severe intoxication, the method of hemodialysis or plasmapheresis is used - cleansing the blood or plasma of toxins and then returning them to the bloodstream.

Disruption of the respiratory process as a result of pneumonia entails hypoxia or oxygen starvation– an extremely dangerous phenomenon for health and life. The lack of oxygen in the body can be replenished using oxygen therapy, when oxygen is supplied to the respiratory tract. pure oxygen or gas with high level oxygen content. For newborns, only the second option is used, since pure oxygen can cause eye damage.

This helps:

• reduce pulmonary edema;
• intensify work respiratory system;
• have a positive effect on the molecular characteristics of blood.

Oxygen gas is given through nasal cannulas, a mask (there is a risk of aspiration from vomit) or by placing the person in an oxygen tent. In severe cases, a device is indicated for artificial ventilation lungs (ventilator).

Probiotics

Probiotics for newborns during treatment of pneumonia are necessary to restore intestinal function due to antibiotic therapy.

For treatment the following are used:

• Bifidumbacterin;
• Bifiform Baby;
• Biovestin;
• Linux;
• Narine.

The drug is added to breast milk or special formulas.

Treatment of cardiovascular failure

Cardiovascular failure often becomes a complication of severe pneumonia. Its signs can appear within a few hours after the onset of the disease, subject to severe intoxication and dehydration.

Heart failure should be treated promptly by an experienced physician. Therapy requires:

• intravenous prednisolone or hydrocortisone;
• plasma and 5% albumin intravenously.

If ineffective - dopamine drip, artificial ventilation.

Symptomatic treatment

Symptomatic treatment aimed at making the patient feel better with pneumonia includes normalizing the temperature and liquefying the sputum.

1. Antipyretic drugs should not be used until the thermometer reaches 39 degrees to allow the immune system to fight the disease. The exception is the risk of febrile seizures - in this case antipyretic drug given to a newborn at a temperature of 37.5 degrees.
   Paracetamol or nimesulide are used as a means to normalize body temperature. Aspirin is strictly contraindicated.
2. The removal of bronchial secretions from the lungs is facilitated with the help of mucolytics:

• Ambrobene;
• Bromhexine.

Newborns can receive any medications for symptomatic treatment only under the strict supervision and supervision of a physician.

Treatment of the mother of the child while breastfeeding

Use for a newborn child during treatment traditional medicine it is impossible, but his mother can do this if she feeds him breast milk. Beneficial substances will be transferred to the baby’s body during breastfeeding and will likely speed up the healing process.

In this way you can use:

• 30 g linden leaves, 30 g viburnum berries, 1 liter of boiling water; drink the resulting tea 50 ml throughout the day;
• regular tea with raspberries, fresh or dried;
• Pour 60 g of wild rosemary and coltsfoot leaves into a liter of boiling water; take 50 ml of decoction twice a day.

Methods of treating a newborn with enrichment useful substances Mother's breast milk is known in homeopathy. But the effectiveness of this branch of medicine has not been scientifically proven.

Complications and consequences

What are the consequences of pneumonia suffered in infancy:

• The danger of pathology lies mainly in intoxication of the body. Exposure to the body of toxic products of microbial decay can cause death if the child does not receive proper medical care.
• Another dangerous complication of pneumonia is bronchopulmonary dysplasia, that is, damage to organ tissue and small bronchi. This entails a violation respiratory function, hypoxia of the whole body. Subsequently, the risk of repeated, recurrent pneumonia is very high.
• Extrapulmonary complications include cardiovascular failure, sepsis, asthenic syndrome, and delayed diuresis.

Prevention

Prevention of pneumonia in newborns is a set of measures that need to be taken even before conceiving a child. The list of preventive measures for pathology includes:

• complete medical examination before a planned pregnancy;
• carrying out all necessary tests blood during pregnancy;
• if possible, choose natural childbirth rather than C-section;
• give preference to breastfeeding rather than using formula feeding;
• Avoid crowded places during epidemics.

A healthy lifestyle during pregnancy and proper care of the newborn significantly reduces the risk of pathology.

Forecast

The prognosis for pneumonia in newborns is favorable with timely initiation of treatment (on the first day). The prognosis for premature babies is least favorable - they have a higher mortality rate.

Conclusion

Pneumonia in a newborn is a disease caused by pathologies occurring during pregnancy or childbirth, as well as improper care for a child in the first days of his life. Pneumonia, as well as its complications, is very dangerous, so it is extremely important to take all measures to prevent it. And in case of illness, consult a doctor immediately.

Pneumonia in newborns is a serious disease that requires timely early diagnosis and adequate treatment. Otherwise, pneumonia can lead to a number of serious complications.

What is pneumonia in newborns

Pneumonia is an inflammatory process in the lungs of infectious origin.

According to statistics, pneumonia is registered in approximately 2% of full-term infants and in 10–15% of premature infants.

Pneumonia in newborns is a very serious and life-threatening disease. Children who have had pneumonia subsequently experience developmental delays, a tendency to recurrent chronic diseases of the respiratory system, etc.

Causes

Among the factors that provoke the development of pneumonia in a newborn are:

• fetal prematurity - pneumonia in premature babies is diagnosed almost 10 times more often than in full-term babies;
• the pregnant woman has an STI (sexually transmitted infection), which is highly likely to be transmitted to the child;
• threat of miscarriage (uterine bleeding);
• premature rupture of amniotic fluid;
• prolonged labor;
• intrauterine hypoxia (oxygen starvation);
• birth injuries (affecting the brain and upper respiratory tract);
• malnutrition ( chronic disorder digestion and weight deficiency), which may be accompanied by congestion in the lungs;
• congenital heart defects;
• hereditary immunodeficiency conditions.

Features that predispose to the occurrence of pneumonia anatomical structure lungs in newborns, and in premature infants there is also immaturity of the respiratory tract.

The cause of pneumonia in newborns can be a variety of pathogens, which are divided into the following groups:

• bacterial infections: streptococci B, anaerobic microorganisms, listeria, ureaplasma, chlamydia;
• viral infections: cytomegalovirus, herpes virus of various types;
• fungal infections of the Candida species, etc.

Pneumonia often develops against the background viral infection, which undermines the immune system and promotes the penetration of bacterial pathogens into the lower parts of the respiratory system.

Modern medicine distinguishes between two methods of infection:

1. Bronchogenic: in this case, pathogenic microflora enters the child’s lungs. Most often, newborn children become infected this way.
2. Hematogenous: the infection is transmitted through blood - from mother to child. This method is much less common.

Species

In newborn children there are the following types pneumonia depending on the time and method of infection:

1. Congenital (intrauterine) – infection occurs during pregnancy:
   • transplacental (the mother’s infection penetrates the placenta);
   • antenatal (infection reaches the baby from amniotic fluid);
   • intrapartum (infection occurs during natural birth or when performing a caesarean section).
2. Acquired (postnatal) – infection occurs after childbirth:
   • out-of-hospital (the child falls ill outside the medical facility);
   • hospital (infection occurs in the maternity hospital, neonatal pathology department or intensive care unit).

In addition, newborns experience so-called aspiration pneumonia - this is inflammation of the lungs and bronchi due to foreign substances entering them during inhalation (food, drink, vomiting).

Pneumonia is 10 times more likely to affect premature babies

The first signs of pneumonia in newborns:

• low blood pressure;
• pale, grayish skin tone;
• respiratory failure;
• lethargy, drowsiness;
• Possible vomiting during feeding, followed by intestinal cramps and bloating;
• moist rales in the lungs when listening.

Intrauterine pneumonia appears immediately after the birth of a child

Symptoms of intrauterine pneumonia depending on the method of infection - table

Intrapartum pneumonia has two development options: in the first case, the disease is provoked by a birth injury that causes breathing problems, then clinical manifestations observed immediately after birth; in other cases, symptoms appear only after a couple of days, before which the child looks healthy.

Symptoms of acquired pneumonia

Acquired pneumonia begins with symptoms of damage to the upper respiratory tract:

• restless behavior;
• regurgitation;
• runny nose.

Then they are joined by symptoms of pneumonia:

• temperature;
• coughing;
• vomit.

If your child's temperature rises, you should urgently call ambulance, and not wait for the doctor to come to your home.

How to detect pneumonia in time - video

Diagnostics

The diagnosis is made based on:

• anamnesis data (information about medical history, illnesses suffered, etc.);
• clinical symptoms;
• X-ray of the lungs.

Pneumonia in newborns is differentiated with the following pathologies:

• pneumopathy (non-infectious lung pathologies);
• congenital defects of the lungs and heart;
• aspiration (entry of foreign contents into the organ).

Doctor Komarovsky about methods of diagnosing the disease - video

Treatment

Treatment of newborn children with pneumonia is carried out inpatiently, as this requires special conditions: maintaining optimal temperature and humidity in the room, etc. Premature babies are placed in an incubator - an intensive care incubator.

How smaller child and the more severe his condition, the more complex and at the same time careful treatment should be, the purpose of which is to eliminate respiratory and cardiovascular failure, increase immunity, and restore the compensatory mechanisms of the newborn’s body.

Conducted complex therapy taking into account individual characteristics child:

The acute period of the disease lasts approximately 2 weeks. After the condition improves, respiratory failure is eliminated, the central nervous system is restored, and the child’s appetite increases. The resolution stage lasts another 1–2 weeks. In premature babies, the duration of the disease is at least a month.

Consequences and forecasts

Prognosis depends on condition immune system child, the presence of provoking factors and accompanying complications, the treatment tactics used. With timely and proper therapy the prognosis is favorable.

The following can complicate the course of the disease and worsen the prognosis:

• abscess, pleurisy;
• change in the acid-base balance of the blood towards acidification;
• intoxication of the body (excess of toxins in the blood);
• respiratory failure, Cheyne-Stokes respiration (intermittent);
• heart failure, arrhythmia;
• brain hypoxia;
• primary immunodeficiency.

Children who have had pneumonia are prone to relapses of the disease. After discharge from the hospital, it is necessary to continue to use restorative drugs (vitamins, bioregulators). The child is under medical supervision for a year.

Prevention of pneumonia in newborns

Prevention by a pregnant woman includes the following measures:

• planned pregnancy management (regular consultations and laboratory tests);
• treatment chronic infections(ideally before pregnancy);
• balanced and fractional meals;
• healthy image life: daily stay on fresh air at least two hours, compliance with the regime (sleep at least 8 hours), refusal bad habits, physical education classes.

To prevent acquired pneumonia, it is recommended:

1. Breastfeed (since the baby receives the necessary antibodies from the mother's milk).
2. Minimize contact with carriers of infections, especially during a flu epidemic or an acute respiratory viral infection outbreak (if someone in the family is sick, you should wear gauze bandages).
3. Avoid hypothermia.

Sanitary and epidemiological standards must also be observed in maternity hospitals and hospital wards for newborns.

Pneumonia in newborns is a very serious and dangerous disease. However, timely diagnosis and adequate treatment of pathology will help avoid severe consequences. Be careful, when the first symptoms of the disease appear, immediately report them to your doctor. Health to you and your baby!

Editor

Pulmonologist, doctor of the highest category

Pneumonia is a group of diseases characterized by the development of inflammatory processes in the lung tissues. Pneumonia is acute infectious disease, which is widespread in both adults and children.

In this article we will look at the features of the disease in newborns, as well as how and for how long it is treated.

Features of the disease in infants

In newborn pneumonia, the infection spreads inside the womb or immediately after birth. In this regard, their pneumonia is divided into two types:

1. - the infection spread during pregnancy through the placenta, amniotic fluid or through the birth canal.
2. Acquired- infection occurred after childbirth.

Symptoms usually appear immediately or, in the case of infection during childbirth, within two days. Most often, the disease appears if the fetus is premature, the mother’s genitals are infected, or during a long labor.

Other development factors include:

• asphyxia and lack of oxygen in the womb;
• injuries received during childbirth;
• congenital heart defects with the development of heart failure;
• underdevelopment of muscles.

Possible injuries to the baby during childbirth

According to statistics, the leading cause of child mortality is pneumonia. Previously, deaths among newborns suffering from this disease reached 80% . The figure has now dropped to 50% , but still high. Measures must be taken immediately after diagnosis.

There are also certain clinical recommendations for diagnosis, treatment and prevention in infants (at the end of the article).

Symptoms

Symptoms of congenital pneumonia in infants are as follows: asphyxia, strong and sudden increase in temperature, weak and muffled cry, blue skin, rapid heartbeat and breathing, belching, and possible vomiting. The acquired form has similar symptoms, but they are often accompanied by diarrhea and general weakness.

For diagnosis, parents are checked for infections and general examination patient, additional instrumental and laboratory tests.

Treatment

If pneumonia is detected in a baby, he must be hospitalized immediately. In the first few months of life, treatment is only inpatient, children are under constant supervision. Physicians must carefully monitor the maintenance the right conditions(temperature, humidity), nutrition, condition of the baby.

General antibiotic therapy regimen

All forms of pneumonia in newborns and infants are treated with. In most cases medicinal product administered parenterally (injection), but oral administration (swallowing) is also possible.

It is difficult to clearly differentiate pneumonia (what its origin is), and lengthy diagnostics to determine the pathogen only hinders the initiation of timely treatment.

To prevent complications, therapy should be started as soon as possible. Typical forms of the disease are recommended to be treated with first-choice drugs. These include amoxicillin. The drug is well tolerated, has a low cost, and has wide range antibacterial activity.

As analogues for therapeutic effect The following antibiotics can be used:

• co-amoxiclav(penicillin);
• spiramycin, clarithromycin, azithromycin, erythromycin(macrolides);
• cefaclor, cefuroxime, ceftriaxone, cefotaxime(cephalosporins).

Cephalosporin group of antibiotics

If there is no effect from the use of penicillins, it is necessary to “connect” the macrolide group, especially if pneumonia caused by chlamydia or mycoplasma is suspected. Therapy is carried out intramuscularly or intravenously. The dose calculation for newborns is carried out by a neonatologist. Doses are determined taking into account the baby's weight.

In the absence of effect from macrolides within 48 hours treatment tactics should be changed. In such a situation, the use of drugs of the cephalosporin group is required. For example, a newborn may be offered cefuroxime, it is prescribed at a rate of 30 mg/kg/day. The drug is administered parenterally.

In the absence positive dynamics after the use of cephalosporins, there will most likely be a need to use chloramphenicol(10-15 mg/kg). After the condition improves, the oral form of the drug is used.

Important! Only preliminary bacterial testing for sensitivity to antibiotics can rationalize the use of antibiotics. Its results make it possible to unambiguously determine which bacterium caused the harm. Unfortunately, bacterial culture results sometimes have to wait up to 5 days or more.

The choice of antibiotics depending on the form of the disease

Anaerobic pneumonia is treated clindamycin, lincomycin(according to the instructions, it is allowed with one month old, in practice they are used earlier), inhibitor-protected penicillins.

Atypical forms of pneumonia respond to macrolides.

The drug Biseptol 480 (co-trimoxazole)

Cytomegalovirus pneumonia requires the use of specific anticytomegalovirus immunoglobulin. If the cause of pneumonia is the herpes virus, you should use antiviral agent acyclovir.

Immunodeficiency pneumonia requires drugs such as vancomycin + amikacin. Also recommended for the treatment of this form of pneumonia: cephalosporins of III-IV generations.

Pneumocystis pneumonia in newborns is treated co-trimoxazole(prescribed from 6 weeks of life).

Fungal pneumonia is treated with antifungal agents, For example, amphotericin B.

Course and recovery period

Medical therapy, especially when severe course pneumonia, requires follow-up X-ray studies. In some cases, when severe complications: pleurisy, pneumothorax, destructive complications, you have to resort to surgical methods treatment.

Newborns who have had pneumonia mandatory are registered at the dispensary. The frequency of appointments is determined by the pediatrician. Typically, examinations are scheduled at 1, 3, 6 and 12 months.

The disappearance of intoxication and retraction of the lower part of the chest, normalization of body temperature are the main criteria for the effectiveness of treatment.

In addition, the child is given glucose (sustaining energy and life), saline solutions(detoxification), medicines to relieve symptoms. In particular, nasal drops, rosehip decoctions, infusions, compresses and more. The baby also needs to be turned from side to side to avoid mucus stagnation.

How long is the treatment?

How long a newborn is treated depends on to a greater extent from the child himself and his immunity, rather than from. According to the degree of damage, the following types are distinguished:

1. - inflammation of individual small areas of the lungs.
2. - inflammation of one lobe.
3. - damage to one or more segments.
4. - defeat connective tissue elastic fibers and smooth muscles that make up the interstitial tissue of the lungs.
5. - inflammation of the tissues of the entire organ.

Duration of antibiotic therapy depending on severity, etiology and site of therapy

How long newborns (prematures) stay in the hospital also depends on the disease, the baby itself, how long the pathogenetic symptoms last and other data.

As a rule, the acute period of pulmonary inflammation lasts 2 weeks. At positive results therapy is still ongoing 1–2 weeks, after which the child recovers.

On average, recovery in newborns takes 4–5 weeks. It is considered complete when everyone disappears clinical symptoms and works stably nervous system, the baby returns to normal.

After discharge from the hospital, the newborn child is redirected to a dispensary registration at the clinic. Examination by a doctor once a week.

Complications

Complications may develop, in which case intravenous infusions will be required. The following complications are possible:

• the appearance of seizures;
• poisoning of the body with toxic substances;
• constant high temperature;
• a sharp decrease in appetite;
• increased level of acetone.

The consequences of complications are different: abscess, respiratory failure, pleurisy, ITS (infectious-toxic shock). They can also be secondary changes, catalysts for complications. In extremely severe cases it is possible fatal outcome. Therefore, in no case should you engage in self-diagnosis and treatment without the supervision of a highly qualified specialist.

Traditional methods

When treating a newborn with folk remedies, it is important to consider that many of existing methods may cause allergic reactions in a child. Therefore from folk remedies It's better to refuse.

• compliance with bed rest;
• fractional and carefully selected;
• timely taking of prescribed medications.

Breastfeeding

How long does the treatment and recovery process last? In general, if a child does not acute stage, about 2 weeks.

Physiotherapy

Prognosis and what to do after recovery

The prognosis is favorable with timely diagnosis and the use of antibacterial therapy. In advanced cases, complications may occur, chronic difficulty breathing, toxicosis, chronic diseases bronchi. In the worst case, death.

After pneumonia, it is necessary to provide the newborn child with rest, make sure that none of the adults have colds or other illnesses, as well as regular examination by a doctor. The basis of prevention are:

• prevention of infectious diseases;
• breastfeeding;
• fractional proper nutrition;
• healthy lifestyle.

Thus, a timely visit to the doctor in medical institutions, as well as careful adherence clinical recommendations increase the chances of recovery.

Useful video

We invite you to watch an educational video in which Professor Ilyina N.A. makes a presentation on the topic “Pneumonia in children and newborns”

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. Pneumonia is a pathology that becomes a test for both the newborn and his parents. Timely diagnosis and treatment will help 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.

Pneumonia 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 at term, the 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 breathing 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 mode of infection, symptoms, severity of the disease and possible consequences for a child.

Congenital pneumonia

This type of pneumonia develops in the womb and accounts for 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 different ways:

• transplacentally, i.e. the causative agent of the disease entered the child’s body through the placenta. Rarely encountered;
• antenatally - through amniotic fluid;
• intrapartum, or during childbirth.

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

Acquired

If the disease occurs after birth in the first month of the baby’s life, then it is called acquired. This type of pneumonia can be:

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

Causes

There are many factors contributing to the development of pneumonia in newborns. They pose a particular danger to premature babies. Often several of them can lead to illness at the same time:

• diseases suffered by a woman during pregnancy;
• use of steroids by the expectant mother;
• oxygen starvation and fetal suffocation;
• complications during childbirth;
• C-section;
• intracranial or spinal injury;
• intrauterine brain damage;
• genetic diseases of the lungs and other internal organs;
• unfavorable environment for raising a child;
• improper care of the baby.

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

In a premature baby, a cesarean section can trigger the development of the syndrome respiratory disorders, in which rapid, irregular breathing is observed and the risk of developing pneumonia increases. Such newborns require careful monitoring, examination and treatment.

Separate mention should be made of aspiration pneumonia. Its cause is often a violation of the child’s feeding regime, in which milk, formula, water, or vomit can enter the lungs. This type of pneumonia develops especially often in premature infants due to their predisposition to regurgitation.

Pathogens of pneumonia

Pneumonia is caused by viruses, bacteria or fungi, which can enter the lungs in two ways:

• hematogenously - in utero through 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 morbidity and mortality of newborns 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 bacillus) and other microorganisms.
2. Viral pneumonia can be caused by different types of herpes virus, in particular cytomegalovirus, as well as influenza virus, adenovirus and others.
3. Fungal pneumonia is more common in children who long time were on artificial ventilation, especially for premature babies. The causative agents of the disease can be fungi of the genus Candida, less often - Aspergillus, pneumocystis (an average between protozoa and fungi).
   

   Pneumocystis pneumonia, or pneumocystis, occurs mainly in premature infants. Infection with this microorganism can occur through contact with a carrier at home or in the maternity hospital. Feature 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 is added to viral or fungal inflammation of the lungs.

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

Symptoms and characteristics of different types of disease

Symptoms and characteristics of the disease depend on whether the baby 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:
   • decreased muscle tone;
   • lack of swallowing and sucking reflexes;
   • impaired blood circulation;
   • swelling of the legs (sometimes);
   • a large loss of the child’s body weight - 15–30%, as well as its slow recovery.
2. Infection during childbirth appears 1–2 days after birth. At the same time, the symptoms of intrapartum pneumonia differ from the symptoms of other types of intrauterine pneumonia.

Features of symptoms depending on the method of infection - table

Symptoms of acquired pneumonia

Acquired pneumonia in its symptoms resembles ARVI. The following signs are noted:

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

Symptoms and course of the disease depend on the pathogen:

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

Diagnostics

X-rays are important for diagnosing pneumonia.

In order to diagnose pneumonia in a newborn, the doctor carries out the following measures:

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

Doctor Komarovsky about methods of diagnosing pneumonia - video

Treatment and its timing

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

An important task of a mother during a child’s illness is to preserve breast-feeding. Breast milk strengthens the immune system and contains all the necessary substances that contribute to the baby’s recovery.

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 treated. With correct 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 treat. Its incubation period ranges from 8 days to 1 month. Total duration illness - 7–8 weeks, but 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

Level modern medicine 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 entire body as a whole and each organ and system separately.

Children who have had pneumonia have a much higher susceptibility to bronchopulmonary diseases. Adhesions and scars called alectasis may remain on the tissue of the lungs or bronchi. Speaking about the consequences for the baby’s health, it is necessary to mention the increased risk of developing anemia and rickets in premature babies who have suffered early pneumonia.

Prevention of illness before and after birth

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

• regularly visit the clinic and take all necessary tests;
• eat properly and balanced;
• give up bad habits;
• lead a healthy lifestyle;
• Avoid getting ARVI, influenza and other infections during pregnancy.

During childbirth, all measures must be taken to avoid fetal asphyxia. After the birth of the baby, you need to organize proper care for him, avoid hypothermia and contact with sick relatives. Important role Breastfeeding helps prevent pneumonia and other diseases. It improves 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 full recovery. Caring for the health of a child should begin not after birth, but from the moment of conception.