Treatment of pneumonia in newborns, a medical reference book. Features of the treatment of pneumonia in newborns. How long do you have to stay in the hospital? Types of lung tissue damage in pneumonia

Pneumonia in infants is one of the most dangerous illnesses which can be fatal. Weak immunity the baby is not yet able to cope various infections, so bacteria quickly spread throughout the body, affecting important organs and systems. Infants are special patients, the treatment of pneumonia in them should be treated with great caution. You need to understand that not all medications can be taken in infancy. Treatment of infants is almost always carried out in a hospital setting.

Causes

Pneumonia in infants can occur for various reasons. The infant's susceptibility to respiratory infections explained by underdevelopment immune system and some structural features of the respiratory organs. The baby’s nasal passages are wide and short, and the openings of the trachea and pharynx are not yet fully developed. The mucous membrane of the respiratory tract in such babies is prone to swelling, which already makes shallow breathing difficult for the baby. In addition, the baby does not have the opportunity to cough well, so sputum accumulates in the bronchi and leads to the development of an inflammatory process.

U infant There are two types of pneumonia. They differ in the mechanism of development and symptoms.

1. Congenital - in this case, infection can occur in the womb or during childbirth;
2. Acquired - this form of the disease can develop during the first months of the baby’s life.

The causative agents of pathology in infants can be different pathogens. These include pneumococci, staphylococci, streptococci, as well as mycoplasmas, pathogenic fungi and chlamydia.

In children younger age Pneumonia is almost always very severe, with characteristic symptoms.

Congenital form

The cause of congenital pneumonia in infants is infectious diseases of the expectant mother. In this case, the baby becomes infected by ingesting infected amniotic fluid or through the placenta. How severe the disease will be depends on many factors:

• The more time passes from the moment of infection to the birth of the child, the more severe the disease will be.;
• from the pathogen. In many cases, the disease in infants is very severe if caused by viruses or mixed infections;
• on the degree of term of the child. In premature babies, any disease is more severe than in children born on time.

In addition, it is important general immunity baby and structural features of the body.

Any infectious pathology, suffered by the mother during pregnancy, can become a trigger for the development of pneumonia in the baby.

A child can be infected in the womb through blood. In this case, manifestations of pneumonia in the baby are observed immediately after birth. Pneumonia can be suspected based on the following characteristic signs:

• The muscle tone of such children is very weak and the limbs hang lifelessly;
• bluish or grayish skin;
• After birth, the baby does not scream or screams rather weakly. Breathing is difficult and more like moaning;
• Body temperature can fluctuate throughout the day. In full-term babies it reaches 40 degrees, and in very premature babies it drops to 35;
• All reflexes are poorly developed in sick children. They cannot breastfeed normally, so from birth artificial ventilation and tube feeding are indicated;
• after birth, the newborn may notice characteristic features asphyxia. Sometimes this condition is accompanied by foamy discharge from the mouth.

If an infant is diagnosed with pneumonia, he is admitted to the ward intensive care, where he remains until complete recovery. The higher the degree of prematurity of the child, the worse the prognosis.

Infection during childbirth

Infection of a baby can also occur when passing through the birth canal. IN such a case Signs of pneumonia appear a couple of days after birth. The main symptoms of the inflammatory process are:

• poor appetite, breast refusal and weight loss;
• dyspepsia – bloating, diarrhea and excessive regurgitation;
• the nasolabial triangle and tongue acquire a bluish tint;
• bluish or earthy skin tone;
• breathing is very noisy, it can be heard from a distance;
• body temperature is high, sometimes reaching critical levels;
• At times there is a weak cough.

In a newborn baby, the immune system is poorly formed, so pneumonia can be very serious consequences. If such a disease is detected, treatment is carried out in the infectious diseases department or intensive care unit.

When treating pneumonia in newborns, broad-spectrum antibacterial drugs are always used.

Acquired pneumonia

Acquired pneumonia occurs in infants under one year of age. There may be several reasons for the pathological phenomenon:

• significant hypothermia or overheating of the child;
• viral and infectious pathologies;
• asphyxia during childbirth and leakage of amniotic fluid into the respiratory organs;
• birth trauma, especially in which the brain was damaged;
• abnormalities in the structure of the respiratory organs;
• premature birth;
• delivery by caesarean section.

In addition, acquired pneumonia can be caused by accidental ingestion of vomit into the respiratory organs. This will lead to the development of infection and subsequent inflammation.

The inflammatory process always begins when viscous mucus stagnates in the respiratory organs. It is this phlegm that becomes favorable environment for the development of infection. Sometimes pneumonia begins in those children who were connected to the device in the first hours of life artificial ventilation lungs.

Acquired pneumonia can also be caused by improper child care. Thus, a poorly treated umbilical wound often becomes the entry point for infection.

How to recognize pneumonia in a baby

In many cases, the acquired form of the disease occurs as a complication after colds. To identify the disease in a timely manner and consult a doctor, you need to know the main signs of pneumonia. Adults should be wary of:

• coughing and high temperature, which is difficult to control with usual medications;
• dry cough and other symptoms colds lasts more than a week;
• the baby's skin acquires a bluish tint;
• the child is unable to inhale deeply and immediately begins to suffer from a cough;
• there is severe shortness of breath;
• The baby's nasolabial triangle may turn blue.

At the very beginning of the disease, the symptoms of pneumonia in an infant are mild, so distinguishing pneumonia from a respiratory disease can be problematic. The main signs of the disease may not appear immediately, but several days after the onset of the inflammatory process. First, the baby refuses to eat, then the temperature rises sharply and general malaise is observed.

In certain cases, pneumonia in infants occurs in a latent form, without high temperature And severe cough. This significantly complicates diagnosis and worsens the prognosis. Parents should be wary if the baby has no appetite, is lethargic and apathetic. A sign of the disease is the child’s severe thirst.

When pneumonia occurs in infants, intoxication quickly develops, and the child’s condition rapidly deteriorates. If treatment is not started in a timely manner, the baby’s body weight rapidly decreases.

Diagnostics

At the first symptoms of the disease, you should call a doctor and, if necessary, undergo a prescribed examination. To clarify the diagnosis, the following research methods are used:

• visual examination of the infant, while the doctor pays attention to the color of the skin and mucous membranes, as well as the depth of breathing;
• listening to the chest with a phonendoscope, Special attention pays attention to the duration of inhalation and exhalation;
• the doctor can gently tap the baby’s back to identify areas of inflammation;
• for rent general analysis blood and urine to determine the degree of inflammation and assess the patient’s general health;
• sputum is taken for bacterial culture. Based on the results of bacterial culture, antibacterial drugs are prescribed.

If the disease occurs without pronounced symptoms, then a chest x-ray must be taken. If there are dark areas in the image, then high probability we can talk about pneumonia.

When an inflammatory process in the lungs is detected, the child must be urgently hospitalized. The prognosis depends on how early treatment is started.

Treatment

The treatment regimen includes broad-spectrum antibacterial drugs. Most often prescribed drugs penicillin group or cephalosporins. Taking medications orally can be difficult due to age, so antibiotics are most often used in an injection solution. Antibacterial drugs are prescribed taking into account the results of bacterial culture. If the disease is caused by viruses, then antiviral drugs, for fungal pneumonia, antibiotics are not prescribed, but treatment is carried out with antifungal agents.

To eliminate the symptoms of intoxication, a sick child can be given intravenous infusions of saline and glucose. This may be supplemented vitamin preparations and immunomodulators.

Treatment must be supplemented with inhaled mucolytics and expectorants. This is necessary to dilute accumulated mucus and remove it quickly. For inhalations, the doctor may also prescribe alkaline solutions - mineral water such as Borjomi or soda solution.

For treatment of pneumonia in infants to be effective, it is necessary to strictly adhere to all doctor’s recommendations. Do not exceed the dosage of drugs or replace them with analogues.

In a sick child's room, you should often wet clean it and open the window for ventilation. During this time, the baby is transferred to another room. It is very important to comply drinking regime. A baby with pneumonia should be given plenty of fluids. It could be pure water, tea, compote or herbal decoction prescribed by a doctor. Treatment may be supplemented with certain prescriptions traditional medicine, but they are agreed upon with a pulmonologist.

Editor

Anna Sandalova

Pulmonologist

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 through the placenta during pregnancy, amniotic fluid or along 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, severe and sharp increase fever, weak and muffled scream, blue skin, rapid heartbeat and breathing, belching, 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, the drug is administered parenterally (injection), but it is also possible oral administration(swallowing).

It is difficult to clearly differentiate pneumonia (what its origin is), and lengthy diagnostics to determine the causative agent 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 a wide spectrum of 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 of 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 (maintaining 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 more on the child himself and his immunity than on. 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.

Usually, acute period 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. Extremely severe cases Possible death. Therefore, under no circumstances should you engage in self-diagnosis and be treated 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 The child has. Therefore, it is better to abandon folk remedies.

• compliance with bed rest;
• fractional and carefully selected;
• taking prescribed medications in a timely manner.

Lactation

How long does the treatment and recovery process last? In general, if the child is not in an 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;
• lactation;
• fractional proper nutrition;
• healthy image life.

Thus, timely appeal to a doctor in a medical institution, 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 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 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 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 with pathogenic microflora located in the mother's birth canal, 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 child's lungs contain a small amount of fluid that is expelled during natural delivery. During a caesarean section, the organs do not have time to adapt to new 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 it is caused by a viral or fungal inflammation a bacterial infection occurs in 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, herpes simplex virus and Candida fungi.
2. The most common pathogens of acquired pneumonia are viruses (respiratory syncytial, parainfluenza and others), gram-negative intestinal microflora, and staphylococci. Less often community-acquired inflammation lungs are caused by Moraxella (a 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 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

To diagnose pneumonia important has radiography

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 everything 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 symptoms respiratory failure, restoration of appetite, normalization of the nervous system.

Inflammation of the lungs caused by pneumocystis takes longer to treat. His incubation period ranges from 8 days to 1 month. The total duration of the disease is 7–8 weeks, but in premature infants 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 infants who have had early pneumonia children.

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;
• to refuse from bad habits;
• lead a healthy lifestyle;
• Avoid 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. Breastfeeding plays an important role in the prevention of 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.

Pneumonia of the newborn (Neonatal pneumonia) is an infection of the lungs in newborns. Pneumonia in children can develop within a few hours after birth and be part of generalized sepsis, or begin after 7 days and relate only to the lungs. Signs of neonatal pneumonia may be limited to respiratory distress or demonstrate severe symptoms right up to death. The diagnosis of neonatal pneumonia is made by clinical and laboratory assessment of sepsis. Treatment of neonatal pneumonia is based on speedy use antibiotics wide range actions.

Pneumonia in a newborn baby is the most common invasive bacterial infection after primary sepsis. Early onset pneumonia is part of generalized sepsis that first appears within hours or birth (see neonatal sepsis). Late start Pneumonia usually occurs after 7 days of age, most often in neonates in pediatric intensive care units who require prolonged endotracheal intubation due to lung disease (called ventilator-associated pneumonia).

Etiology of pneumonia of the newborn

Bacterial organisms come from the mother's reproductive tract or umbilical cord. These organisms include gram-positive cocci (for example, groups A and B streptococci, Staphylococcus aureus) and gram-negative rods (for example, coli, Klebsiella, Proteus). Methicillin-resistant Staphylococcus aureus occurs in late stages ventilator associated pneumonia. In infants who have received broad-spectrum antibiotics, many other pathogens may be found, including Pseudomonas, Citrobacter, Bacillus, and Serratia. Viruses and fungi cause some cases of pneumonia in newborn babies.

Symptoms and signs of newborn pneumonia

Pneumonia appears with unexplained worsening after birth respiratory state patient and increased number and changes in airway quality. Infants may become acutely ill, with temperature instability and neutropenia (decreased number of neutrophils in the blood).

Diagnosis of pneumonia in a newborn

Chest X-ray

Evaluation includes chest x-ray, pulse oximetry, blood culture, and tracheal puncture with aspiration of secretions (transtracheal aspiration method).

New, persistent infiltrates should be visible on a chest x-ray but may be difficult to recognize if the child has severe bronchopulmonary dysplasia.

If a significant amount of polymorphonuclear granulocyte elastase and a single organism that matches that growing from a tracheal aspiration culture is found, the likelihood that this organism is the cause of neonatal pneumonia increases. Because the bacterial pneumonia may spread in neonates, a full sepsis evaluation should be performed, including lumbar puncture. However, blood cultures are positive in only 2 to 5% of cases of ventilator-associated pneumonia.

Treatment of pneumonia in a newborn

Usually Vancomycin and Cefotaxime

Antimicrobial therapy early in the disease is similar to the treatment of neonatal sepsis. Vancomycin and cefotaxime are the initial choice for the treatment of most advanced cases of ventilator-associated pneumonia. This method treats sepsis as well as pneumonia with typical hospital-acquired pathogens. More specific antibiotics are prescribed after resistance results are obtained. General treatment the same as for neonatal sepsis (see chlamydial pneumonia: treatment).

In most health care settings, initial empirical therapy consists of Ampicillin, Gentamicin, or Cefotaxime. Dosage regimens vary depending on gestational and postnatal age and renal function. Observational studies have shown an increase in adverse outcomes, including increased risk death in neonates receiving cefotaxime more than gentamicin as a routine component of initial empiric treatment in neonates.

Treatment of neonatal pneumonia

Treatment of children with neonatal pneumonia is multifaceted. The goal of therapy is to eradicate the infection and achieve adequate gas exchange support to ensure the survival and ultimately well-being of the child.

Options for targeted treatment of inflammation, regardless of antibiotic therapy, are significantly limited. There is considerable speculation that current antimicrobial agents aimed at killing invasive organisms may temporarily worsen inflammatory cascades and associated injuries child because dying organisms release pro-inflammatory structural and metabolic components into the surrounding microenvironment. This does not mean that eradicating invasive microbes should not be a goal; however, other methods to eradicate pathogens or methods to directly influence pathological inflammatory cascades await further identification.

Drainage restrictive or pleural effusion or empyema may increase clearance of infection and improve lung mechanics.

Even if the infection is cleared, many children develop long-term or permanent changes in the lungs that negatively affect lung function, quality of life, and susceptibility to infection later.

As a result of neonatal pneumonia non-infectious causes, effective and safe anti-inflammatory therapy may be even more important.

Chlamydial pneumonia of newborns

Exposure to chlamydial organisms during childbirth can lead to the development of chlamydial pneumonia between 2 and 18 weeks. Babies are heavy but usually not critically ill; may also have a history of conjunctivitis caused by a bacterial organism. Eosinophilia may be present and x-rays may show bilateral interstitial infiltrates with hyperinflation.

Treatment with Erythromycin leads to quick deliverance from chlamydial pneumonia of a newborn. However, erythromycin in neonates may cause hypertrophic pyloric stenosis; all neonates treated with erythromycin should be monitored for symptoms and signs of HES, and their parents should be aware of the potential risks. Azithromycin 20 mg/kg orally once/day for 3 days may also be effective method treatment. A diagnosis of chlamydial pneumonia should prompt an assessment of the health of the mother and her partner, because women chlamydial infection may have complications such as inflammatory diseases pelvic organs and infertility.

Risks, containment and prevention of neonatal pneumonia

Risk factors for newborn pneumonia are:

• Presence of Streptococcus bacteria in the birth room
• Premature birth
• Membrane rupture more than 18 hours before delivery
• Temperature during childbirth
• Septicemia caused by group B streptococcus
• History of a previous child with neonatal sepsis and streptococcal infection Group B

Preventive strategies may include prenatal and intrapartum treatment with broad-spectrum antibiotics in mothers with premature rupture of membranes or in mothers with suspected chorioamnionitis.

There is currently little evidence to suggest potential effectiveness following measures in newborns:

• Head lift
• Use of antireflux medications

Denial of responsibility : The information presented in this article about neonatal pneumonia is intended to inform the reader only and is not a substitute for consultation with a healthcare professional.

Pneumonia - inflammation lung tissue, which has an infectious or bacterial nature, still remains one of the most dangerous diseases, the final outcome of which can be death. According to the World Health Organization (WHO), pneumonia is one of the 10 diseases that can lead to death, especially in childhood. According to statistics, the most vulnerable to this disease are children in the first year of life, most often premature.

Causes of the disease

Due to its physiological and anatomical characteristics, babies are often susceptible to respiratory diseases, which is due to their fragile immunity and imperfection respiratory system. The lumens of the larynx, bronchi, trachea and nasal passages are still very poorly developed, and the mucous membrane tends to swell quickly, which complicates the child’s already shallow breathing. In addition, infants are not able to get rid of sputum on their own, and it excessive accumulation in the bronchi, slows down the healing process and causes a severe cough.

Infants are susceptible to two types of pneumonia:

1. Congenital – when infection occurs in the womb or during childbirth.
2. Acquired – occurring in the first months of a baby’s life.

As a rule, the causative agents of the disease are:

• streptococci;
• pneumococci;
• staphylococci;
• herpes virus;
• chlamydia;
• mycoplasma;
• cytomegalovirus;
• fungus type Candida;
• Haemophilus influenzae and Escherichia coli.

Congenital form of the disease

The cause of the congenital form of pneumonia is a consequence of a disease suffered by a woman during pregnancy, in which viral agents enter the child’s body through the placenta or amniotic fluid. The severity of the congenital form of the disease can vary and depends on a number of factors:

1. The length of time that elapses from the moment of infection to the birth of the baby, the longer it is, the more difficult the disease will progress;
2. The causative agent of the disease;
3. The degree of term of the newborn;
4. Individual characteristics child's body, immunity.

Infection in the womb

If the fetus is infected in the womb, through the blood (hematogenous method), the disease is diagnosed immediately after the baby is born and is characterized by the following symptoms:

1. Weak muscle tone - the child’s movements are sluggish, limbs hang down, muscles are in a relaxed state;
2. The color of the skin varies from gray to bluish;
3. Immediately after birth, the baby does not cry or his cry is very weak, and his breathing is hoarse and intermittent, more like groans;
4. Unstable body temperature. For premature babies, a decrease to 35˚ C is typical, and for newborns born at term, an increase to 40˚ C;
5. The baby has no or weakly expressed congenital reflexes (breathing, swallowing, sucking). Such children are on artificial ventilation after birth and receive nutrients through a special probe;
6. After birth, the baby exhibits obvious signs of asphyxia;
7. Foamy discharge from the mouth is possible.

Infection during childbirth

Infection of the baby can occur during its passage through infected birth canal, in this case pathogenic microorganisms penetrate through the baby’s lungs (bronchogenic method), and signs of inflammation that appear on days 2-3 are characterized by the following symptoms:

• Lack of appetite, breast refusal, great loss weight;
• Indigestion, diarrhea, cramps and bloating;
• Frequent regurgitation and vomiting;
• A bluish tint to the nasolabial triangle and tongue;
• Pale or earthy-gray skin color;
• Whistling, noisy, arrhythmic breathing;
• Increase in body temperature to very high values;
• Sometimes a superficial cough;
• Poor breathing in premature babies;

Due to the lack of immunity, pneumonia for newborn children is quite serious disease and can lead to aggravating consequences. When making such a diagnosis, urgent drug treatment baby in a hospital or maternity hospital.

Acquired pneumonia

Acquired or postnatal form of pneumonia can develop in infants in the first months of life, at home or inpatient conditions, for several reasons:

1. Viral diseases;
2. Hypothermia or overheating of the child;
3. Asphyxia during childbirth and penetration into Airways amniotic fluid;
4. Intrauterine brain damage;
5. Birth injury;
6. Deviation in the development of the respiratory system;
7. Premature birth;
8. Childbirth by caesarean section;
9. Ingestion of vomit into the respiratory tract of a newborn.

Symptoms of the disease

In most cases, acquired pneumonia develops as a consequence improper treatment colds and viral diseases. What symptoms should young parents pay attention to in order to identify and recognize incipient pneumonia, advises Dr. Komarovsky:

1. The main signs of the disease are a dry, superficial cough and fever, which cannot be brought down with the help of antipyretics;
2. ARVI, cold, severe dry cough, lasting more than a week;
3. The skin becomes pale gray;
4. The child's attempt to make deep breath accompanied by a severe cough;
5. The frequency and depth of breathing is impaired, shortness of breath appears;
6. Blue discoloration in the area of ​​the nasolabial triangle.

At primary disease, the symptoms of pneumonia are mild and very similar to the manifestations of acute respiratory infections and acute respiratory viral infections. Signs of the disease may not appear immediately, but several days after the onset of the inflammatory process. The onset of the disease is accompanied by a sharp rise in temperature, weakness, refusal to eat and general malaise. With further development of the disease, the above symptoms appear.

The level of severity of acquired pneumonia depends on the degree of formation of the newborn’s body, in premature infants clinical picture the disease will be more severe than in babies born at term.

Pediatrician Evgeniy Komarovsky warns that in some cases, pneumonia in newborns is hidden and is not accompanied by symptoms such as cough and fever, because of this timely diagnosis quite difficult. Therefore, the task of parents and doctors is to identify and recognize other signs of the disease in a timely manner. Komarovsky notes that the latent form of the disease is characterized by symptoms such as lethargy, drowsiness, thirst and lack of appetite.

Types of lung tissue damage in pneumonia

With any type of pneumonia, the degree of damage to the lungs is not the same, and this determines how severe the symptoms of the disease will be. Based on the location and severity of damage to the lung tissue, several types of inflammation can be classified. The most common is focal pneumonia, which affects small area lung, it is characterized by symptoms such as wet cough, temperature and increased sweating. With total inflammation, one of the lungs is completely affected, and bilateral inflammation covers both organs at the same time,

Diagnosis and treatment

Dr. Komarovsky advises: at the first suspicion of pneumonia, the baby’s parents should urgently contact medical institution and undergo the appropriate examination:

• Visual examination of the skin and mucous membranes of the baby;
• Listening to the lungs for the presence of wheezing and the duration of inhalation and exhalation;
• Tapping the chest to identify inflamed areas;
• Biochemical and general blood test;
• General urine analysis;
• Bacteriological cultures of sputum;
• X-ray or fluorography of the chest.

When a diagnosis of pneumonia is made, the infant requires immediate hospitalization. The sooner treatment is started, the more likely a successful outcome of the disease and the absence of complications.

In most cases, treatment of pneumonia begins with broad-spectrum antibacterial drugs, either orally or intramuscularly.

In addition to them, the doctor may prescribe immunomodulatory drugs and vitamin complexes.

Play a major role in successful anti-inflammatory therapy herbal infusions or medicines, which relieve swelling from the mucous membranes, transform a dry cough into a wet one, and promote the rapid discharge of sputum.

To relieve symptoms of intoxication, measures are taken to administer intravenous saline solutions.

Dr. Komarovsky advises to accompany the treatment of a sick baby by performing elementary rules hygiene and prevention. The room where it is located must be subject to daily wet cleaning, ventilation, and maintain optimal levels of temperature and humidity. The child should drink as much fluid as possible and eat more often, but in small portions so as not to overload gastrointestinal tract. Good help in complex treatment, after the patient’s condition improves, a massage will begin to help cleanse the respiratory system of phlegm.

Important preventive measures to fight pneumonia, is vaccination against pneumococcal infection.

Possible complications

Timely and competent treatment gives effective results, the disease can be defeated within 10 – 15 days. Belatedly started antibacterial therapy and, if the pneumococcal vaccination is not done on time, it is fraught with a number of complications:

1. Cough that persists for a long time after the end of treatment;
2. Inflammation of the lungs caused by pneumococci can further lead to otitis media and meningitis;
3. If during the course of the disease he suffers serosa respiratory organs (pleura), there is a possible risk of developing pleurisy, causing the child severe chest pain;
4. A protracted illness is likely to take chronic form, and any further respiratory diseases the child may be provoked by another pneumonia;
5. Sepsis of lung tissue.

Prevention of pneumonia

The disease is easier to prevent than to cure, therefore, to reduce the risk of infection, pediatrician Evgeniy Komarovsky advises parents of infants to follow some preventive measures:

• Competent planning and management of pregnancy (timely testing and regular visits to the antenatal clinic);
• Timely detection and treatment of inflammatory processes during pregnancy;
• Compliance with the regime and a healthy lifestyle;
• Vaccination against pneumococcus;
• Feeding a newborn with breast milk;
• Correct and balanced diet mothers;
• Avoiding contact with infected people.

In the last few years in Russia, the list mandatory vaccinations, a vaccination against pneumococcal infection was included, represented by the Prevenar (USA) and Pneumo-23 (France) vaccines. The first vaccination is given to infants starting at 2 months of age, the second to children from 2 to 5 years of age.

Children's doctor Evgeniy Komarovsky believes that timely vaccination against pneumococcal infection can protect a child in the future from the occurrence of such serious illnesses, such as pneumonia, tonsillitis, otitis media and meningitis.