Sepsis of newborn

Neonatal sepsis. The most susceptible premature infants.

Etiology, pathogenesis. The causative agent is different pathogens and opportunistic pathogens (Staphylococcus aureus, Salmonella, Escherichia coli and Pseudomonas aeruginosa, and others.). Infection of the fetus and newborn may occur in the ante-, intra- and post-natal periods. Important role played by acute and chronic infectious diseases in the mother, and various obstetric interventions, prolonged rupture of membranes, endometritis, the presence of other chronic inflammatory foci in the mother (purulent mastitis, etc.). Contributing factors are intrauterine hypoxia, intracranial birth trauma, the immaturity of the newborn, newborn skin damage during obstetric operations and manipulations such as intubation, umbilical catheterization and subclavian veins, and others. A large role in the generalization of the process belongs to a viral infection. The input gate more often wound surface of the skin, mucous membranes, umbilical wound and umbilical vessels, as well as the intact skin and mucous membranes of the upper respiratory tract, gastrointestinal tract. In utero infection sepsis focus is usually localized in the placenta, or any body of the pregnant woman. Often the entrance gate and the primary septic focus can not be determined.

The process can proceed by septicemia type (mainly preterm, term weakened) or septicopyemia. Septicaemia is characterized by an intoxication of an organism without local chronic inflammatory foci, while at septicopyemia piemicheskie detected lesions (abscesses, cellulitis, osteomyelitis, pneumonia destructive type with pleural complications, purulent meningitis, otitis media, and others.).

The clinical picture. As a rule, septicemia in the newborn runs hard. There are acute (within 3-6 weeks), subacute (1.5-3 months), prolonged (more than 3 months) and fulminant course of the disease. Depending on the entrance gate of infection distinguished navel, skin, lung, intestinal, otogenny sepsis.

If the septic process occurs in the antenatal period, and the child is already born ballroom, his condition is severe: marked regurgitation, vomiting, fever, pale grayish skin coloration often with extensive dermatitis such as pemphigus, hemorrhagic rash, jaundice, swelling, exsicosis, enlarged liver and spleen a large initial weight loss tala, greenish coloration fetal waters, or the child is born dead. Sepsis, which developed intra- and postnatally, often characterized by gradual onset -uhudsheniem general state of the first or second week of life, skin pallor, regurgitation, low grade fever or hypothermia, considerable diminution, flattening the curve of body weight, an increase in the duration and increased severity of jaundice , hemorrhagic phenomena in the mucous membranes, pyoderma. There have been mummification retention and separation of umbilical residue omphalitis, prolonged bleeding of the umbilical wound with a late epithelialization, long falling off bloody scab in the center of the navel, a symptom of a second revealed the navel, unstable stupas, interstitial pneumonia and others. Strengthening of clinical symptoms (weight loss, weakening of the physiological reflexes, weakness, muscle hypotonia, anxiety, regurgitation, stools with mucus and greens, bloating) are often accompanied by growing changes around the umbilical vessels - puffiness or pasty abdominal wall, redness of the skin over the arteries, increasing the grid subcutaneous veins, thickening of the umbilical vein or artery , the growth of umbilical bleeding wounds. If septicemia is dominated by symptoms of intoxication on the part of the central nervous system, disorders of the respiratory and cardiovascular systems, shifts in homeostasis (decompensated acidosis), is characterized by the appearance of various pyosepticemia piemicheskih foci. Isolation of the pathogen from the blood child is valuable, but not necessarily diagnostic criterion. In peripheral blood are often marked by anemia, leukocytosis, often with shifts leukocyte formula to the left; in urine - transient albuminuria, bacteriological and leucocyturia.

Diagnosis is based on signs of infection in the ante- and intrapartum periods, there are multiple foci of infection, the severity of the general symptoms, blood culture seeding, dysgammaglobulinemia.

The differential diagnosis is carried out with immunodeficiencies, intrauterine infection (salivary gland disease, toxoplasmosis), acute leukemia, severe purulent unit at the site of infection.

Treatment. Patients are subject to immediate hospitalization specialize. TED neonatal pathology, if necessary, surgical intervention - in surgical departments (wards) for newborns. It is desirable feeding mother's milk (breast or the mother's expressed breast milk through a tube from the nipple). As shown pronounced toxicity, especially with dyspepsia, respiratory failure, total amount of milk in the daily diet of children to be reduced by 30-50% in 1-3 days; You can go on feeding the fractional go even a drip of milk through the nipple, the probe. Missing number compensated liquid milk (0.9% sodium chloride solution, Ringer's solution, glucose solution orally) in the intervals between feedings; in severe cases, solutions are administered parenterally.

In children with recurrent bouts of suffocation, vomiting, intestinal paresis before the introduction of breast milk or liquid suctioned mucus from the upper respiratory tract, the stomach is washed. The greatest therapeutic effect makes use of broad-spectrum antibiotics - semisynthetic penicillins: ampicillin sodium salt of 100-200 mg / (kg day â,¬) / m in 4 divided doses; ampioksa 100-200 mg / (kg day â,¬) in 4 doses / m; tseporina 50-100 mg / (kg day â,¬) / m in 3-4 divided doses or /, lincomycin hydrochloride, 20 000-30 000 U / (kg day â,¬) in 2 hours, gentamicin sulfate 20 mg / (kg â,¬ d) into 4 doses or 4.3 mg / kg, 3 times a day, and others. Antibiotics are often used parenterally (V / m, and at unfavorable course of sepsis and endangered sostoyaniyah- w / w). The ineffectiveness of antibiotics requires replacement. The duration of one course of antibiotic treatment by an average of 7-14 days; undulating and prolonged course of the disease is an indication for several consecutive courses, with repeated administration of the same antibiotic should be avoided. Treatment is continued until a stable therapeutic effect. When purulent meningitis antibiotics introduced into / m, in / in and endolyumbalno in large doses.

For detoxification appoint gemodez, reopoligljukin 10% solution of glucose, plasma is 5-10 ml / kg / jet, with nature-staphylococcal disease antistaphylococcal immunoglobulin (20 AU / kg for 7-10 days), exchange transfusion of fresh heparinized blood, plasma transfusion, 15 ml / kg. Corticosteroid hormones used only when pronounced intoxication in the acute stage of the disease or protracted course - prednisolone at a dose of 1-2 mg / (kg day â,¬). Purulent meningitis, empyema, abscesses, acute destruction of the lungs are contraindications to hormones. If necessary, surgery is performed early.

A one-time amount of the liquid jet at the introduction should not exceed 15-20 ml of full-term and preterm infants 10 ml; / in the drip solution newborns should not take more than 3-4 hours at the rate of 30-40 ml / kg at a frequency of 6-12 drops in 1 min. If necessary, a constant infusion therapy (exsicosis, pronounced bowel syndrome, and others.) Shows the vein catheterization (drip 40-60 ml of liquid 4-6 times a day). The introduction of large amounts of glucose should be combined with the appointment of insulin (4-5 g of dry glucose 1 unit of insulin). When violations of hemodynamics recommended rehydration therapy (concentrated or regular plasma with simultaneous administration of 0.1 ml of 2.5% solution pipolfen), before which administered 0.1 ml of 0.06% Korglikon solution. In order to use the dehydration la ziks- 1 mg / (kg day â,¬) 2-3 hours (w / o or w / w); 15% mannitol solution at the rate of 1 g of dry matter per 1 kg of body weight per day (in / drip) and OE diuretics are contraindicated in patients with renal insufficiency, anuria. Infusion therapy should be under the control of the parameters of homeostasis (acid-base status, blood sugar, electrolytes, hematocrit), ECG, blood pressure.

Children with severe cardiovascular disease (tachycardia, cyanosis seizures general cyanosis, an increase in liver, etc.). Korglikon administered, strophanthin (0.05% solution of 0.05-0.1 ml per 10 ml of 10% glucose solution) digoxin. To remove hyperexcitability shown phenobarbital, chlorpromazine, pipolfen and others. When necrotizing colitis appointed interior Shostakovskiy balm, rosehip oil or sea buckthorn 1/2 teaspoon 2 times a day. Vaccinations for children who have had sepsis, are allowed to carry out no earlier than 6-12 months after complete recovery on the conclusion of the medical council.

Forecast serious, mortality reaches 10 to 20%.

Prevention: control of the pregnancy, compliance with the conditions for women, early detection of diseases; prevention of intra- and post-natal infection.