Pneumonia in newborns

Pneumonia in newborns. Etiology, pathogenesis. The etiology are important utero infection, aspiration of amniotic fluid, the immaturity of the lung tissue, atelectasis, pulmonary circulatory disorders, respiratory distress syndrome. There are prenatal and acquired pneumonia. At the heart of intrauterine pneumonia is transplacental (hematogenous) infection or aspiration of amniotic water and mucus (often a combination of reasons). Most children with intrauterine pneumonia are born from mothers with complicated obstetric history (acute or chronic infection during pregnancy, prolonged rupture of membranes, and so on. D.), In a state of asphyxia or hypoxia. Viral and bacterial pneumonia in neonates and premature babies usually develops on the background of respiratory diseases and can occur in the form of focal, drain and interstitial pneumonia (first two forms are more common).

The clinical picture. When intrauterine pneumonia observed hypo- or arefpeksiya; hypotension, pale-gray color of the skin, signs of respiratory distress. When you try feeding -rvota or regurgitation, in 2-3 days the intestinal paresis. In light wet finely wheezing or krepitiruyuschie. Characterized by a large decline in initial body weight (15-30%) and its slow recovery. Duration of illness 3-4 weeks. There is a high mortality rate.

Children become lethargic, drowsy, stop sucking, they appear cyanosis, shortness of breath, cough of varying intensity, sometimes foamy discharge from the mouth, the lungs are listened finely wheezing. Expressed respiratory failure. There are 3 degrees of respiratory failure: I degree - a slight shortness of breath, mild retraction intercostal spaces, blurred perioral cyanosis observed in repose; Grade II - involved in respiration auxiliary muscles, tachypnea alone expressed perioral and periorbital cyanosis; Grade III-respiratory rate more than 70 in 1 min with rhythm disorders, prolonged apnea, marked participation in the breath auxiliary muscles, nodding his head in-time with the breath, persistent widespread cyanosis. Almost always there are signs of cardiovascular disease. Signs of respiratory distress in children with low birth weight does not always correspond to the severity of the process. It reveals metabolic or mixed acidosis, alkalosis rarely. Often there is a sharp bloating caused by intestinal paresis. The toxic form of pneumonia with neurotoxicosis, hyperthermia, massive bleeding in the lungs observed in children weighing more than 2000. In peripheral blood - leukocytosis or leukopenia, a shift to the left in combination with neutropenia, but in some premature infants, even with severe diseases of the blood picture It corresponds to the age norm.

Diagnosis is based on anamnesis, clinical symptoms and the results of X-ray examination.

The differential diagnosis is carried out with pneumopathy, congenital heart and lungs, aspiration.

Treatment of the complex with regard to the shape, weight, condition of the child and its individual characteristics. What matters appropriate care for the child, a thorough ventilation of the chambers, free swaddling, elevated position with slightly upturned head, suction mucus from the mouth and nose, flatulence prevention. Antibiotics are indicated for any pneumonia. If the background of prescription drugs the disease progresses, it is necessary to replace the antibiotic. In the treatment of Pneumocystis carinii pneumonia appoint pentamidine -4mg / (kg â,¬ d) under the control of blood sugar levels, daraprim 1 mg / (kg day â,¬), quinine - 0.25 mg / (kg day â,¬). Apply etazol at 0.05-0.15 g 4 times a day in combination with ampicillin, tetraoleanom, tseporinom. If any form of pneumonia and needed oksigeno- aerotherapy. Aerotherapy used for children older than 3 weeks with a body weight of greater 1700-2000 In order to conduct detoxification infusion therapy 10% glucose solution, cocarboxylase (0.5 1 ml), a solution of 0.02% vitamin By 5% solution of vitamin C. (2.1 mL), aminophylline (0.15-0.2 ml of 2.4% solution). In decompensated acidosis is necessary to introduce sodium hydrogen carbonate solution. Total liquid jet administration at 10-12 ml / kg, with a drip total liquid volume of not more than 80 to 100 ml. With cardiovascular disease - or strofantin Korglikon, digoxin, sulfokamfokain. When toxic and asthmatic syndromes shown glucocorticoids and the appropriate symptomatic therapy.

The prognosis for timely treatment favorable.

Prevention is the prevention of diseases in the mother during pregnancy, toxemia, and aspiration asphyxia during delivery, providing proper care for the child.