Pneumonia is a very common pathology in babies who were born prematurely. Why can such babies develop this disease, how is it treated, and is it possible to prevent its occurrence in a baby?
Features:
- Congenital pneumonia in premature babies is much more common than in babies born at term.
- The incidence of aspiration pneumonia in these children is also increased due to their tendency to regurgitate.
- The disease is often combined with circulatory problems, intestinal infection, hemolytic disease and other pathologies.
- The acute period of the disease in children born prematurely lasts longer.
- The dominant symptoms of ailment in newborns are manifestations of respiratory failure and intoxication.
- Fever in premature infants is less common than hypothermia.
- Very often there are complications that can be extrapulmonary.
- Pneumonia in prematurity often leads to the development of sepsis.
Causes
Lung inflammation in premature babies is caused by bacteria, parasites, fungi or viruses. Various factors contribute to their entry into the baby's respiratory tract, among which the main ones are called immaturity of the lungs, aspiration during childbirth, infections during intrauterine development and ARVI.
The alveoli in the lungs of a baby who was born prematurely are generally not fully extended, and the surfactant may be of poor quality or immature. Besides, in such babies in the lungs immediately after childbirth, metabolic processes are disrupted and circulatory disorders are observed.
As for the predisposing factors, the appearance of pneumonia in babies born prematurely can be triggered by:
- Caesarean section.
- Problems with bearing, which led to hypoxia or asphyxia.
- Infectious diseases in a pregnant woman that affect the respiratory or genitourinary system.
- Hereditary diseases of the respiratory system (pneumopathies).
- Lesions of the central nervous system of the child, as well as birth injuries that have affected the spinal cord or brain.
- Resuscitation measures during childbirth.
- Malformations in a baby.
- Improper care of the baby, for example, prolonged stay of the baby in one position, poor ventilation of the room, hypothermia of the baby or overheating.
- Poor sanitary and epidemiological conditions in the maternity hospital.
Parasitic pneumonia in babies born prematurely, are most often caused by pneumocysts, which can get to the baby from a sick person or carrier (often from staff in the hospital).
Fungal pneumonia, which most often causes candida, is due to candidiasis in the mother or as a result of inappropriate treatment of a premature baby with broad-spectrum antibiotics.
Forms of pneumonia
Depending on the cause and circumstances that contributed to the onset of pneumonia, pneumonia is:
- Congenital... The baby becomes infected transplacentally, that is, from the mother, the pathogen enters the body of the crumbs through the placenta. Most often, these are pneumonia caused by rubella virus, cytomegalovirus, toxoplasma, listeria, herpes virus, mycoplasma and other pathogens.
- Antenatal... The baby becomes infected during childbirth, when it passes through an infected birth canal or amniotic fluid containing the pathogen enters its lungs. Typically, such pneumonia is caused by mycoplasmas, streptococci, haemophilus influenzae, candida, trichomonas, ureaplasma, listeria, tubercle bacilli, herpes viruses, chlamydia and other infectious agents.
- Postnatal... The baby becomes infected after giving birth in a hospital or at home. Such inflammations are mainly caused by Klebsiella, Escherichia coli, Staphylococcus aureus, Proteus, Pseudomonas aeruginosa, Enterobacteriaceae and other pathogens.
Symptoms
At the onset of the disease, nonspecific signs may predominate. The baby's general condition worsens, body weight can change dramatically due to the appearance of edema. Also, pneumonia can manifest itself:
- Subfebrile or low temperature.
- Inhibition.
- Bad sucking.
- Irritability.
- Pallor of the skin.
- Bloating.
Further, breathing disorders are added to such symptoms. The baby begins to breathe frequently, the wings of the nose swell, wheezing becomes audible, attacks of apnea, periodic breathing, coughing appear, there are retractions of the gaps between the ribs, the heart rate increases, and frothy mucus can be released from the mouth.
Diagnostics
To identify pneumonia in a premature baby, use:
- Anamnestic data.
- The clinical picture.
- X-ray examination. On the roentgenogram, darkening is found at the sites of inflammation.
- Laboratory data. In the blood of a child with pneumonia, a stab shift, a decrease in hemoglobin, a decrease in the number of platelets, and leukopenia will be noted. In addition to a clinical blood test, children with suspected pneumonia are prescribed a virological or bacteriological examination, urinalysis and a blood gas analysis.
Treatment
Pneumonia in children born prematurely is treated only in a hospital setting. At the same time, babies should stay in special departments in intensive care units, and their mother is next to the baby and helps to care for the baby.
The newborn should be in optimal conditions for him to prevent overheating or hypothermia of the baby. During the day, the position of the child is often changed, and the clothes should not hinder the movements of the baby. The type of feeding and the amount of food received is determined by the doctor taking into account the condition of the baby, but often children with pneumonia are injected parenterally with nutrients.
The following methods are especially important in the treatment of such an ailment in newborns:
- Antibacterial drugs... In the early days, the antibiotic is selected at random using a wide range of drugs. As soon as the results of culture and antibiotics are obtained, a drug is prescribed to which the pathogen is sensitive. The medicine is administered parenterally.
- Oxygen therapy. The baby is dosed with 35% heated oxygen using a mask, catheter or other devices.
- Passive immunization. The infant is prescribed the administration of immunoglobulins and plasma.
- Other medicines according to indications... If required, the child is given heart medications, probiotics, bronchodilators, glucocorticoids, and other medications.
Some babies are prescribed bronchoscopy to debride the lungs. Many children are recommended to perform massage - both general and vibration.
Potential consequences and complications
Inflammation of the lungs in a premature infant can be complicated by atelectasis, pleurisy, pneumothorax, and other lung pathologies. Among the extrapulmonary complications in children born prematurely, hypotrophy, otitis media, hemodynamic disorders, sclera, adrenal insufficiency, bleeding, and various metabolic disorders are often diagnosed. One of the most dangerous complications of pneumonia in a premature baby is sepsis.
Babies who have had pneumonia have an increased risk of anemia, thrush, and rickets.... In addition, many children develop pneumonia after bronchopulmonary dysplasia, which becomes the cause of recurrent diseases of the lungs and bronchi.
Prevention
To prevent pneumonia in a premature baby, it is important to eliminate the factors provoking the disease:
- The expectant mother should monitor her health and treat infections in a timely manner.
- In the maternity hospital and children's hospitals, it is important to strictly observe the sanitary and epidemiological regime.
- A newborn with asphyxia should be given timely and correct resuscitation measures.
- Babies should be applied to the breast and fed with human milk immediately after childbirth.
- If a newborn, born prematurely, has breathing disorders, and also has predisposing factors (difficult childbirth, mother's illness, and others), it is advisable to prescribe an antibiotic immediately after delivery.
- At home, you need to monitor the hygiene, microclimate and daily routine of the newborn.
