Diseases in newborn symptoms
Mar 06, 2018
The period of the newborn begins with the first inhalation of the baby and the ligation of the umbilical cord and lasts 3-4 weeks. This period is characterized by immaturity of all organs and systems, especially the central nervous system, as well as a number of functional, biochemical and morphological changes caused by the transition from intrauterine development of the fetus to the extrauterine life of the child.
The organism of the newborn is characterized by the great lability of water metabolism. The average water requirement is 160-200 g / kg of baby per day. All the basic functions of the body are in a state of unstable equilibrium;even a slight violation of environmental conditions can lead to serious changes in the body and some physiological processes easily become pathological. All this requires special hygienic conditions and careful special care for newborns, the correct organization of feeding.
For the newborn period, special conditions bordering physiology and pathology are characteristic, for example, erythema of newborns, physiological jaundice, physiological mastitis, transient fever, physiological weight loss, albuminuria, uric acid infarct of the kidneys, and sexual crises.
Diseases of the newborn period also have principal features. In this period, the following can be observed:
1) congenital diseases that have developed in the child in utero( toxoplasmosis, congenital viral hepatitis, cytomegaly, listeriosis, congenital malaria, tuberculosis, syphilis);
2) diseases caused by congenital malformations of organs and systems( congenital malformations of the heart, lungs, gastrointestinal tract, etc.);
3) diseases associated with the birth act, birth trauma( damage to the skeleton, peripheral and CNS - cerebrovascular disorders of the brain, the effects of intrauterine asphyxia, cerebral hemorrhage, paresis and paralysis);4) hemolytic disease of newborns, hemorrhagic disease of newborns and other blood diseases;
5) diseases caused by the infectious origin and, above all, the cocci flora, to which the newborn is helpless, and the infection can occur in utero, during childbirth and after childbirth. There is a tendency to rapid generalization of the process with the development of severe septic and toxic-septic conditions, pneumonia.
To some diseases( measles, rubella), newborns are not susceptible, since the mother is still in utero, and then with breast milk passes on the child specific antibodies.
In the newborn period, they are short-lived, never repeated in the future, but under unfavorable conditions they can go into the pathological process.
Albuminuria - increased protein in the urine to 0.25 g / l: observed in almost all newborns during the first week of life and is due to increased capillary permeability and increased erythrocyte decay, as well as stagnation in the kidneys during childbirth. Treatment is not required.
Urinary renal infarction of the .In the first 2-4 days of life, a newborn has 4-5 urination per day( due to limited fluid intake), by the end of the first week it already happens 15-20 times a day. Urinary acid infarctions are observed in the first days of a child's life and are caused by increased formation of uric acid due to the increased disintegration of cellular elements and protein metabolism, as well as a small amount and high concentration of urine with a high urate content.
Urine is colored reddish and leaves reddish-brown spots on diapers. With an increase in the amount of fluid and excreted urine during the first 10-15 days, the infarction passes without a trace. Treatment is not required.
Sexual crises. Regardless of the sex of the child in the first days of life, there may be an increase in mammary glands, usually bilateral. From the nipples with pressure( which is contraindicated), a fluid resembling colostrum is secreted. The condition is caused by the transition of estrogen hormones from the mother in utero to the fetus. As the child's body is freed from maternal hormones, swelling of the mammary glands disappears. In girls, as a result of the presence of maternal sex hormones in the body, mucous, bloody discharge from the sexual fissure can appear. In addition, swelling of the genitalia can occur. All this usually happens on the 5th-7th day of life and persists for several days. Treatment of sexual crisis is not required. Only with a very large increase in the mammary glands is recommended dry heat in the form of a cotton bandage and with vaginal discharge - toilet with a weak solution of potassium permanganate( 1: 5000-8000).
Transient fever is observed more often in children born with a large body weight, in the period of maximum weight loss - on the 3rd-6th day of life. Body temperature can rise to 381-39 ° C or higher, persists for several hours, rarely 1-2 days. Usually the general condition is not disturbed, but in some cases there is excitement, anxiety, temporary refusal of food. Treatment and prevention of transient fever consist in the timely administration of liquid( boiled water, isotonic sodium chloride solution, Ringer's solution, 5% glucose solution) at a rate of up to 200 g per day, but not more than 10% of body weight. The baby is not swaddled, it is easy to wear.
Physiological jaundice is observed in 60-70% of newborns, appears on the 3rd day of life and, gradually fading, disappears on the 7th-10th day, and in some cases( asphyxia in childbirth, prematurity, birth trauma) remains up to 2-3 weeks. There is icteric staining of the skin, mucous membranes, sclera with a persistent normal color of urine and stool. Jaundice is caused by the relative immaturity of the liver and the violent disintegration of red blood cells in the first days of a child's life. Treatment is not required. With severe jaundice, drink 5-10% glucose solution is prescribed.
Physiological loss of body weight ranges from 3 to 8% of the body weight at birth, the maximum observed on the 3-4th day of life. Most children restore their original weight by the 7th-10th day. The cause of weight loss is due to relative malnutrition in the early days, a mismatch between the fluid being produced and discharged, regurgitation of amniotic fluid, etc. A mass loss of more than 8% requires clarification of the cause.
Physiological erythema .Hyperemia of the skin, sometimes with a cyanotic shade, caused by a significant expansion of the surface capillaries, remains 2 - 3 days, then comes peeling, more on the palms and feet. It is observed in all newborns, and if it is absent in the first days of life, it is necessary to find out the cause( pathology of the mother during pregnancy, birth trauma, lung atelectasis).With abundant peeling, the skin is smeared with sterile fish oil, sunflower oil. Some newborns may have toxic erythema in the form of a slightly infiltrated rash. Simultaneously with a bright spotty rash, whitish, yellowish nodules appear surrounded by a corolla of hyperemia. After 2-3 days the rash disappears completely.
On the discharge of a newborn from a maternity hospital, a telephone message is sent to the polyclinic. Primary care is performed by the paramedic on the first day after discharge, the doctor within 3 days. Currently feldshersky patronage is conducted daily in the first 2 weeks of the child's stay at home. Systematic and quality patronage contributes to reducing morbidity and mortality of newborns.
The room in which the newborn lives, must be kept clean and well-ventilated. The cot should be closer to the window. The mattress is hard, covered with oilcloth and then with a sheet. Under the head put a flat little pillow( not downy!).Bedding daily aired, and an oilcloth is washed with soap. Baby clothes after washing are ironed with a hot iron on both sides.
The newborn is bathed daily in boiled water at 37 ° C followed by dousing with water, the temperature of which is 1 ° C lower. The temperature in the room where the child is bathing should be 22-23 ° C.It is better to bathe the child in the evening, before feeding;you can use "Children's" soap. The child should be washed every time after bowel movement, preferably by running water at a temperature of 36 ° C, from front to back from genitals to the anus, so as not to infect the genitals. Nails on the hands and feet are carefully cut with small scissors once every 7-10 days.
Given the great susceptibility of the newborn to infection, it is necessary to protect him from contact with strangers, to observe the strict hygiene of carers for the child;if you use nipples and pacifiers, they must be boiled before use.
ATHLETICS OF LUNGS are more likely to occur in children who are weakened, premature, born in asphyxiation. It is revealed during X-ray examination. Clinical manifestations of the phenomenon of respiratory failure, it is easy to attach pneumonia.
Treatment. If there is no pneumonia, oxygen, cardiac funds, cordiamine, caffeine are prescribed.
THE ATTRESION OF THE ESOPHAGUS is a developmental defect. There may be complete obstruction of the esophagus, but more often there is a combination of atresia of the esophagus with fistula in the trachea.
Symptoms are typical: at the first feeding or taking a liquid through 2-3 pharynx all accepted food pours back, a painful cough arises, the child gasps and becomes blue. All symptoms are repeated with any attempt to feed. Very quickly, aspiration pneumonia can develop. Confirms the diagnosis of radiologic examination with lipidol. You can not use the barium mass, because with a fistula it easily penetrates into the lungs and causes severe pneumonia.
Treatment. Urgent operation( in the first day of life).The prognosis is very serious and depends on the timing of the diagnosis and the connection of aspiration pneumonia.
GREAT ADRESSION - developmental flaw with possible complete absence of bile ducts or partial atresia( obstruction) both inside and outside the liver.
Symptoms: the appearance of jaundice from the first days of life or somewhat later with a gradual increase in its intensity. Kale is discolored or retains a slightly yellow color, urine is intensely colored, contains bile pigments. The general condition of the child is not disturbed at first, but cirrhosis gradually develops, dystrophy increases, the liver increases in size, becomes dense, tuberous. The level of prothrombin in the blood decreases, hemorrhages appear.
Treatment is only prompt. The prognosis is very serious.
Hemolytic Disorder of the Newborn. The disease develops in utero, due to the incompatibility of the blood of the mother and fetus or the Rh factor( the mother of the rhesusotritsatelnaya, the child rezpospolitelny), or by blood groups of the ABO.
In Rh disease, the mother produces Rh antibodies, which, after hitting the placental barrier in the blood of the child, cause hemolysis of red blood cells containing the Rh factor. The intensity of hemolysis usually depends on the titer of Rh-antibodies in the mother( in some cases such strict parallelism may not be noted).More often, hemolytic disease in newborns manifests itself after the second and especially after the third pregnancy. So, the first child, as a rule, is born healthy, the second - with mild signs of anemia and only the third - with obvious signs of the disease. If a woman was sensitized before the pregnancy by transfusion of resuspension blood, even the first pregnancy can result in miscarriage, the birth of a dead child or a child with severe manifestations of hemolytic disease. If the blood is incompatible in the ABO system, lighter clinical variants of hemolytic disease are more often observed, but they can appear after the first pregnancy.
Clinically, hemolytic disease of the newborn can manifest itself in three forms - edematous, icteric and anemic.
The edematous form is the heaviest;often children are born dead, macerated or die in the first hours after birth. The appearance of the newborn is characteristic: the sharp pallor of the skin and mucous membranes, the generalized edema of the subcutaneous tissue, the accumulation of fluid in the pleural, abdominal cavities. Abrupt anemia, the number of red blood cells drops to 1-1.5 million, hemoglobin to 32-48 g / l.
Severe jaundice of newborns is one of the most frequent hemolytic syndrome syndromes. The child is usually born full-term with yellow skin integuments or jaundice develops on the first or second day and progressively increases. The skin becomes yellow-green or yellow-brown in color. The amniotic fluid and original grease can also be colored yellow. The liver and spleen are enlarged. Children are listless, apathetic, and suck badly. The heart sounds are muffled. Urine of dark color, color of feces is normal. In the blood, anemia, a high content of indirect bilirubin in cord blood( from 51.3 to 171 μmol / l and higher at a rate of up to 25.6 μmol / l).Further rapid increase in the level of bilirubin in the blood becomes toxic to the central nervous system and a clinic of nuclear jaundice can develop - seizures, stiff neck and opisthotonus, oculomotor disorders, a symptom of the "setting sun" appear. Duration of jaundice up to 3 weeks or more. In severe forms, especially with nuclear jaundice, death may occur during the first week;if the child remains alive, serious consequences are possible in the form of a lag in mental and physical development.
Anemia is the easiest form of hemolytic disease in newborns. It usually appears at the end of the first week of life, the number of erythrocytes is reduced to 2-3 million. The liver and spleen can be enlarged. The diagnosis is based on the definition of the blood type of the mother and child and the study of the Rh factor. The prognosis is good.
Treatment. In severe forms of hemolytic disease, an early replacement of the transfusion of the rhesusotricative blood is necessary. Blood is administered at the rate of 150 ml / kg of the baby's weight( maximum 160-170 ml / kg, and with extreme jaundice - up to 250 ml / kg of body weight).According to the indications, a replacement blood transfusion can be repeated. It is recommended intravenous drip injection of 10-20% glucose solution, plasma transfusion( 10 ml / kg of baby weight), the introduction of B vitamins, hormonal drugs;when the nervous system is affected - glutamic acid, vitamins B6, B12.
In anemic forms - a fractional re-transfusion of the rhesusotritsatelnoy, preferably one-group blood of 30-50 ml. Within 2 weeks of the baby, they do not apply to the breast, they are fed with donor milk( because of the presence of Rhesus antibodies in the mother's milk).
Prevention. All pregnant women are tested for blood on the Rh factor and blood group. With rhesusotritsatelnoy blood is determined antibodies to the Rh factor. With a significant increase in the antibody titer, the pregnant woman is hospitalized, carries out specific and nonspecific desensitization and premature delivery. If necessary, the child is given a blood transfusion.
The hemorrhagic disease of newborns develops as a result of physiological insufficiency in the blood of certain coagulation factors.
Symptoms. There are different localization and intensity of hemorrhage and bleeding( bloody vomiting, bloody stool, bleeding from the umbilical wound, nose, bloody urine, there may be intracranial hemorrhages, adrenals, etc.).Sometimes true melena develops( bloody vomiting and copious bloody stool, common pallor) on the 2nd-4th day of life, which takes place after 1-3 days. With large bleeding, severe anemia can develop, the child becomes sluggish, dystrophic.
Treatment. The early administration of vitamin K to 0,002 g 3 times a day for 3 days or vicasol in / m to 0.2 ml. Ascorbic acid, vitamins B1, B12, P. 5% calcium chloride solution 1 teaspoon 3-5 times a day. In case of severe bleeding, a single-group blood and plasma transfusion is calculated at the rate of 5-10 ml / kg of mass, administration of aminocaproic acid. With timely therapy, the prognosis is usually favorable, only in particularly severe cases death may occur on a background of massive bleeding.
GIALYNAMIC MEMBRANES OF LUNGS - homogeneous protein formations that accumulate in the alveoli, lining their walls, alveolar courses and lead to a sharp disruption of gas exchange. More common in preterm or babies born in asphyxia, with caesarean section, from mothers with diabetes, with placenta or premature detachment of the placenta. It is assumed that as a result of increased permeability of pulmonary capillaries, the high-molecular plasma protein penetrates into the alveolar lumen, which undergoes coagulation and becomes the basis for the formation of hyaline membranes.
Symptoms. In the nearest time after childbirth, dyspnea, cyanosis attacks, which progress rapidly, gradually or suddenly appear. Dyspnea takes the character of inspiration with the retraction of the compliant places of the chest. At first, the child is very restless, in the future, with increasing respiratory insufficiency, becomes sluggish, adynamic, can not suck. The skin acquires a gray-earthy color. In the lungs weakened breathing, there is no coughing. When fluoroscopy - diffuse darkening of lung fields or a mesh-granular pattern of the lungs. It is necessary to differentiate from atelectasis, diaphragmatic hernia, intracranial hemorrhages, lung cysts. The prognosis is poor, usually children die within the first 2 days.
Treatment is ineffective. Assign antibiotics, oxygen, cardiac agents, glucose, vitamins.
DERMATYE EXCIOLATIVE RITTER.One of the severe forms of pyoderma in newborns. It is caused by staphylococcus aureus.
Symptoms. More often at the end of the first week of life, there are common areas of reddening of the skin with abundant blisters, which quickly burst and expose a burnt surface. The general condition of the child is severe.
Treatment. Children need individual care;diapers should be sterile. Erosive surfaces are covered with sterile gauze moistened with sterile sunflower oil. Assign penicillin according to
100 000 units / kg of child's weight per day IM or semisynthetic antibiotics - methicillin, etc. for 100 000 units / kg of weight per day for 7-8 days, blood transfusion, plasma, gamma globulin, complexvitamins.
CEFALOGEMATOMA( bloody swelling of the head).Hemorrhage occurs between the periosteum and the outer surface of the cranial bones. The tumor fluctuates, it is strictly delimited by the edges of one or another bone of the skull, often parietal, less often occipital. Disappears a cephalothorem in 3-8 weeks.
Treatment is usually not required: with suppuration - surgical treatment, antibiotics.
HUMIDIFICATION INSULAR.In complicated pregnancies, with prenatal fetal asphyxia, in the course of pathological birth, under the influence of physical factors( improper application of forceps, vacuum extractor) and in some other cases favorable conditions are created for increased vascular permeability, and sometimes for rupture of cerebral vessels, which leads tointracranial hemorrhages.
Localization of hemorrhage can be:
1) epidural - between the bone and the dura mater;occur with damage to the skull bones;
2) subdural - are more common in pathological births;
3) subarachnoid - hemorrhages in the soft medulla( the most common form);
4) hemorrhages in the substance of the brain and
5) intraventricular hemorrhage. The last two are less common.
Symptoms depend on the intensity and localization of hemorrhage and are very diverse. With minor hemorrhage the child is sluggish, drowsy, sucking and swallowing are disturbed. Sometimes the clinic of intracranial birth trauma appears 2-3 days after birth, which indicates the initial minimal hemorrhage, which gradually continued and increased. In severe cases, the child is pale, movements are constrained, eyes wide open with an eyes fixed in the distance, a cry monotonous, quiet, convulsive twitching of the muscles of the face and limbs, bradycardia, moaning, rapid breathing, thermoregulatory disturbance. Local neurological symptoms depend on the localization and magnitude of hemorrhage.
Treatment. Strict peace after birth. Do not apply to the breast! To feed only from a spoon. Wash carefully. Cold to the head, oxygen. Inside vitamin K up to 5-10 mg per day for 3 days, ascorbic acid, calcium chloride. According to the indications of cardiac remedies, with asphyxia attacks - the means that excite the respiratory center( cytiton 0.2 ml 0.15% solution under the skin, lobeline 0.2 ml 1% solution), glutamic acid. In severe condition, a calming effect is produced by aminazine( 0.001 g / day on
1 kg of baby weight) in 0.25% solution( 1 ml of a 2.5% solution of aminazine is dissolved in 9 ml of bidistilled water).To combat cerebral edema and increased intracranial pressure, intravenous infusion of plasma with 10 ml / kg of baby weight is shown every 1 to 2 days( 3-4 times), as well as diuretics.
Prognosis depends on localization and intensity of hemorrhage. With extensive damage, especially in the area of vital centers, death occurs soon after birth in the event of progressive asphyxia. With extensive damage to the brain, a disability in the child may occur in the form of hemi and monoparesis, hydrocephalus, a tendency to convulsive conditions, a violation of intelligence, speech. With timely, consistent therapy and moderate brain damage, recovery without serious consequences is possible.
Lysterioz - an acute infectious disease;The causative agent of listeria disease is transmitted from pets and birds. The child is infected in utero, transplacental or with swallowing amniotic fluid.
Symptoms. On the skin from the first hours of life there is a profuse small rash( roseola and papules), on the mucous membrane of the mouth, pharynx, esophagus there are often rashes in the form of small grayish-white granules. There are fever, respiratory disorders, cyanosis attacks, tachycardia. In the lungs - the phenomenon of pneumonia. Increased liver and spleen. The general condition resembles sepsis. In the blood, leukocytosis with a neutrophilic shift to the left. With the defeat of the nervous system, the clinic resembles a picture of purulent meningitis.
The diagnosis can be confirmed by the reaction of agglutination with an increasing titer in the mother and infection of the experimental animals by the injection of urine or cerebrospinal fluid obtained from a sick child. It is necessary to differentiate from toxoplasmosis, cytomegaly, purulent meningitis of another etiology. The earlier the infection of the fetus occurs, the more serious the prognosis;children die in the first days after birth. With late infection and early complex treatment, recovery is possible.
Treatment. Penicillin is combined with tetracycline at the age-appropriate dose;duration of treatment - until complete recovery.
DAIRY( monilijaz) - fungal infection of the mucous membranes of the mouth, pharynx, less often genitals in the form of white dotted rashes, sometimes draining character, difficult to remove. More often the disease occurs in premature or weakened children, hypotrophic, against the background of antibiotic treatment, especially a wide spectrum of action. In some cases, moniliasis takes a heavy course, spreading to the upper respiratory tract, esophagus, stomach. With the further spread of infection, fungal sepsis may develop.
Treatment. With mild forms of treatment is not required, you can wet your mouth( without removing plaque) 2% sodium bicarbonate solution or 20% borax solution with glycerin. In severe cases, prescribe nystatin inside for 125,000 units 3 times a day for 3-4 days. It is advisable to provide the baby with breast milk. The prognosis is favorable, but the development of thrush against the background of another disease usually worsens the course of the main process.
NECROSIS OF THE SUBCUTANEOUS CELL ASEPTIC.In children born with a large mass in difficult births, foci of necrosis of the subcutaneous tissue, which are associated with trauma, can develop.
Symptoms. At the 1-2-nd week of life, seals of subcutaneous tissue of different size and localization appear. Usual localization - back, buttocks, shoulders, limbs, less often - cheeks. Skin over seal or normal color, or violet-red-new shade. Within 2-3 months infiltrate disappeared without a trace. In some cases, secondary infection or calcification of necrotic areas may join.
Treatment is usually not required, dry heat can be used.
FLEXIBILITY.With poor care of the child on the skin of the buttocks, in the inguinal folds, axillary and cervical folds, the integrity of the epidermis may be compromised. Most diaper rash arises due to maceration of the skin with urine and calves. In mild cases, there is skin hyperemia, with more pronounced diaper rash on the general hyperemic background of the skin there are individual erosions, in severe cases - extensive erosive surfaces against the background of severe erythema. The erosive surface serves as a gateway to secondary infection.
Treatment. It is necessary to improve the care of the child;with easy intertrigo help the usual hygienic bath and the timely change of diapers, mandatory washing after each evacuation of the intestine. The skin is smeared with sterile sunflower, peach oil, fish oil. With severe intertrigo, treatment of erosion with 1-2% solution of silver nitrate is shown, followed by lubrication with oil. Swaddling the child should be without oilcloth. The prognosis for timely treatment is favorable.
PEMFIGUS( pemphigus) of newborns - superficial purulent inflammation of the skin caused by staphylococcus or streptococcal infection;the disease is very contagious.
Symptoms. On the skin, various localization and size of the blisters with turbid serous-purulent contents are formed. Bubbles open independently, exposing the erosive surface. With the common process the general condition of the child is severe, fever is expressed.
Treatment. Bubbles must be opened without waiting for a spontaneous dissection;Wound surface treated with 2% solution of silver nitrate or 1% alcohol solution of diamond green. Use only sterile diapers. Prescribe antibiotics, in severe cases, blood transfusion, plasma, gamma globulin, vitamins.
Prognosis favorable, in some cases, sepsis may develop.
PILOROSPASM-spasms of the gatekeeper due to imperfect nervous regulation of gastric motor function.
Symptoms - characterized by regurgitation and vomiting from the first days of a child's life. It often occurs in children with increased excitability of the nervous system. Vomiting is unstable, not very abundant, vomiting usually contains unchanged milk, sometimes with an admixture of bile. The increase in the body weight of the child may be slowed down or terminated.
Treatment. Feeding is prescribed more often, after 2-2 / 2 hours, in smaller portions of milk. In severe cases, temporarily weaned and fed with expressed milk;Before feeding it is recommended to give I - 2 teaspoons 5-10% of semolina porridge welded in breast milk. After feeding for 8-10 minutes, keep the baby in a vertical position. On the stomach area put a warm water bottle. In case of persistent cases, prescribe aminazine at the rate of 0,001-0,002 g / kg body weight per day in / m or inside;2-3 drops of 0.1% solution of atropine 2-3 times a day;Vitaminotherapy - ascorbic acid, vitamins B1 and B2 are shown. Usually within 2-3 months the phenomena of a spasm pass or take place, if there is no combination with pyloric stenosis.
PILOROSTENOSIS-congenital narrowing of the pylorus due to hypertrophy of the circular musculature of the pyloric part of the stomach;often happens in boys.
Symptoms. The disease manifests itself on the 2nd-4th week of the child's life and is characterized by abundant vomiting( "fountain");the amount of vomit exceeds the amount of food eaten. The child loses in mass, dehydrates, his electrolyte balance is disturbed. On examination, the peristalsis of the stomach is noticeable. Radiologic examination of the stomach with barium sulfate shows a delay in the stomach for more than 24 hours, in the intestine of barium is detected in small portions, while with pilorospasm all the barium taken after 4-6 hours is in the intestine.
Treatment is only surgical. With a timely intervention, the prognosis is good.
PNEUMONIA OF NEWBORNS develop in utero and after birth. They can be primary and secondary( for example, with sepsis).The frequency of pneumonia at this age is determined by the anatomical and physiological features of the respiratory system, the low resistance of the organism to infection, the ease of atelectasis, the aspiration of amniotic fluid during labor, the aspiration of milk during feeding, the immaturity of the respiratory center and some other factors. The cause may be microbial and viral factors, fungal infection and protozoa.
Focal bronchopneumonia often begins with catarrhal phenomena;gradually the child's condition worsens, the activity of sucking and weight gain decrease, insignificant dyspnoea, nasal articulation, foamy discharge from the mouth, cyanosis of the nasolabial triangle, rhythm of breathing is disturbed, apnea becomes more frequent;the temperature response is insignificant. Strong breathing is audible in the lungs, there can be single wet rales. If focal pneumonia is caused by adenovirus infection, the clinic of the disease may be more acute and bright( a sharply inflated thorax, an abundance of small bubbling wet rales, deaf heart tones, a decrease in body weight, a decrease in tissue turgor).
Acute interstitial pneumonia is caused mainly by a viral infection.
Symptoms. High fever, acute anxiety, followed by lethargy, rejection of the breast, loss in body weight, regurgitation, vomiting. There may be meningeal syndrome( tension of the fontanel, rigidity of the occipital muscles, convulsions).Catarrhal phenomena are insignificant or absent. Breath "grunting", moaning, arrhythmic, with apnea, swelling of the wings of the nose;respiratory rate up to 80-100 per minute, cyanosis. The thorax is sharply swollen, the breathing is hard, wheezing may not be heard, or there are single dry and wet ones. The heart sounds are deaf, the rhythm is broken up to embryocardia. The dimensions of the liver are increased. There may appear diaper rash on the skin, thrush on the mucous membrane of the mouth. The course of pneumonia is prolonged - up to 3-4 weeks, sometimes up to l-2 months. The disease can recur and is complicated by otitis, pyoderma, pleurisy. The outcome is not always favorable.
Septic pneumonia is more often caused by a staphylococcal infection. There may be a primary staphylococcal pneumonia with an outcome in sepsis and a secondary one - as a complication of sepsis.
Symptoms. Septic pneumonia is the most severe form of neonatal pneumonia, sometimes has a lightning-fast course with a fatal outcome. In the anamnesis there may be indications of foci of staphylococcal infection( pyoderma, mastitis in the mother, etc.).The beginning rough, the toxicosis is expressed. Characteristic destructive changes in the lungs: bullous emphysema with small and large cavities and abscesses of various locations, sometimes with a break in the pleura and the development of pyopneumothorax and empyema.
Pneumonia in utero develops in the fetus as a result of a mother's disease during pregnancy or aspiration of infected amniotic fluid during labor.
Symptoms. The general condition of the child from the first hours of life is very difficult: shortness of breath, cyanosis, asphyxia attacks, fever, hard breathing, dry and wet wheezing.
Pneumonia atelectatic often develops in preterm and debilitated newborn babies, as they can easily form multiple atelectasis with impaired normal ventilation and subsequent congestive events.
Symptoms of the disease are not always clearly pronounced. Moderate dyspnea, worsening of general condition, increased cyanosis, asphyxia attacks are possible. Above the lungs there is a blunting of percussion sound in accordance with the location of atelectasis. Wet hoarseness can be heard only at the depth of inspiration when the child screams. The course of the disease is sluggish, prolonged, with periodic exacerbations.
Treatment of neonatal pneumonia. Natural feeding, careful care( raised head end of bed, frequent change of position of the child by turning it from one side to the other, to the back), ensuring a constant supply of fresh air and supply of moistened oxygen - better in the oxygen tent dosed;correction of acidosis. Antibiotics: penicillin( 40 000-50 000 units / kg of body weight per day, in severe cases - 150 000-200 000 units / kg of body weight per day IM), semisynthetic preparations of penicillin, erythromycin( 0.04-0,05 g / kg body weight per day), chain, gentamicin and other broad-spectrum antibiotics. The duration of continuous treatment with antibiotics is 10-15 days, combining antibiotics is appropriate in accordance with the current scheme of rational combinations of antibiotics according to AM Marshak. If the treatment is ineffective, then in 4-6 days you can change antibiotics or give other combinations of drugs.
With prolonged, especially staphylococcal pneumonia, stimulating therapy is shown: antistaphylococcal gamma globulin at 1.5-3 ml IM in 2-3 days, for a course of 3-5 injections;transfusion of antistaphylococcal plasma, direct blood transfusion at the rate of 5-10 ml / kg of body weight several times in 3-4 days. In case of toxicosis - drinking 5% glucose solution and intravenous infusion of 10-20% glucose solution at 15-20 ml / kg body weight daily, isotonic sodium chloride solution. Sometimes, in severe cases, prescribe a short course of prednisolone at a rate of 1 -
2 mg / kg body weight per day for 7-8 days( the maximum dose is given 3-4 days, followed by a decrease until complete withdrawal).From the very beginning of the disease appoint a cordiamine 0.2 ml 3-4 times a day under the skin or sulphocamphocaine 0.1 ml 10% solution v / m 2-4 times a day, depending on the severity of the condition.
PULSE, DISEASES.Normally the umbilical remnant is mummified and falls off on the 5th-7th day, the umbilical wound heals on the 10th-14th day. When infected, these processes are delayed, and the gangrene of the umbilical cord, the collapsing navel, fungus, and omphalitis can develop. In addition, there may be congenital changes - umbilical fistula and a hernia of the umbilical cord.
The gangrene is an umbilical cord. The cordate residue acquires a greenish-brown color, an unpleasant smell appears, the general condition is disturbed. The process can spread and cause peritonitis.
Treatment. Begin immediate treatment with broad-spectrum antibiotics and a systematic umbilical cord rest;surgically remove necrotic areas.
Collapsible navel .Umbilical wound heals slowly, there is a serous or serous-nasal discharge.
Treatment. Careful systematic processing of the umbilical wound with hydrogen peroxide and cauterization with 5% nitrate solution of the ribs. It is necessary to refrain from hygienic baths;the skin is treated with patches.
Fungus. With prolonged non-healing umbilical wound, there is an excessive development of granulation tissue, which is protruded from the wound by a cone.
Treatment. Careful treatment of the umbilical wound and cauterization of granulations with a 5% solution of silver nitrate.
Omphalit is a purulent inflammation of the umbilical cord, skin and subcutaneous tissue around the navel. The child thus is disturbed, does not add in weight, regurgitates, at it the temperature rises. Purulent contents are separated from the umbilical wound, the skin around is swollen, red. It is necessary to plant the flora and diphtheria bacillus.
Treatment. Washing of the umbilical wound with 3% hydrogen peroxide solution followed by treatment with 5% alcohol solution of silver nitrate. In the future, dressings with furatsilinom or hypertonic sodium chloride solution. In severe course, antibiotics of a wide spectrum of action and stimulating therapy-gamma-globulin, vitamin therapy are prescribed.
Umbilical fistula - congenital disease;is formed with partial or complete excretion of the yolk-intestinal or urinary duct. From the umbilical wound, respectively, constantly excrete either stool or urine. Umbilical wound does not heal. A probe is easily inserted into the available hole.
Treatment. At full nezarashchenii treatment only surgical, at partial - careful leaving and processing of an umbilical wound. If the fistula has not closed independently within 3-5 months, surgical intervention is indicated. Hernia of the umbilical cord .With a small size of the hernial sac in the navel area, only the gland comes out, while it is easily refilled. The treatment is conservative, applying special bandages, usually with the help of adhesive plaster. It is necessary to eliminate flatulence. In severe cases, not only the epiploon falls into the large hernial sac, but also the intestine, liver, and spleen. The size of the hernia sometimes can reach the size of the baby's head. In these cases urgent surgical intervention is indicated.
Umbilical diseases - periarteritis of the umbilical artery and phlebitis of the umbilical vein - develop when the rules of antiseptic are violated during the treatment of the umbilical cord and replacement blood transfusions.
Symptoms. The general condition of the child is broken, the temperature rises. Inflammation in the navel may be absent, but with palpation of the abdominal wall, tightened vessels in the form of strands at a distance of 1.5-2 cm from the navel are determined. When pressing down from above or from the bottom up, a drop of pus can be released from the unhealed umbilical wound. Inflammation of blood vessels can be latent and complicated by phlegmon, peritonitis, diffuse hepatitis with abscessed liver, sepsis.
Treatment. Breastfeeding, broad-spectrum antibiotics, gamma globulin. Locally - bandages with hypertonic sodium chloride solution.
SEPSIS is a disease to which newborns are particularly prone. The causative agent can be a variety of microorganisms and their combinations. Recently, Staphylococcus is especially often secreted. Infection is possible in utero, during childbirth and is often extra-utero. The source of infection is a sick mother;staff caring for the child may be the carrier of the infection;Important are contaminated care items, as well as the baby's food and inhaled air. The entrance gates of infection can be skin, mucous membranes, gastrointestinal tract and respiratory tract;The most frequent gateway to infection is the navel. Sepsis has no definite incubation time;with intrauterine infection it can begin at the 1st week of life, in other cases - at the 2nd and even the 3rd week. Two main forms of the disease, septicemia and septicopyemia, are distinguished along the course.
Common initial manifestations of sepsis - deterioration of well-being, sluggish sucking, regurgitation, vomiting, cessation of weight gain or slight weight loss. There may be a high fever, a low subfebrile condition and even a normal temperature. Skin with a grayish tinge.
Septicemia is more common in preterm and debilitated children, is more violent, malignant. Often begins with acute intoxication, violations of water and mineral metabolism, with the development of dyspepsia, jaundice, hemorrhagic syndrome, rapid loss of weight. Tachycardia, muffling of cardiac tones, toxic respiration are observed. Sometimes symptoms of nervous system damage prevail( anxiety, frustration, convulsions).There is an increase in the liver, spleen, anemia, leukocytosis, neutrophilia, increased ESR.In the urine can be found leukocytes, red blood cells, cylinders.
Septicopyemia, ie sepsis with metastases, secondary purulent foci, proceeds more benignly, more often in full-term children, with better reactivity of the body. It begins with the appearance of pustules on the skin, sometimes abscesses develop, furuncles. Possible purulent foci in the pleura, pericardium, in the lungs, as well as purulent otitis, meningitis, etc. With umbilical sepsis in cases where the entrance collar of the infection was the navel, in addition to general phenomena, omphalitis, periarteritis of the umbilical artery and phlebitis of the umbilical vein can be observed.
Treatment. Careful care, breastfeeding. Immediate administration of broad-spectrum antibiotics, penicillin is used in a daily dose of up to 200,000 U / kg of body weight. It is advisable to administer antibiotics at the lesion site( intrapleural, into the abscess cavity, etc.).In severe cases, a combination of antibiotics with sulfanilamide preparations is shown at a rate of 0.2 g / kg of body weight per day. Carry out stimulating therapy - direct blood transfusion, the introduction of plasma( up to 10 ml / kg of body weight every 3-4 days) and gamma globulin directed( 1.5-3 ml every other day, only 3-5 times).Corticosteroids are prescribed a short course only in the acute period of sepsis with severe general toxic effects( 1 mg / kg body weight per day).Vitamins, enzymes, local treatment of septic foci( medicamentous, surgical, physiotherapeutic) are recommended. The prognosis is favorable with timely and active treatment.
SKLERODEMA - swelling of the skin in newborns;often occurs in premature babies. The reason is not known.
Symptoms. The skin is pale, cold, dense. With a limited process( more often on the hips) the general condition does not suffer. With common forms, the condition is severe.
Treatment. Careful care, constant body warming( warmers, warm baths), massage. In severe cases, prednisolone( 1 mg / kg body weight per day for 5-7 days).
COLLEMA-diffuse edema of the skin and subcutaneous tissue develops mainly in premature, weakened, emaciated children. The reason is not clear.
Symptoms. Edema often begins with the legs, then gradually spreads to the trunk and upper limbs. The fabrics are very dense, with no pressure left on them. The limb movements become limited. The general condition of the child is severe.
Treatment is the same as with sclerotherapy. It is advisable to prescribe cordiamine, caffeine. The outcome is usually favorable.
INJURY FAMILY, INNER.The condition is characterized by a violation of the function of the central nervous system and the regulation of the activity of other organs and systems. The cause of birth trauma can be various diseases of the mother during pregnancy, especially the toxicosis of the second half, cardiovascular diseases, various abnormalities during childbirth: pathological births, intrauterine infection.
Symptoms. In childbirth - asphyxia, rhythm and respiratory rate, cyanosis, in the lungs - atelectasis. Violation of cardiovascular activity( deaf heart sounds, bradycardia, arrhythmia, lowering blood pressure);a decrease in muscle tone, reflexes, a convulsive syndrome is possible, a quiet monotonous cry;violation of thermoregulation( may be hyperthermia and hypothermia), a painful facial expression.
Treatment is the same as with intracranial hemorrhage.