Neonatal pneumonia

Introduction to neonatal pneumonia Neonatal pneumonia (pneumonia of newborn) is the most common disease in neonatal infectious diseases with high morbidity and high mortality. It is characterized by diffuse pulmonary lesions and atypical clinical manifestations, requiring early diagnosis and proper management. Most neonatal pneumonia is caused by postnatal infection. It is called late-onset pneumonia. It is mainly caused by members of the family who are in close contact with the newborn. They are transmitted to the newborn by droplets after a cold or respiratory infection. The minority is in the intrauterine or childbirth process. Infected. If it is not treated in time, it will cause respiratory distress and even suffocation. In severe cases, the brain will be damaged due to lack of oxygen, leaving a permanent sequela (such as epilepsy). Once confirmed, the doctor will use antibiotics or antiviral drugs according to the actual situation of the child. And timely assist oxygen therapy and airway treatment to correct hypoxia and electrolyte imbalance and avoid other complications. basic knowledge The proportion of illness: 0.035% Susceptible people: infants and young children Mode of infection: non-infectious Complications: sepsis, purulent meningitis, septic shock, empyema, bullae

Neonatal pneumonia

Inhalation of meconium, amniotic fluid, milk, etc. (30%):

Aspiration pneumonia is caused by inhalation of meconium, amniotic fluid, milk, etc., but also due to immature swallowing reflex, inconsistent swallowing action, esophageal reflux or cleft palate caused by milk or secretions, premature infants and brain and The sick children are uncoordinated due to swallowing function, poor reflex or absent, prone to vomit, and milk aspiration pneumonia.

Infection (30%):

Infectious pneumonia Infectious pneumonia is divided into intrauterine, intrapartum infection and postnatal infection.

(1) prenatal, infectious pneumonia: If the fetus is infected in the uterus, most of the mother is infected, caused by blood circulation, and infectious pneumonia is related to obstetric factors.

1 prenatal infection: during pregnancy, the virus is infected by viruses (such as cytomegalovirus, herpes simplex virus, rubella virus, etc.), bacteria, protozoa (such as toxoplasmosis), chlamydia and mycoplasma, and the pathogen invades the fetus through the placenta and amniotic membrane.

2 infection at birth: premature rupture of membranes more than 6h, amniotic fluid may be contaminated, if the premature rupture of membranes exceeds 24h, infection may reach 30%, or amniotic chorioamnion, bacteria in the birth canal such as Escherichia coli, Klebsiella, Listeria, group B streptococci, etc., cause infection, or the fetus in the palace inhaled contaminated amniotic fluid and cause disease, in addition, emergency production, delayed production or birth canal is not completely disinfected, the fetus in the process of childbirth Pneumonia occurs by inhaling contaminated secretions in the birth canal.

(2) Infectious pneumonia after birth

1 Respiratory route: If you are exposed to a newborn, if you have a respiratory infection, the pathogen can spread from the upper respiratory tract of the baby to the lungs by droplets, or when the resistance of the baby is reduced (such as cold, etc.), the upper respiratory tract infection causes pneumonia. .

2 blood-borne infection: suffering from umbilical inflammation, skin infection, sepsis, pathogens spread to the lungs through the blood to cause pneumonia, pathogens with group B hemolytic streptococcus, Staphylococcus aureus, Escherichia coli and cytomegalovirus, respiratory tract Cytoviruses are more common.

(3) iatrogenic sexually transmitted infections: iatrogenic infections may be caused by Pseudomonas aeruginosa, anaerobic bacteria and certain bacteria with low pathogenicity, due to medical devices such as suction devices, nebulizers, oxygen masks, Insufficient disinfection of tracheal intubation, high humidity of the warm box makes the aquatic bacteria easy to breed, or the use of ventilator for too long, etc., causing crowding of the pneumonia ward, the disinfection system is not strict, the medical staff wash their hands and not, the pathogen of the child will be Bringing other broad-spectrum antibiotics to other newborns is prone to fungal pneumonia. Late-onset pneumonia is most common in neonatal care rooms, and chronic lung disease requires long-term tracheal intubation in neonates.

Other (15%):

Improper care, cold, etc. are also the cause of pneumonia.

Pathogenesis

Aspiration pneumonia is mainly caused by hypoxia, fetal breathing, amniotic fluid, meconium or vaginal secretions, causing aspiration pneumonia, of which meconium aspiration pneumonia is the most serious, see meconium aspiration syndrome, milk inhalation is common in swallowing Insufficient function, vomiting after breastfeeding, esophageal atresia and cleft lip, cleft palate, etc.

In the uterus, the pathological changes of infectious pneumonia at birth are extensive. The alveolar exudate contains multinucleated cells, monocytes and a small amount of red blood cells. Amniotic fluid sediments such as keratinized epithelial cells, fetal sebum and pathogens can be seen by microscopy. The pathological changes of infectious pneumonia are mainly bronchial pneumonia and interstitial pneumonia. The lesions are scattered, affecting one leaf or several leaves, sometimes fused into large lesions, atelectasis and emphysema are more likely to occur. Microscopic examination has different lesions. Inflammatory reactions at the stage, pathogens are different, and pathological changes are also different.

Neonatal pneumonia prevention

1. Regular prenatal checkups

Amniotic fluid or meconium aspiration pneumonia, the key to prevention is to prevent intrauterine hypoxia in the fetus. It is very necessary for the mother to do prenatal examination regularly during pregnancy, especially at the end of pregnancy, the problem of intrauterine hypoxia can be discovered in time. Take appropriate monitoring and treatment measures to minimize the occurrence of aspiration pneumonia and reduce the severity of the disease.

2. Prevent infection

(1) Before birth: The mother should prevent infection during pregnancy, do well during pregnancy, keep the living environment clean and hygienic, pay attention to personal hygiene, and prevent the occurrence of infectious diseases.

(2) After birth: the living space should be clean and comfortable, the quilt should be soft and clean, the nursing equipment should be disinfected, parents and nursing staff should pay attention to hygiene, pay attention to washing hands, avoid contact with cold patients, if the mother catches a cold, wear a mask to feed When the child is found to have umbilical inflammation or skin infection, he or she will be treated immediately to prevent the spread of the bacteria.

Neonatal pneumonia complications Complications sepsis purulent meningitis septic shock empyema lung bullae

1. Systemic infections can easily cause systemic infections such as sepsis, purulent meningitis, ventriculitis and septic shock.

2. Pulmonary complications When the child suddenly has shortness of breath, difficulty breathing, and obvious increase in bruising, it may be accompanied by empyema, pus and pneumothorax, pulmonary bullae or mediastinal emphysema.

3. Children with heart failure are irritated, heart rate is accelerated, shortness of breath, and the liver increases significantly in a short period of time, suggesting that heart failure is combined.

Symptoms of neonatal pneumonia Common symptoms Fever heart failure, meningitis, respiratory failure, irritability, suffocation, herpes, low fever

1. Aspiration pneumonia amniotic fluid, meconium inhaled people have a history of asphyxia, shortness of breath or dyspnea with convulsions after resuscitation or birth, sputum, meconium inhalers are often more serious, can cause respiratory failure, atelectasis, Central nervous system manifestations of emphysema, pulmonary hypertension, and hypoxic ischemic encephalopathy (see meconium aspiration syndrome), once pneumothorax, mediastinal emphysema, sudden mutation or even death, milk inhalers often have cough and cough. Milk from the mouth, nose out, accompanied by shortness of breath, cyanosis, etc., severe cases can lead to suffocation.

2. Infectious pneumonia bacteria, viruses, chlamydia, etc. can cause neonatal pneumonia, the onset can be acute and slow, prenatal, postpartum and postnatal pneumonia have different clinical manifestations, as follows:

(1) prenatal infectious pneumonia: early onset of intrauterine infection, also known as early onset pneumonia, is part of systemic sepsis, occurs at birth or within hours after birth, more than within 24 hours after delivery, when the baby is born There are many suffocation. After resuscitation, it can be seen that breathing is fast, convulsions, unstable body temperature, poor response, and gradually appearing vocalization. In severe cases, respiratory failure may occur. People with blood infection often lack lung signs, and jaundice, liver spleen, Meningitis and other multi-system involvement are mainly caused by amniotic fluid infection, often with obvious dyspnea and lung vocalization.

(2) Infectious pneumonia at birth: Infectious pneumonia at birth is often an infection obtained at birth. It takes several days to several weeks for the onset of the incubation period. For example, bacterial pneumonia often occurs 3 to 5 hours after birth, herpes virus Most of the infections appear symptoms 5 to 10 days after delivery, while the incubation period of chlamydia infection lasts for 3 to 12 weeks. The pneumonia infected at birth is different in clinical manifestations due to different pathogens, and is prone to systemic infection.

(3) Post-natal infection: The infection is late after birth.

1 Symptoms are not typical: Because the neonatal cough reflex has not yet fully formed, there is very little cough, and because the neonatal thoracic development is relatively imperfect, the respiratory muscles are weak, the neonatal respiratory movement range is small, the respiratory movement is superficial, and there is no deep breathing. Characteristics, lack of specificity in clinical manifestations, clinical symptoms are often atypical, breathing difficulties only manifest as irregular breathing, pause or shortness of breath, cyanosis can occur when severe hypoxia, lungs can not hear the auscultation Arpeggio, can be fever or fever or body temperature does not rise.

2 General characteristics: There are sometimes symptoms of upper respiratory tract infection before onset, mainly due to poor general condition, shallow breathing, nose flapping, nodding breathing, foaming at the mouth, cyanosis, poor appetite, sucking milk, low response, crying Light or not crying, vomiting, abnormal body temperature, early signs of lungs are often not obvious, a few can be heard on both sides of the spine with fine wet voice or at the end of inhalation and snoring.

The most valuable symptom of neonatal pneumonia is the oral foam of the sick child. This is a manifestation of neonatal cough and asthma. Other manifestations include apathetic or irritability, refusal of milk, and milking.

3 severe cases: severe cases can occur breathing difficulties, apnea, nodding, breathing and chest when there are three concave signs, appear not to eat, do not cry, low body temperature, respiratory distress, etc., severe respiratory failure and heart failure.

Staphylococcus aureus pneumonia often occurs in the neonatal room, and can cause epidemics, children with severe symptoms of poisoning, prone to purulent meningitis, empyema, pus, pneumothorax, etc., Escherichia coli pneumonia There is a godsickness, the liquid of the empyema is sticky and smelly. The respiratory syncytial virus pneumonia can manifest as wheezing, coughing, lungs and wheezing.

Neonatal pneumonia examination

[Laboratory Inspection]

1. The white blood cells around the blood can be <5×109/L or >20×10 ⁹ /L, which can also be in the normal range.

2. Fluorescent antibodies and serum antibodies to check IgG, IgM increased, cord blood IgM> 200 ~ 300mg / L, or increased specific IgM for the diagnosis of intrauterine infection.

3. The pathogen diagnosis should be based on bacterial culture of the nasopharyngeal secretions, virus isolation, diagnosis, gastric smear immediately after birth to find white blood cells and antigen, or take blood samples, pharyngeal secretions, tracheal secretions, etc., smear, Culture, convective immunoelectrophoresis and other tests are helpful for pathogenic diagnosis.

[Auxiliary inspection]

X-ray chest examination findings and significance:

1. Interstitial pneumonia caused by intrauterine virus infection, X-ray chest radiograph showed interstitial pneumonia changes.

2. Bronchial pneumonia through amniotic fluid infection, X-ray chest radiograph showed thickening of lung texture on both sides, showing more changes in bronchial pneumonia, post-natal infectious pneumonia X-ray film often shows diffuse, blurred shades of light, can also It is characterized by a broadly spotted or infiltrated shadow of both lungs, and occasionally a large leaf is transformed.

3. Complications common emphysema, meconium inhalation often have obvious obstructive emphysema, atelectasis and irregular lung patch or gross nodules shadow, Staphylococcus aureus infection often accompanied by empyema, pus Pneumothorax or bullae.

Diagnosis and diagnosis of neonatal pneumonia

diagnosis

Mainly based on medical history, such as suffocation and other clinical features to make a diagnosis, neonatal fever, cough, cough, these pneumonia are common symptoms, mainly manifested as poor mental health, increased breathing, loss of appetite, spit milk, milk and mouth Spit foaming, perioral cyanosis, etc., most children do not have fever, or only low fever, plus the characteristics of lung X-ray film to make a diagnosis, early pneumonia, pneumonia within 1 week after birth, often have Apgar scores and Perinatal complications, such as premature rupture of the amnion, premature delivery, placental abruption, dystocia, laboratories, midwifery, midwifery, and inhalation history, birth history may prompt diagnosis, increased secretions from tracheal intubation, often prompted Iatrogenic infectious pneumonia, often gradually onset.

Differential diagnosis

It needs to be differentiated from the following diseases, especially for prenatal infectious pneumonia.

1. Lung hyaline membrane disease Due to the lack of pulmonary surfactant, dyspnea occurs within 12 hours after birth, gradually worsening, and the disease progresses slightly slower than prenatal pneumonia, but these two diseases are often difficult to get from clinical, X-ray and pathology. Identification, so the hyaline membrane disease can also be tested for prenatal infectious pneumonia (especially group B streptococcal pneumonia) treatment, using a larger dose of penicillin.

2, hypoxic-ischemic encephalopathy in term infants and children due to asphyxia, in premature infants may not have a history of hypoxia, respiratory irregularities, increased or decreased muscle tone, sometimes convulsions, but produced The pre-pneumonia started slightly later and the nervous system symptoms were less.

3, congenital heart disease generally needs to be complicated with the congenital heart or the birth of cyanosis soon after birth, the heart will appear in the days after birth, breathing increase or bruising, the heart can sometimes hear the murmur, and the lungs are not Voice, chest X-ray film can be identified.

4, transverse stenosis of the abdominal cavity through the pupil into the chest, oppression of the heart and lungs, causing lung dysplasia, the emergence of shortness of breath, chest X-ray film can help identify.

5, cytomegalovirus caused by pneumonia slow onset, symptoms of fever, dry cough, shortness of breath, chest X-ray film is a typical interstitial pneumonia, these are similar to chlamydia pneumonia, but hepatosplenomegaly in children with giant cell inclusion disease Obviously, sometimes accompanied by jaundice.

6, intracranial hemorrhage has a history of birth injury, early onset of the disease can appear irregular breathing, irritability, screaming crying and convulsions and other symptoms, check the body is full of sputum, the size of the pupils, the light response disappeared and nystagmus.

7, persistent atelectasis without infection symptoms, cyanosis is often relieved when crying.

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