home Audience 3 Big illnesses of a little man. A pediatrician talks about the symptoms and prevention of sepsis in newborns

Big illnesses of a little man. A pediatrician talks about the symptoms and prevention of sepsis in newborns

A generalized form of purulent-inflammatory infection, which is caused by opportunistic bacterial microflora when activity is impaired immune system and the emergence of inadequate systemic inflammatory reaction.

Diagnostic criteria are vague, so there is no accurate information on the frequency of sepsis among infants. According to foreign statistics, the frequency is from 0.1 to 0.8%. Among the patients, the majority of children are premature and are in intensive care units. Blood infections have a mortality rate of 30 to 40%.

Classification of neonatal sepsis

There is no generally accepted division of neonatal sepsis into types. In ICD-10, the disease is designated under code P36. The disease can be divided into types according to the time of appearance of infection in the blood, according to symptoms, according to the location of the entrance gates of infection, etc.

Recently, fumigation, ultraviolet irradiation, and antiseptics have been used to treat the umbilical cord. Important correct application Rogovin brackets and Kocher clamps.

To prevent sepsis in newly born children, hygienic baths with the addition of various disinfectants are used.

Some researchers advise giving a bath with a solution of potassium permanganate in the first hours of a baby’s life. A bath with a 3% hexachlorophen solution is also offered.

The fight against pustular diseases in newborns includes a protective ointment that is placed in the folds of the skin. It contains: Amyli tritici aa 25.0, Zinci oxydati, Worsulfa-soli 0.5, etc.

Women in labor should be provided with sterile caps and scarves that completely cover their hair. Staff must wear sterile hoods.

To prevent the spread of staphylococci, masks should be worn, changing them every three hours. Masks should cover the mouth and the front of the nose, through which pathogenic staphylococci can enter the newborn's body.

Children with different shapes staphylococcal infection must be handled with gloves that are disinfected or changed frequently.

Specific prevention is also proposed in the form of immunization of pregnant women, which was proposed at the beginning of the 20th century by V. Ya. Yankelevich. He used killed streptostaphylococcal vaccine for immunization. Further research has shown that staphylococcal antitoxin is effective.

To increase the immunity of newborns, researchers suggest using sodium nucleic acid.

In cases of development of nosocomial epidemics in maternity hospitals a commission should be created, which will include a bacteriologist, an epidemiologist, clinicians and a sanitary doctor. Their goal is to establish sources of infection and current transmission mechanisms, to develop and evaluate systems of preventive and anti-epidemic actions.

Which doctors should you contact if you have Sepsis in a newborn:

Infectious disease specialist

Immunologist

Hematologist

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Other diseases from the group Children's diseases (pediatrics):

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Neonatal sepsis – this term refers to the general infectious process throughout the body, the disease occurs due to the entry of pathogenic and pyogenic bacteria into the bloodstream and is always accompanied by severe complications.

According to statistics, the incidence of sepsis is less than 1% in premature babies and children with perinatal pathologies, for those in the intensive care unit - about 14%.

About 35% of babies suffering from this pathology die, since sepsis weakens the baby’s immune system and defense mechanisms.

Such high mortality rate is also due to the fact that it is correct to diagnose this disease on early stages quite problematic. Modern equipment and fundamental knowledge of doctors and scientists cannot always save the life of a small patient. Treatment neglected cases often does not give any results.

Only regular examinations and a measured pace of life will help the expectant mother undergo pregnancy with better results.

Classification of the disease

Despite the fact that this disease was first identified many years ago, there is still no generally accepted classification for it. Experts around the world call it “bacterial sepsis of the newborn.”

Nevertheless, doctors distinguish this disease depending on the time and conditions of infection - it enters the body at the stage of fetal development or after the birth of the child. Treatment of the disease depends entirely on these factors.

The location of the septic focus and the clinical features of the pathology also play a major role in the classification. Based on these factors, specialists will select treatment methods and anti-epidemic measures.

According to the time of development, sepsis is distinguished:

intrauterine sepsis (appears even before the birth of the child). It is characterized by infection even at the stage of formation of the organism; the purulent focus will be located outside the fetus. Most often, chorionitis or placentitis acts as a septic focus. This form of the disease involves antenatal or intrapartum infection of the fetus;
neonatal - divided into early neonatal sepsis: symptoms appear within the first 3 days after birth, as well as late neonatal sepsis ( characteristic features will begin to appear no earlier than 4 days after the baby is born).

According to the location of the primary septic focus, there are the following types diseases:

Sepsis is divided according to the signs of multiple organ failure:

septic shock;
cerebral edema;
pulmonary failure;
renal failure;
intestinal failure.

Causes

Sepsis can be caused by many different pathogens; doctors now distinguish about 40 types of opportunistic microflora. The most common pathogens in a child’s body are:

staphylococci and streptococci;
coli;
Klebsiella;
various gram-negative bacteria.

The infection enters the baby's body in various ways, the entrance gates usually serve as:

The causes of this pathology also differ significantly; according to statistics, the primary source is most often:

the birth of a baby earlier than expected;
excessively low body weight of the child;
receiving various birth injuries (damage to the skull is especially dangerous);
presence intrauterine infections in a baby;
birth of a child in inappropriate conditions (outside a hospital):
anhydrous period of more than 6 hours;
long stay of the baby artificial ventilation lungs;
surgery immediately after childbirth.

Such an infection of a child can only be provoked by the introduction of an infectious pathogen into the blood; the leading positions among them are occupied by staphylococci and streptococci.

Symptoms

Whatever acts as the primary source of the pathology, its harbinger is usually a very lethargic state, which is completely unusual for children after birth.

A sure sign of sepsis is also poor appetite and lack of weight gain, constant regurgitation after eating. Especially if it is accompanied by navel suppuration and conjunctivitis.

When studying the general clinical picture, the doctor often encounters the following symptoms:

local inflammation on the skin. To avoid such a defeat, in initial days In life, special attention should be paid to the treatment of the baby’s body;
excessive pallor of the skin;
too fast or, conversely, muffled heartbeat;
low body temperature;
the appearance of shortness of breath, in which x-ray the lungs will not notice any changes;
swelling of the skin;
low blood pressure;
too weak manifestation of reflexes;
bleeding of mucous membranes;
problems with blood clotting ();
local tissue necrosis.

In some cases, this disease develops septic shock - a severe condition with rapid progression of all symptoms. The chances of saving the life of a newborn in this case will be minimal.

Diagnostics

Parents may suspect sepsis if fever persists for more than 3 days or if hypothermia worsens. The doctor should be especially alert to the manifestation of such symptoms.

To identify the overall clinical picture, the first step is to do a general detailed analysis of blood and urine, as well as study the nature of the inflammatory process.

To pick up suitable treatment, the first step is to identify what exactly is the causative agent of the infection. If sepsis is suspected, diagnosis usually includes:

blood test for sterility;
bacteriological examination of a smear from the conjunctiva;
urine microflora analysis;
skin scraping for microflora;
throat swab analysis;
stool examination for dysbacteriosis.

The difficulty of diagnosis also lies in the fact that sepsis is often confused with diseases that manifest themselves in a similar way, for example, peritonitis, necrotizing enterocolitis, meningitis.

Treatment

Treatment of sepsis is carried out only in a hospital; it is impossible to get rid of this disease at home. Medical therapy usually divided into 2 categories: etiological and pathogenetic.

Etiological therapy is prescribed immediately after confirmation of the diagnosis or if the baby was prescribed antibiotics after birth.

Until the specific causes of sepsis are identified, the child will be prescribed a systemic antibacterial drug or several medications with a pronounced bactericidal effect.

After passing and studying the tests, therapy will be aimed at combating a specific primary source. When deciding on a treatment method, the physician will need to consider:

exactly how the infection entered the body;
baby's age;
where exactly the infection was contracted (in the hospital or outside the clinic);
toxicity and activity of the drug;
how strong is the child’s immune system;
presence of allergies;
Are the kidneys functioning properly?

On initial stage As a rule, specialists prescribe several treatments at once antimicrobials, because until the test results are received, doctors will not be able to determine which strains of infection they are dealing with.

Antibacterial treatment

Antibacterial agents used to treat newborns can be divided into the following groups:

medications of first choice - prescribed for treatment light form diseases. Such drugs include aminoglycosides and 1st generation cephalosporins, synthetic penicillins;
Second choice medications - used to combat specific strains. The most effective and common are: aminoglycosides and cephalosporins 3 and 4 generations;
third choice medications - they are prescribed only in extreme cases, when the baby is in a very serious condition, and it is already a question of life or death. TO similar drugs include carbapenems.

Such drugs are administered only intravenously and are usually prescribed in the maximum allowable doses. Treatment almost always begins with the use of first choice medications. If 2 days after their administration the baby’s condition still does not improve, they are replaced by second-choice drugs. If a child was born premature, it is advisable to start treatment immediately with second-generation drugs.

The duration of the course of antibacterial medications is at least 3 weeks, and doctors will periodically change the drugs to analogues. All this time the child will remain in a separate box and will be under constant supervision.

Discontinuation of medications is prescribed only if the pustular lesions have completely disappeared and new metastatic inflammation does not appear. In addition, if the treatment is successful, the baby will begin to gain weight well.

Pathogenetic therapy

It is aimed at suppressing the pathological mechanisms of disease development in the child’s body. This type of therapy consists of several stages:

correction of the child’s immunity - since a weakened baby does not have enough protective forces, doctors prescribe the administration of immunoglobulins or interferon. Achieve best effect possible by introducing recombinant interferons obtained by genetic engineering. A popular drug in this group is Viferon;
detoxification - to reduce the concentration of pathogenic microbes, the baby is prescribed intravenous administration glucose-saline solutions or fresh frozen plasma. Such injections help reduce intoxication and reduce symptoms;

anti-shock therapy - in the event of septic shock, the child requires urgent medical attention, otherwise he will simply die. After correction of immunity, treatment will be aimed at reducing inflammatory cytokines in circulatory system. If the disease worsens, the baby will be placed in a special chamber with controlled temperature and humidity. Doctors will constantly monitor the concentration of hemoglobin in the child’s blood;
recovery period - after the child’s condition improves and the signs of intoxication pass, the baby will be transferred to a separate room with his mother, where he will be prescribed rehabilitation therapy. To activate metabolic processes, enzyme preparations, amino acids and multivitamins are used. At this stage, it is also extremely important to restore the proper functioning of the internal organs.

Forecast

It’s worth saying right away that even with modern medicine The prognosis for sepsis for a baby is unfavorable. About half of the cases end in the death of the child.

This happens due to the fact that this disease almost always entails septic shock, which leads to a serious failure of all body systems. During such a state blood pressure the baby’s blood pressure can drop to virtually zero, which subsequently entails the death of the patient.

There is a chance for a successful recovery of the baby only if the pathology is detected on early stage and begin treatment immediately.

Since neonatal sepsis is a the most dangerous diseases and usually ends fatal, any woman should try to prevent its occurrence in the body of her child.

To do this, you must attend an antenatal clinic throughout the entire period of pregnancy. You should also take all tests, eat right and monitor your lifestyle.

Sepsis means a generalized infection, which is characterized by the circulation of pathogenic microbes (bacteremia) or their toxins (toxemia) in the blood and the development of various pathological processes(purulent foci, degenerative and dystrophic changes, functional disorders).

Sepsis occurs predominantly in newborns and especially in premature infants. However, not every purulent focus in a newborn child should be identified with sepsis. One of the conditions for the occurrence of sepsis is a sharp decrease in local and general immunity. While maintaining sufficient immunity purulent infection, even in very premature infants, may be limited to a local process and not spread further.

The entry point for the development of sepsis is most often the umbilical wound. Other routes of infection include the skin and lungs.

Infection of a child can also occur in utero. This is possible if there is some kind of inflammatory process in the pregnant woman’s body or with certain types of criminal intervention (introduction into the uterine cavity foreign bodies). Predisposing factors for intrauterine infection of the fetus are toxicosis of pregnancy and a long anhydrous period.

Extrauterine infection occurs as a result of violation of the basic principles of asepsis and antisepsis when caring for a newborn child. This especially applies to the first days of life (ligation of the umbilical cord, care of the umbilical cord).

The causative agents of sepsis are various pathogenic microbes (staphylococci, streptococci, E. coli and others), among which the leading role belongs to staphylococcus.

The clinical picture is very diverse. This is due to the fact that sepsis is not characterized by damage to any one specific organ. Inflammatory process may develop into various systems body, and the symptoms of sepsis are to one degree or another determined by the localization infectious foci. So, some children in clinical picture symptoms of peritonitis predominate, in others - osteomyelitis, in others - meningitis, etc. Therefore, among the various symptoms of sepsis, one should highlight general symptoms, characterizing it as a severe infectious disease, and local, due to the localization of purulent foci.

General symptoms. Sepsis is primarily characterized by severe intoxication. Children become lethargic and adynamic. There is a decline in the sucking reflex. The weight curve becomes flat. The liver enlarges.

One of distinctive features sepsis is a change in skin coloration. The skin becomes pale, pale gray, and sallow. Many children develop jaundice. Prolonged jaundice is generally typical for most premature babies, but with sepsis it takes on a greenish or waxy hue.

Some children experience joining hemorrhagic syndrome. After taking blood from a finger or from a vein, it does not clot for a long time; intramuscular injections small hematomas are formed. Hematuria and the appearance of a pinpoint hemorrhagic rash are possible.

All children, including extremely premature ones, experience certain changes in the peripheral blood (early anemization, leukocytosis and neutrophilia, shift of the formula to the left). ROE is usually within normal limits.

Patients with sepsis are predisposed to the formation of diaper rash, bedsores, trophic ulcers. After opening abscesses or infiltrates, purulent discharge is observed for a long time from the resulting wound.

Sepsis is very serious illness which threatens the life of a child. It is characterized by the occurrence in the body of a massive systemic inflammatory response to infection, which leads to disturbances in microcirculation, hemostasis disorders, as well as acute disruptions in the functional activity of all systems of the baby’s body. Next, we will look at the causes of the development of this disease, treatment methods, proper care for the patient and methods of prevention.

Causes

Sepsis in a newborn child can develop under the influence of a single factor or a combination of several factors:

Low level of immunity and underdeveloped barrier mechanisms at the time of birth;

Specific stress of the child that arose during birth, during the transition from comfortable conditions into the external extrauterine environment;

Hormonal imbalance in the newborn’s body;

Flaw nutrients mothers during pregnancy, various maternal ailments, as well as intrauterine fetal hypoxia.

Sepsis can develop early and also later after birth.

Early sepsis appears before the fourth day of a baby’s life. It occurs due to infection during the passage of the maternal birth canal. The disease begins suddenly and acutely, and almost all organ systems are involved. The most common complication of early sepsis is pneumonia. This form of the disease is characterized by high level Mortality: Five to twenty percent of affected newborns die.

Late sepsis can develop from the fifth day of a baby’s life and later. Most often, a child who was diagnosed with this form of the disease was born with pathologies, and the mother’s pregnancy and childbirth occurred with complications.

Septic infections can occur under the influence of pathogenic conditions external environment, as well as as a result of infection from the maternal birth canal. The late form of sepsis is characterized by a slow course, constant progression and development of foci of septic lesions.

Consequences

A common complication of this type of disease is meningitis. Death is possible in 5-10% of sick children. The most common causative agents of late sepsis are enterococcus, Staphylococcus aureus and Staphylococcus epidermidis.

In hospital settings, outbreaks of hospital-acquired sepsis often occurred, which occurs due to dirty hands, unclean instruments, various staff ailments and violations sanitary standards. Nowadays, all maternity hospitals practice conducting planned preventive measures to prevent such outbreaks of neonatal morbidity.

Factors that may predispose to the development of sepsis:

Infectious respiratory diseases;
- congenital pathologies development, as well as tissue injury;
- dysbacteriosis;
- complication of catheterization of the central vein and veins in the umbilical ring;
- incubation activities;
- birth injury, asphyxia, hypoxia;
- prematurity of the child (weight less than 1.5 kg);
- chlamydia or bacterial vaginosis, as well as other infections of the maternal genital tract;
- mother's taking antibiotics, especially in the last trimester of pregnancy;
- hereditary immunodeficiency.

Sepsis can have acute clinical manifestations: general intoxication of the body, a characteristic skin rash, weight gain, tachycardia, shortness of breath, pallor, diarrhea, vomiting and regurgitation, rapid progression of the disease.

Late sepsis often occurs minor symptoms: some lethargy, pallor, cough, regurgitation and a slight increase in body temperature. Then jaundice suddenly appears, and local phlegmon with purulent content appears on the body, meningitis, osteomyelitis and pneumonia develop.

A child with suspected sepsis must be immediately isolated in an infectious disease ward. However, it is recommended to continue feeding him mother's milk, if this is not possible, preference should be given to sour mixtures that contain fermented milk living flora. They are easily digestible and help boost immunity.

If the baby's condition is too serious, he is fed through a tube. The frequency of feedings increases a couple of times a day.

The mother must constantly support the baby, clean the skin and mucous membranes, massage and stroke the hands and feet. You also need to stretch your fingers.
In the boxes, things and air are regularly disinfected and ventilated.

The baby is given complex therapy antibiotics. The two most commonly used drugs are: wide range actions, with the maximum dosage possible for this age.

The child is also given a course of therapy to combat intoxication, and blood or blood plasma is transfused.

In order to support normal microflora intestines use bifid drugs.

After recovery, the child must be monitored for another three years, and a medical exemption from vaccinations is given. Parents should know about proper care for the baby, nutrition, hardening and therapeutic exercises.

Prevention development of sepsis is planning pregnancy, regular visits to the gynecologist, timely treatment all diseases of the mother, proper management of childbirth. It is especially important to monitor the cleanliness of hospital equipment and premises and conduct timely medical examinations of hospital staff.

Ekaterina, www.site

Sepsis (blood poisoning) is a severe general infectious pathology, which occurs in children due to imperfect immunity. In sepsis, the infection cannot be limited by immune forces to one organ or part of the body, which leads to its spread into the blood and body tissues. As a result, septicemia is formed - the presence of pathogens in the blood and septicopyemia - the formation of secondary infectious foci in all organs and tissues. Usually develops as a complication various kinds infectious diseases, purulent lesions of the skin and mucous membranes, sometimes formed as a primary disease.

Causes

The cause of sepsis in infants in the first month of life is pathogenic bacteria that entered the child's body. They could penetrate there both at the moment of the baby’s birth and during the period when the baby had already left the mother’s womb - that is, after birth. Most often, the following harmful microorganisms become causative agents of sepsis in the infant body:

Enterobacter, staphylococcus, streptococcus, Escherichia coli, Klebsiella, pseudomonas.

The “doors” for pathogenic microbes most often become the umbilical cord (if the infection occurred in utero) or the remains of the navel (if the infection occurred after birth). In addition, pests are able to penetrate the blood of a newborn through any area of skin with compromised integrity.

Ways of infection with sepsis can be as follows:

through maternal blood, upon contact skin a baby with the maternal genital tract that is infected, through the penetration of harmful microorganisms from the genital tract into the mother’s uterus, and from there into the fetus’s body.

Once in the baby’s blood, pathogenic bacteria are spread along with the blood to all of his internal organs. The baby, without an immune system, is susceptible to negative influence these microorganisms. That is why the first contact with aggressive residents environment often fatal.

The development of sepsis is greatest in premature babies and children who suffered in utero due to lack of oxygen. Such newborns are at particular risk.

Symptoms

Sepsis plunges the baby into extreme serious condition and declares itself with the following characteristic features:

if the baby was born full-term, then his body temperature reaches forty, or even forty-one degrees, that is, it increases; in premature babies, the body temperature, on the contrary, goes down: the thermometer shows thirty-five degrees and below; the newborn shows sudden anxiety, which almost instantly gives way to apathy and lethargy; the baby begins to moan; the baby’s skin becomes dirty white; hemorrhages inside the child’s body are possible; the baby’s facial features become noticeably sharper than usual; the limbs (both upper and lower) begin to swell (the case ends in complete physical edema); due to the fact that such internal organs how the spleen and liver begin to enlarge due to blood poisoning, the baby’s tummy swells very much; the baby vomits and constantly regurgitates; he has an uneven heartbeat, there is no heart rhythm; the baby does not eat anything, even refuses the mother’s breast; with the development of sepsis, the baby stops going to the toilet completely - does not poop or pee; the weight of the sick baby decreases before our eyes.

Diagnosis of sepsis

In order to diagnose neonatal sepsis in a child under twenty-eight days old, the doctor must, first of all, detect the source of infection. That is, to find the “gate” through which pathogenic bacteria entered the infant’s body. Next, the doctor prescribes a blood test for the newborn patient to see the number of leukocytes in it. In sepsis there are either a lot of them or very few. It is worth recalling that leukocytes are the blood cells responsible for carrying out protective function body. A diagnostic test such as blood culture is mandatory for infants. This study allows you to determine which specific pathogen is rampant in children's body, and what is the baby’s sensitivity to certain antibiotic drugs. Culture of pus (optionally, urine or cerebrospinal fluid). Using this analysis, doctors determine the pathogen.

Complications

Unfortunately, in 50% of cases, neonatal sepsis is fatal. However, the remaining half of cases result in complete recovery with timely treatment. medical care. Therefore, it is so important to react to symptoms in time and immediately begin therapy.

Treatment

Treatment of a newborn baby who has been diagnosed with sepsis occurs exclusively in a hospital setting medical institution. The baby is placed in an incubator (translated from French as an incubator) - a device designed specifically for the survival and nursing of newly born babies, which maintains the required temperature.

What can you do

If a newborn has been diagnosed with sepsis, the mother can help him breastfeeding. It is advisable to feed infants with sepsis exclusively breast milk. However, if the case is too severe, nutrition will be administered intravenously to the baby.

What can a doctor do?

The cardinal, that is, the main, method of treatment for sepsis in newborns is antibacterial therapy. Appropriate prescribed by a doctor antibacterial drugs provide negative impact on the causative agents of the disease. Antibiotic therapy is also mandatory, which usually undergoes corrections after receiving the results of the baby’s blood culture. In addition, the doctor prescribes immunocorrective therapeutic treatment for the newborn. Neonatologists also give the baby a transfusion, because his blood needs to be purified and its cellular composition replenished.

Prevention

Measures to prevent neonatal sepsis should be taken by the expectant mother:

she needs to eat nutritiously and efficiently, promptly treat infectious diseases affecting her body, not have contact with sick people, promptly and efficiently treat serious illnesses like diabetes.