How to deal with neonatal pneumonia?
2022-04-28
Neonatal pneumonia is the most common serious respiratory disease in the neonatal period. Characterized by diffuse pulmonary lesions, the clinical manifestations are not typical, and early diagnosis and correct treatment are required. So, is neonatal pneumonia serious? How to treat and prevent? Let's find out together.
Causes of neonatal pneumonia
Reason 1: Inhalation of meconium, amniotic fluid, milk, etc.
Aspiration pneumonia: mostly caused by inhalation of meconium, amniotic fluid, milk, etc., but also esophageal reflux or cleft lip and palate caused by immature swallowing reflex, uncoordinated swallowing movements, inhalation of milk or secretions, premature infants and craniocerebral and disease Infants are prone to vomiting and milk aspiration pneumonia due to uncoordinated swallowing, poor or lack of reflexes.
Reason 2: Infection
Infectious pneumonia: Infectious pneumonia is divided into intrauterine infection, intrapartum infection and postpartum infection.
(1) Prenatal and intrapartum infectious pneumonia: If the fetus is infected in the uterus, it is mostly caused by maternal infection and blood transmission. Intrapartum infectious pneumonia is mostly related to obstetric factors.
① Prenatal infection: The mother is infected by viruses (such as cytomegalovirus, herpes simplex virus, rubella virus, etc.), bacteria, protozoa (such as toxoplasmosis), chlamydia and mycoplasma during pregnancy, and the pathogens invade through the placenta and amniotic membrane through blood fetus.
② Intrapartum infection: If the premature rupture of membranes exceeds 6 hours, the amniotic fluid may be contaminated. If the premature rupture of membranes exceeds 24 hours, the possibility of infection may reach 30%. Klebsiella, Listeria, Group B Streptococcus, etc., ascend to cause infection, or the fetus inhales contaminated amniotic fluid to cause disease. In addition, in the case of acute labor, prolonged labor, or incomplete disinfection of the birth canal, the fetus is in the process of labor, and pneumonia occurs due to inhalation of contaminated secretions in the birth canal.
(2) Postnatal infectious pneumonia
①Respiratory tract: If a person in contact with a newborn develops a respiratory tract infection, the pathogen can be transmitted from the upper respiratory tract of the infant down to the lungs through droplets, or when the infant's resistance decreases (such as cold, etc.), the upper respiratory tract infection descends and causes pneumonia.
②Blood-transmitted infection: When suffering from omphalitis, skin infection, and sepsis, the pathogen spreads to the lungs through blood, causing pneumonia. The pathogen is group B hemolytic streptococcus, Staphylococcus aureus, Escherichia coli and cytomegalovirus, Respiratory syncytial virus is more common.
(3) Hospital-borne infections: Hospital-borne infections can be caused by Pseudomonas aeruginosa, anaerobic bacteria and some low pathogenic bacteria. Insufficient disinfection of endotracheal intubation, high humidity in the incubator, easy breeding of aquatic bacteria, or prolonged use of ventilators, etc., can cause congestion in pneumonia wards, the disinfection system is not strict, and medical staff do not wash their hands frequently. Other neonates who use broad-spectrum antibiotics for too long are prone to fungal pneumonia. Late-onset pneumonia is more common in neonatal intensive care units and in neonates who require prolonged tracheal intubation due to chronic lung disease.
Reason 3: Others
Improper care, colds, etc. are also incentives for pneumonia. Due to improper warmth after birth, or contact with someone with respiratory tract infection, the upper respiratory tract infection first occurs and then spreads downward to become pneumonia. In addition, it may also be part of the manifestations of sepsis.
Symptoms of neonatal pneumonia
The early manifestations of neonatal pneumonia are mostly shortness of breath, labor, irregularity, coughing, spitting, etc., and varying degrees of bruising will appear around the mouth and nose of the sick baby. Sometimes babies have "cold" symptoms, such as nasal congestion and choking. However, careful observation will reveal that the baby has shortness of breath (more than 45 times/min), and may even be accompanied by difficulty in breathing such as the suprasternal fossa, intercostal space, and xiphoid process depression during inspiration.
The most direct symptom of neonatal pneumonia is foaming at the mouth, which is a form of neonatal cough and asthma. If the mother has emergency delivery, premature rupture of membranes, etc., special attention should be paid to the above conditions of the baby. At the same time, if the mother and baby have been in close contact with someone who has recently developed a respiratory infection, the baby also needs special care in this case.
How to deal with neonatal pneumonia
Treatment method 1: general treatment
Keep the airway open: remove the inhaled substances as soon as possible, suck the secretions from the oropharynx and nose, and regularly turn over and pat the back to facilitate the discharge of sputum.
Strengthen nursing and monitoring, pay attention to keep warm. Keep indoor air fresh, temperature and humidity suitable and stable.
Treatment 2: Antibiotics
Antibiotic therapy should be started when the neonatal respiratory volume increases after birth: intravenous antibiotics should be given in the early stage of bacterial pneumonia. In principle, antibiotics should be selected according to the pathogenic bacteria:
(1) Staphylococcus aureus infection: first-generation cephalosporins, enzyme-resistant penicillin or ampicillin (ampicillin) can be used.
(2) Group B hemolytic streptococcal pneumonia: can be treated with ampicillin (ampicillin) and penicillin for 3 days, and then switch to high-dose penicillin for 10-14 days.
(3) Gram-negative bacteria: Pseudomonas aeruginosa, severe or resistant to general antibiotics, third-generation cephalosporins can be used; Enterobacter pneumonia can be treated with amikacin (amikacin) and ampicillin .
(4) Listeria pneumonia: Ampicillin (ampicillin) can be used.
(5) Chlamydia pneumoniae: The first choice is erythromycin, the dose is 50 mg/kg per day, for 2-3 weeks.
(6) Anaerobic infection: intravenous injection of metronidazole (Metidine) is preferred.
(7) Viral pneumonia: can be treated with ribavirin or interferon. Respiratory syncytial virus pneumonia can be inhaled by inhalation of ribavirin (ribavirin) for 3-7 days. Herpes simplex virus can be administered intravenously with vidarabine or acyclovir (acyclovir).
Treatment method 3: Oxygen supply
In severe cases complicated by respiratory failure, continuous positive pressure breathing or mechanical ventilation can be used after endotracheal intubation.
For hypoxemia, oxygen can be supplied according to the situation to maintain blood oxygen at 6.65-10.7kPa (50-80mmHg), not exceeding 16.0kPa (120mmHg).
Treatment method 4: symptomatic treatment
Symptomatic treatment should be carried out according to specific symptoms, such as irritability, convulsions, and timely sedation.
Treatment method 5: Supportive care
(1) Enhance disease resistance: transfusion of fresh blood or plasma, 10ml/kg each time, can be used in small amounts and multiple times according to the condition, and human serum gamma globulin or human serum albumin to enhance immune function, 500mg/(kg·d), Can be used for 3-5 days.
(2) Guarantee nutrition and fluid volume: ensure nutrient supply and maintain water and electrolyte balance.
Causes of neonatal pneumonia
Reason 1: Inhalation of meconium, amniotic fluid, milk, etc.
Aspiration pneumonia: mostly caused by inhalation of meconium, amniotic fluid, milk, etc., but also esophageal reflux or cleft lip and palate caused by immature swallowing reflex, uncoordinated swallowing movements, inhalation of milk or secretions, premature infants and craniocerebral and disease Infants are prone to vomiting and milk aspiration pneumonia due to uncoordinated swallowing, poor or lack of reflexes.
Reason 2: Infection
Infectious pneumonia: Infectious pneumonia is divided into intrauterine infection, intrapartum infection and postpartum infection.
(1) Prenatal and intrapartum infectious pneumonia: If the fetus is infected in the uterus, it is mostly caused by maternal infection and blood transmission. Intrapartum infectious pneumonia is mostly related to obstetric factors.
① Prenatal infection: The mother is infected by viruses (such as cytomegalovirus, herpes simplex virus, rubella virus, etc.), bacteria, protozoa (such as toxoplasmosis), chlamydia and mycoplasma during pregnancy, and the pathogens invade through the placenta and amniotic membrane through blood fetus.
② Intrapartum infection: If the premature rupture of membranes exceeds 6 hours, the amniotic fluid may be contaminated. If the premature rupture of membranes exceeds 24 hours, the possibility of infection may reach 30%. Klebsiella, Listeria, Group B Streptococcus, etc., ascend to cause infection, or the fetus inhales contaminated amniotic fluid to cause disease. In addition, in the case of acute labor, prolonged labor, or incomplete disinfection of the birth canal, the fetus is in the process of labor, and pneumonia occurs due to inhalation of contaminated secretions in the birth canal.
(2) Postnatal infectious pneumonia
①Respiratory tract: If a person in contact with a newborn develops a respiratory tract infection, the pathogen can be transmitted from the upper respiratory tract of the infant down to the lungs through droplets, or when the infant's resistance decreases (such as cold, etc.), the upper respiratory tract infection descends and causes pneumonia.
②Blood-transmitted infection: When suffering from omphalitis, skin infection, and sepsis, the pathogen spreads to the lungs through blood, causing pneumonia. The pathogen is group B hemolytic streptococcus, Staphylococcus aureus, Escherichia coli and cytomegalovirus, Respiratory syncytial virus is more common.
(3) Hospital-borne infections: Hospital-borne infections can be caused by Pseudomonas aeruginosa, anaerobic bacteria and some low pathogenic bacteria. Insufficient disinfection of endotracheal intubation, high humidity in the incubator, easy breeding of aquatic bacteria, or prolonged use of ventilators, etc., can cause congestion in pneumonia wards, the disinfection system is not strict, and medical staff do not wash their hands frequently. Other neonates who use broad-spectrum antibiotics for too long are prone to fungal pneumonia. Late-onset pneumonia is more common in neonatal intensive care units and in neonates who require prolonged tracheal intubation due to chronic lung disease.
Reason 3: Others
Improper care, colds, etc. are also incentives for pneumonia. Due to improper warmth after birth, or contact with someone with respiratory tract infection, the upper respiratory tract infection first occurs and then spreads downward to become pneumonia. In addition, it may also be part of the manifestations of sepsis.
Symptoms of neonatal pneumonia
The early manifestations of neonatal pneumonia are mostly shortness of breath, labor, irregularity, coughing, spitting, etc., and varying degrees of bruising will appear around the mouth and nose of the sick baby. Sometimes babies have "cold" symptoms, such as nasal congestion and choking. However, careful observation will reveal that the baby has shortness of breath (more than 45 times/min), and may even be accompanied by difficulty in breathing such as the suprasternal fossa, intercostal space, and xiphoid process depression during inspiration.
The most direct symptom of neonatal pneumonia is foaming at the mouth, which is a form of neonatal cough and asthma. If the mother has emergency delivery, premature rupture of membranes, etc., special attention should be paid to the above conditions of the baby. At the same time, if the mother and baby have been in close contact with someone who has recently developed a respiratory infection, the baby also needs special care in this case.
How to deal with neonatal pneumonia
Treatment method 1: general treatment
Keep the airway open: remove the inhaled substances as soon as possible, suck the secretions from the oropharynx and nose, and regularly turn over and pat the back to facilitate the discharge of sputum.
Strengthen nursing and monitoring, pay attention to keep warm. Keep indoor air fresh, temperature and humidity suitable and stable.
Treatment 2: Antibiotics
Antibiotic therapy should be started when the neonatal respiratory volume increases after birth: intravenous antibiotics should be given in the early stage of bacterial pneumonia. In principle, antibiotics should be selected according to the pathogenic bacteria:
(1) Staphylococcus aureus infection: first-generation cephalosporins, enzyme-resistant penicillin or ampicillin (ampicillin) can be used.
(2) Group B hemolytic streptococcal pneumonia: can be treated with ampicillin (ampicillin) and penicillin for 3 days, and then switch to high-dose penicillin for 10-14 days.
(3) Gram-negative bacteria: Pseudomonas aeruginosa, severe or resistant to general antibiotics, third-generation cephalosporins can be used; Enterobacter pneumonia can be treated with amikacin (amikacin) and ampicillin .
(4) Listeria pneumonia: Ampicillin (ampicillin) can be used.
(5) Chlamydia pneumoniae: The first choice is erythromycin, the dose is 50 mg/kg per day, for 2-3 weeks.
(6) Anaerobic infection: intravenous injection of metronidazole (Metidine) is preferred.
(7) Viral pneumonia: can be treated with ribavirin or interferon. Respiratory syncytial virus pneumonia can be inhaled by inhalation of ribavirin (ribavirin) for 3-7 days. Herpes simplex virus can be administered intravenously with vidarabine or acyclovir (acyclovir).
Treatment method 3: Oxygen supply
In severe cases complicated by respiratory failure, continuous positive pressure breathing or mechanical ventilation can be used after endotracheal intubation.
For hypoxemia, oxygen can be supplied according to the situation to maintain blood oxygen at 6.65-10.7kPa (50-80mmHg), not exceeding 16.0kPa (120mmHg).
Treatment method 4: symptomatic treatment
Symptomatic treatment should be carried out according to specific symptoms, such as irritability, convulsions, and timely sedation.
Treatment method 5: Supportive care
(1) Enhance disease resistance: transfusion of fresh blood or plasma, 10ml/kg each time, can be used in small amounts and multiple times according to the condition, and human serum gamma globulin or human serum albumin to enhance immune function, 500mg/(kg·d), Can be used for 3-5 days.
(2) Guarantee nutrition and fluid volume: ensure nutrient supply and maintain water and electrolyte balance.
