Good afternoon Using my resource, I want to congratulate and support my good friend Yulechka, who became a mother yesterday. Unfortunately, the newborn baby was diagnosed with an infectious disease and the girls will not leave the hospital any time soon. To keep my finger on the pulse of events, I made an analysis of the main childhood diseases that can be encountered immediately after childbirth. The main problem of newborn children is diseases. Both the mother and the medical staff should help the baby adapt in the first days of life. However, there are frequent cases of a child contracting infections in the maternity hospital that arise due to illness or underexamination of the mother, lack of sterility and improper behavior of doctors during childbirth.
Therefore, it is so important that from the first minutes of life the baby receives colostrum first, and then breast milk. Both products are known to contain a lot of substances that are useful for the child’s immunity and can protect the baby from infection in the maternity hospital.
There are also intrauterine and congenital infections. Intrauterine ones arise from disturbances in the interaction between the fetus and the placenta, and congenital ones arise from rubella, hepatitis, AIDS and herpes.
Most diseases occur in the fetus due to these viruses. In particular, due to herpes appears cytomegalovirus infection. That's why it's so important to pass early stages pregnancy tests (including additional ones) for these diseases.
Danger in the first days of life
Infections in newborns can be early or late. Early diseases include those that appear in a child in the first 72 hours of life. Late ones appear in the baby after 72 hours (or more) during his stay in the maternity hospital. Children born prematurely are especially at risk of infection.
Infections of premature babies include:
- pneumonia;
- meningitis;
- bacteremia;
- genitourinary infection.
On the one hand, these diseases still occur quite rarely, but on the other hand, they are very difficult and with complications, which in some cases leads to death. , as a rule, resolves with the use of strong antibiotics and is an inevitable option. Refusal to treat with strong medications will only worsen the situation.
Diseases late period occur due to fungi and microorganisms. In the first place are staphylococcal infection and intestinal infection, i.e., in fact, diseases of dirty hands. The symptoms of these infections are approximately the same: children sleep poorly, eat poorly and are generally quite lethargic.
Antibiotics are used for treatment, and as preventive measures - careful hygiene, when communicating with the baby - treating hands with an antiseptic.
What else should moms worry about?
Not as scary, but still unpleasant, are newborn jaundice and umbilical infection. Yellow skin in a baby indicates a high level of bilirubin in the blood. This is a natural manifestation, especially in premature babies, but here it is very important to track the increase in this pigment in tests, since the consequences are very serious - from cerebral palsy to mental retardation.
The main solution to the problem is to place the child under a so-called blue lamp, the light of which destroys bilirubin pigments.
Until now, I knew only physiological jaundice, however, it turned out that there is also breast milk jaundice, pathological jaundice And hemolytic disease. And if the pigmentary reaction to breast milk is almost natural and can be corrected (while maintaining breastfeeding), then pathological options require serious intervention due to their strong influence on the nervous system and brain of the child.
Among children's problems, infection of the baby's navel is also noted - these are various types of suppuration that arise due to non-compliance with sterility during childbirth and after it, often accompanied by staphylococcus.
The newborn may develop suppuration, swelling, or ulcers at the site umbilical wound. Only doctors should treat such problems, since self-medication can lead to a significant deterioration in the child’s condition.
If your baby has such problems, you must agree to hospitalization, because strong remedies, in particular immunotherapy, may be needed to get rid of the infection.
Today’s post turned out to be completely sad, but I hope it will make expectant mothers think about prevention, getting rid of bad habits, timely treatment and continuity during pregnancy. After all, the same cytomegalovirus infection can be detected in the early stages, and by finding out when it occurred, you can help yourself and your unborn child.
Dear readers! I wish that you, your friends and loved ones will avoid all the troubles that I wrote about. Let the babies come into this world healthy and full of strength! I send rays of goodness to everyone, I hope for a repost.
In this article we will look at the main infectious diseases in newborns: how to diagnose, prevention and treatment.
Often such diseases occur due to weakened immunity at birth. Premature babies have an incompletely developed immune system and increased permeability of the skin and mucous membranes.
Children often get sick due to hospital infections, unsanitary conditions in the maternity hospital, infection from hospital staff, from other children in the general ward (when the infection is transmitted through the air).
Vesiculopustulosis
The disease is characterized by purulent inflammation on the child’s skin. Small bubbles (vesicles) filled with cloudy liquid appear on the body.
They burst after a few days, and scabs form in their place. Later they fall off, leaving no marks on the skin.
As a rule, this disease is not dangerous and does not cause complications.
Small blisters (up to 1 cm in diameter) filled with pus and gray liquid appear on the baby’s skin. They usually appear in the lower abdomen, near the navel, on the legs and arms.
The disease can progress to severe stage: large bubbles up to 3 cm in diameter. Intoxication of the entire body occurs. Urgent medical intervention is required!
The infection usually clears up within 2-3 weeks. May end in sepsis.
Treatment: pierce the bubbles and treat the puncture site with alcohol solutions of aniline dyes.
Pseudofurunculosis
The disease begins as an inflammation under the scalp and spreads further. After puncturing the blisters, pus is discovered.
Localization: on the head under the hairline, on the neck, back and buttocks.
Main symptoms: fever, mild intoxication, sepsis, increased levels of leukocytes in the blood.
Mastitis
The main cause of the disease is improper functioning of the mammary gland. It may not appear in the first days.
The newborn has increased breast. And when pressed, pus is released from the nipples.
The child constantly cries, refuses to breastfeed, and symptoms of body intoxication appear.
Mastitis is dangerous due to subsequent purulent complications for the entire body. Therefore, do not delay your visit to the doctor.
Streptoderma
The infection usually appears in the navel area, in groin area, on the hips, on the face and spreads further.
This is a very serious disease: the temperature reaches 40 degrees, the child becomes lethargic, refuses to eat, meningitis, diarrhea.
The disease can be complicated by toxic shock. In this case, you should immediately consult a doctor.
Phlegmon
This disease is characterized purulent inflammation subcutaneous tissue. At the most severe stage, necrotic phlegmon (tissue death) is observed.
The inflammatory-purulent process occurs on the chest and buttocks, rarely on the arms and legs.
Determining the onset of the disease is simple: a slight inflammation appears, painful to the touch. Gradually it grows. The skin becomes dark purple, then dies (on the second and subsequent days of the infectious disease it becomes pale and or gray).
If you cut into an inflamed area of skin, you will find pus and dead tissue inside.
Symptoms of the disease: intoxication of the body, temperature up to 39 degrees, vomiting, there are a lot of leukocytes in the blood (leukocytosis).
With timely and correct treatment, it is usually possible to prevent the spread of infection, necrosis and skin rejection.
Omphalitis
This is an inflammation of the skin in the navel area, possibly with pus.
The disease is not dangerous to the baby's health. Mothers are recommended to treat the wound with a 3% hydrogen peroxide solution 3 times a day. Then - a solution of potassium permanganate.
If a newborn becomes ill: the temperature rises, vomiting occurs, and regurgitation occurs after feeding.
Conjunctivitis
The disease is characterized by inflammation of the lacrimal glands, swelling, release of wax from the eyes, and constant tearing. May be complicated by deeper inflammation and ulcers.
Infection can occur in the maternity hospital or from the mother.
Treatment: Use a separate cotton swab for the right and left eyes to carefully remove purulent discharge. Wash with antibiotic solution several times a day. After rinsing, apply eye ointment (penicillin).
Acute rhinitis
The disease is characterized by inflammation of the nasal mucosa. Pus begins to come out of the nose.
Subsequently, swelling of the nasal mucosa is possible. The child's breathing is difficult. The baby cannot suckle (cannot breathe through his nose), cries constantly, and loses weight.
If the inflammation is not treated, it can spread to the middle ear and pharynx.
Treatment: suck out the pus using suction. You can use sterile swabs with petroleum jelly. Drop a solution of antibacterial drugs into your nose and insert gauze swabs (soaked in the solution) into each nostril for a few minutes.
In acute cases of the disease, the doctor may prescribe antibiotic injections.
Acute otitis media
The disease is characterized by inflammation of the mucous membrane of the middle ear cavity.
Otitis media can be purulent or serous. For serous otitis in the area eardrum Edema fluid accumulates. At purulent otitis there is severe swelling and suppuration in the area of the eardrum.
It is not always possible to detect the disease; it occurs secretly. The following can be distinguished symptoms of infection:
If an infection is detected, see an otolaryngologist. He will prescribe dry heat and UHF for the child.
Pneumonia
This is the most common infectious disease in newborns. Characterized by inflammation of lung tissue. The baby can get sick in the womb or in the maternity hospital.
In premature babies, inflammation lasts a long time and can develop into purulent inflammation + necrosis of lung tissue.
The first symptoms of the disease:
Treatment:
Enterocolitis
An infectious disease characterized by inflammation of the mucous membrane of the small and large intestines. Intestinal function is disrupted. Main pathogens: coli, salmonella, staphylococcus.
Symptoms of the disease:
Treatment: proper nutrition and hydration therapy. The doctor may prescribe antibacterial drugs, therapy with large doses of bifidumbacterin and bactisubtil (normalize the normal functioning of the intestines).
Sepsis
A very dangerous infectious disease. Inflammation occurs due to the penetration of infection into the blood against the background of reduced immunity. Often the infection penetrates through the navel, damaged areas of the skin, wounds, mucous membranes, and eyes.
After infection, a slight inflammation first appears at the site of penetration, then spreads to adjacent areas of the skin.
Purulent areas form on the skin, and intoxication of the body occurs. Purulent metastases to the brain (meningitis), liver and lungs are possible.
Main symptoms:
Duration of sepsis in children:
The mortality rate among newborns with sepsis is 30-40%!
Treatment of sepsis prescribed by the attending physician and carried out under strict supervision. Typically, children are prescribed the following procedures:
At the beginning of treatment, general drugs are prescribed, then specific drugs are prescribed based on the results of their effect on the flora. For prolonged sepsis use metronidazole. Along with antibiotics, you can give Lactobacterin 3 times a day and vitamins.
Prevention of sepsis consists of strict adherence to sanitary and epidemiological standards in hospitals and at home. Remember, newborns are most susceptible to infections, the risk of infectious diseases is very high. In premature babies, weakened immunity is also added to this.
Attention! The information in the article is given strictly for informational purposes. Don't study self-treatment child. Seek help from a specialist.
Intrauterine infections Localized and generalized purulent infection: causes and epidemiology Omphalitis, pyoderma, mastitis, conjunctivitis: clinical picture Treatment of localized purulent diseases Sepsis of newborns: etiology, pathogenesis, clinical picture, diagnosis, treatment, prognosis Prevention of purulent-septic diseases
Intrauterine infections
Intrauterine infections of newborns(IUI) are infectious diseases in which pathogens from an infected mother penetrate to the fetus during pregnancy or childbirth.
In newborns, IUI manifests itself in the form of severe damage to the central nervous system, heart, and organs of vision.
The time of infection of a pregnant woman, as well as the type and virulence of the pathogen, the severity of infection, the route of penetration of the pathogen, and the nature of the course of pregnancy are important in the development of the disease.
Infection of the mother occurs from Toxoplasma-infected domestic animals and birds (cattle, pigs, horses, sheep, rabbits, chickens, turkeys), wild animals (hares, squirrels). The mechanism of transmission is fecal-oral through unwashed hands after contact with soil contaminated with animal feces, consumption of unpasteurized milk, raw or undercooked meat; hematogenous - during transfusion of infected blood products. A person infected with toxoplasmosis for others not dangerous.
Infection from mother to fetus is transmitted through the placenta only once in a lifetime, if she was infected for the first time during this pregnancy. During a subsequent pregnancy or in the event of an illness before pregnancy, the fetus is not infected. This is due to the fact that the mother’s body has already developed high immunological activity to this pathogen.
Damage to the fetus in the first trimester of pregnancy leads to miscarriages, stillbirths and severe organ damage. When infected in the third trimester of pregnancy, the fetus is less likely to become infected, the disease manifests itself in more mild form. Toxoplasmosis can be asymptomatic for a long time and can be detected in children at an older age, even at 4-14 years of age.
There are acute, subacute and chronic phases of the disease. Clinical symptoms infectious diseases are diverse and not always specific. For acute phase(generalization stage) is characterized by a general serious condition, fever, jaundice, enlarged liver and spleen, maculopapular rash. Possible dyspeptic disorders, interstitial pneumonia, myocarditis, intrauterine growth retardation. Damage to the nervous system is characterized by lethargy, drowsiness, nystagmus, and strabismus. The fetus becomes infected shortly before the birth of the child, and a severe infection that begins in utero continues after birth.
IN subacute phase(stage of active encephalitis) a child is born with symptoms of central nervous system damage - vomiting, convulsions, tremors, paralysis and paresis, progressive micro-, hydrocephalus are detected; changes in the eyes are observed - clouding vitreous, chorioretinitis, iridocyclitis, nystagmus, strabismus.
IN chronic phase irreversible changes in the central nervous system and eyes occur - micro-, hydrocephalus, calcifications in the brain, delayed mental, speech and physical development, epilepsy, hearing loss, atrophy optic nerve, microphthalmia, chorioretinitis. Infection of the fetus occurs in the early stages, the child is born with manifestations of chronic toxoplasmosis.
Treatment. IN pyrimitamine preparations are used in treatment (chloridine, daraprim, tindurine) in combination with sulfonamides ( bactrim, sulfadimezin). Use combination drugs fansidar or Metakelfin. Effective spiramycin (rowamycin), sumamed, rulid. For active inflammation, corticosteroids are indicated. Multivitamins are a must.
To prevent toxoplasmosis, it is important to carry out sanitary educational work among women of childbearing age, identify infected women among pregnant women (screening test at the beginning and end of pregnancy), and prevent contact of pregnant women with cats and other animals;
Wash your hands thoroughly after handling raw meat. Identified infected women are treated in the first half of pregnancy spiramycin or terminate the pregnancy.
Congenital cytomegalovirus infection. The causative agent of the disease belongs to DNA viruses from the herpes family. The disease is characterized by damage to the salivary glands, central nervous system and other organs with the formation of giant cells with large intranuclear inclusions in their tissues.
The source of infection is only a person (patient or virus carrier). The virus is released from an infected body in urine, saliva, secretions, blood, and less often with feces. Shedding the virus in urine can last for several years. The transmission mechanism is predominantly contact, less often airborne, enteral and sexual.
The source of infection for newborn children is mothers who are carriers of the cytomegaly virus. Viruses penetrate to the fetus through the placenta, ascending or during childbirth, to the newborn - with infected milk, through transfusion of infected blood. Infection during childbirth occurs through aspiration or ingestion of infected amniotic fluid or secretions of the mother's birth canal.
Signs of the disease may be absent in pregnant women. asymptomatic form). If a latent infection is activated in a pregnant woman, a less intense infection of the placenta is observed. Due to the presence of specific IgG antibodies in the mother, less pronounced damage to the fetus is observed.
Damage to the fetus in early pregnancy leads to miscarriages and stillbirths. A child is born with developmental defects of the central nervous system, of cardio-vascular system, kidneys, lungs, thymus, adrenal glands, spleen, intestines. Organ damage is fibrocystic in nature - liver cirrhosis, biliary atresia, kidney and lung cysts, cystic fibrosis. Viremia and release of the virus into the external environment are not observed, since it is in a latent state.
If infection occurs shortly before birth, during labor, the child is born with generalized form disease or it develops soon after birth. It is characterized by clinical symptoms from the first hours or days of life, involvement of many organs and systems in the process: low birth weight, progressive jaundice, enlarged liver and spleen, hemorrhages - petechiae, sometimes resembling “blueberry pie” on the skin, melena, hemolytic anemia, meningoencephalitis and small cerebral calcifications around the ventricles. Chorioretinitis, cataracts, and optic neuritis are detected. When the lungs are affected, children experience persistent cough, shortness of breath and other signs of interstitial pneumonia.
Localized form develops against the background of isolated damage to the salivary glands or lungs, liver, or central nervous system.
Diagnostics. Laboratory diagnosis is based on the results of cytological, virological and serological studies. The virus is isolated in urine sediment, saliva, and cerebrospinal fluid. Serological methods - RSK, PH, RPGA - confirm the diagnosis. ELISA, PCR and D NK hybridization are used.
Treatment. During treatment, you should make sure that there are no pathogens in the mother's milk. A specific anti-cytomegalovirus 10% immunoglobulin solution is used - cytotect, sandoglobulin(IgG). Use pentaglobin - IgM, KIP, antiviral drugs (cytosine arabinoside, adenine arabinoside, iododeoxyuridine, ganciclovir, foscarnet). Syndromic and symptomatic therapy is carried out.
It is important to observe the rules of personal hygiene when caring for newborns with jaundice and toxic-septic diseases. All pregnant women are examined for the presence of cytomegaly.
Sometimes it happens that the pregnancy seemed to be going well, and the birth went well, and the baby immediately screamed after birth, but suddenly on the second or third day of life, the doctor says that the child’s condition has worsened somewhat. The baby has become lethargic, pale, eats poorly, spits up, and does not gain weight. This sounds like a serious and incomprehensible diagnosis: intrauterine infection. What is intrauterine infection, where does it come from and how to cope with it?
Intrauterine infections are those diseases that occur when the fetus is infected from an infected mother during pregnancy or during childbirth. Predisposing factors for development intrauterine infection are different chronic diseases mothers, especially inflammatory processes of the kidneys and pelvic organs (cystitis, pyelonephritis, vaginitis, inflammation of the uterine appendages, etc.). Occupational hazards, stress, bad habits and poor nutrition are also of great importance. The causative agents of intrauterine infection can be viruses (herpes, cytomegaly, influenza, rubella), bacteria (streptococci, E. coli, treponema pallidum, chlamydia), fungi (Candida) and protozoa (toxoplasma). When a pregnant woman encounters any infection for the first time, the likelihood of infecting the baby increases sharply.
The period during which infection occurs is critical and determines the further course of pregnancy. At 3-12 weeks of pregnancy, intrauterine infection can lead to termination of pregnancy or the formation of fetal malformations. When infected during the 11-28th week of pregnancy, intrauterine growth retardation occurs and the child is born with low body weight. Infection at a later stage affects already formed internal organs: the central nervous system is the most vulnerable; the heart, liver, and lungs are also often affected. Intrauterine infection often leads to premature birth, which also affects the condition of the baby.
Also, infection with intrauterine infection can occur during childbirth, for example, through ingestion of infected amniotic fluid, contents of the birth canal, and by contact (through the skin and mucous membranes). In this case, the baby will feel good at birth, and signs of infection - lethargy, pallor, decreased appetite, increased regurgitation, respiratory failure, etc. - may appear only after some time, but no later than on the third day of life.
The outcomes of intrauterine infection are different and again depend on the time when the infection occurred and on the specific pathogen. If a child falls ill long before birth, then the entire infectious process occurs in utero; the child may be born healthy, but with low body weight. But long-term consequences are also possible (especially for viral infections): for example, disruption of the development of any organs or tissues; various brain cysts, etc. If contact with an infection occurs shortly before birth, the child may be born with an infectious process in the form of pneumonia, enterocolitis, meningitis, etc.
Diagnosis of intrauterine infections difficult due to the lack of specific clinical manifestations. That is, almost all intrauterine infections in a child manifest themselves in the same way: intrauterine growth retardation, enlarged liver and spleen, jaundice, rash, respiratory disorders, cardiovascular failure and neurological disorders. For diagnosis during pregnancy and after the birth of a baby, they use the determination of specific antibodies to a particular pathogen, the search for the pathogen itself in the blood, urine or cerebrospinal fluid of the child and/or mother. Also, many conventional examination methods, such as a general blood test, urine test, biochemical blood test, ultrasound examination of the brain and internal organs, X-rays help in making a diagnosis.
Treatment of intrauterine infections in newborns depends on the pathogen that caused the disease and the manifestation of the disease. Antibacterial, antiviral, immunostimulating, and restorative drugs are usually prescribed.
The most effective is prevention of intrauterine infections. Even before pregnancy, it is worth examining for some infections, since many of them can have a hidden, sluggish course and appear only during pregnancy. If a woman has not had rubella, then when planning a pregnancy (at least 3 months in advance), it is advisable to get vaccinated against this infection, since infection with rubella in the early stages can lead to serious developmental defects in the child. In addition, it is advisable for the expectant mother to follow certain sanitary and hygienic rules: avoid contact with sick relatives, examine pets (cats for the presence of toxoplasmosis), and also be promptly examined and treated if they are carrying any infections. It is worth paying attention to nutrition: avoid fast food, eat well-fried meat and fish and do not get carried away with exotic cuisine - these simple measures are an excellent prevention of toxoplasmosis and listeriosis.
Developing in the mother's belly, the child is relatively safe. Relatively, since even in such sterile conditions there is a risk of developing infectious disease. This large group diseases are called intrauterine infections. During pregnancy, a woman should especially carefully monitor her health. A sick mother can infect her child during fetal development or during childbirth. We will discuss the signs and methods of diagnosing such diseases in the article.
The danger of intrauterine infections is that they unceremoniously interfere with the formation of a new life, which is why babies are born weak and sick - with defects in mental and physical development. Such infections can cause the greatest harm to the fetus in the first 3 months of its existence.
Intrauterine infection during pregnancy: what statistics say
- A timely diagnosed and treated infectious disease in a pregnant woman poses minimal danger to her child.
- Infectious agents pass from mother to baby in 10 out of 100 pregnancies.
- 0.5% of infants infected in the womb are born with corresponding signs of the disease.
- An infection that has settled in the mother’s body does not necessarily pass to the fetus, and the child has a chance to be born healthy.
- A number of infectious diseases that do not promise anything good for the baby may be present in the mother at hidden form and have virtually no effect on her well-being.
- If a pregnant woman gets sick with one or another infectious disease for the first time, there is a high probability that her child will also become infected.
Intrauterine infection - ways of infection of the embryo
There are four ways in which infectious agents can enter a tiny growing organism:
- hematogenous (transplacental) – from the mother, harmful microorganisms penetrate to the fetus through the placenta. This route of infection is characteristic of viruses and toxoplasma;
- ascending - infection occurs when the causative agent of the infection rises through the genital tract to the uterus and, having penetrated its cavity, infects the embryo. So the baby may develop chlamydial infection and enterococci;
- descending – the focus of infection is the fallopian tubes (with adnexitis or oophoritis). From there, the pathogens penetrate the uterine cavity, where they infect the child;
- contact - infection of the baby occurs during childbirth, when it moves through the birth canal of a sick mother. Pathogens enter the child’s body after he has swallowed infected amniotic fluid.
Intrauterine infection at different stages of pregnancy: consequences for the child
Exodus infectious infection the fetus depends on at what stage of intrauterine development it was attacked by dangerous microorganisms:
- pregnancy period 3 – 12 weeks: spontaneous termination of pregnancy or the appearance of various developmental anomalies in the fetus;
- gestation period 11 – 28 weeks: the fetus is noticeably delayed in intrauterine development, the child is born with insufficient body weight and various malformations (for example, congenital heart disease);
- pregnancy period after 30 weeks: developmental anomalies affect the fetal organs, which by this time have already formed. Nai great danger the infection affects the central nervous system, heart, liver, lungs and organs of vision.
In addition, congenital infection has acute and chronic forms. About acute infection The child at birth is evidenced by the following consequences:
- state of shock;
- pneumonia;
- sepsis (blood poisoning).
Some time after birth, acute intrauterine infection in newborns may manifest itself the following signs:
- excess daily sleep duration;
- poor appetite;
- insufficient physical activity, which decreases every day.
If the congenital infection is chronic, there may be no clinical picture at all. Distant signs of intrauterine infection include:
- complete or partial deafness;
- deviations in mental health;
- vision pathologies;
- lagging behind peers in motor development.
Penetration of infection to the fetus through the uterus leads to the following consequences:
- stillbirth of a baby;
- intrauterine embryonic death;
- frozen pregnancy;
- spontaneous abortion.
The following pathological consequences are recorded in children who survived such infection:
- heat;
- rash and erosive skin lesions;
- non-immune hydrops fetalis;
- anemia;
- enlarged liver due to jaundice;
- pneumonia;
- pathologies of the heart muscle;
- pathology of the eye lens;
- microcephaly and hydrocephalus.
Intrauterine infection: who is at risk
Every expectant mother runs the risk of being captured by an infectious agent, because during pregnancy her body’s defenses are depleted to the limit. But the greatest danger awaits women who:
- already have one or more children attending kindergarten or school;
- are related to the medical field and are in direct contact with people who may be potential carriers of infection;
- work in kindergarten, school and other children's institutions;
- have had 2 or more medical terminations of pregnancy in the past;
- have inflammatory diseases in a sluggish form;
- faced untimely rupture of amniotic fluid;
- have had a previous pregnancy with abnormal embryo development or intrauterine fetal death;
- have already given birth to a baby with signs of infection in the past.
Symptoms of intrauterine infection in a woman during pregnancy
Doctors identify several universal signs that suggest that the expectant mother has contracted an infectious disease:
- sudden increase in temperature, fever;
- shortness of breath when walking or climbing stairs;
- cough;
- rash on the body;
- enlarged lymph nodes that react painfully to touch;
- painful joints that appear swollen;
- conjunctivitis, lacrimation;
- nasal congestion;
- painful sensations in the chest.
This set of indications may also indicate the development of allergies in a pregnant woman. In this case, there is no threat of infectious infection of the fetus. Be that as it may, the expectant mother should go to the hospital as soon as at least one of these symptoms appears.
Causes of intrauterine infection during pregnancy
The activity of ubiquitous pathogenic microorganisms is the main cause of morbidity among women who are preparing to become mothers. Many bacteria and viruses, entering the mother's body, are transmitted to the child, provoking the development of serious anomalies. Viruses responsible for the development of acute respiratory infections viral diseases, do not pose a danger to the fetus. A threat to the child’s condition appears only if a pregnant woman develops a high body temperature.
One way or another, intrauterine infection of the baby occurs exclusively from the sick mother. There are several main factors that can contribute to the development of infectious pathology in the fetus:
- Acute and chronic diseases of the mother in the genitourinary system. Among them are inflammatory pathologies such as cervical ectopia, urethritis, cystitis, and pyelonephritis.
- The mother has an immunodeficiency state or HIV infection.
- Organ and tissue transplantation that the woman has undergone in the past.
Intrauterine infections: main characteristics and routes of infection
Cytomegalovirus (CMV)
The causative agent of the disease is a representative of herpes viruses. You can get the disease through sexual and close household contact, through blood (for example, through a transfusion from an infected donor).
During the primary infection of a pregnant woman, the microorganism penetrates the placenta and infects the fetus. In some cases, the baby does not experience any abnormal consequences after infection. But at the same time, statistics say: 10 out of 100 babies whose mothers encountered an infection during pregnancy have pronounced signs of intrauterine infection.
The consequences of such an intrauterine infection during pregnancy are as follows:
- spontaneous abortion;
- stillbirth;
- hearing loss of sensorineural origin;
- low birth weight;
- hydro- and microcephaly;
- pneumonia;
- lag in the development of psychomotor skills;
- pathological enlargement of the liver and spleen;
- blindness of varying severity.
Cytomegalovirus under a microscope
If the infectious lesion is of a general combined nature, more than half of the babies die within 2 to 3 months after birth. In addition, the development of such consequences as a lag in mental development, hearing loss and blindness. With mild local damage, the consequences are not so fatal.
Unfortunately, there are no medications yet that can eliminate the symptoms of CMV in newborns. If a pregnant woman is diagnosed with cytomegalovirus infection, the pregnancy is abandoned because the child has a chance to remain healthy. The expectant mother will be prescribed an appropriate course of treatment to minimize the effect of the disease on her body.
Intrauterine infection - herpes simplex virus (HSV)
A newborn baby is diagnosed with a congenital herpes infection if his mother is diagnosed with herpes simplex virus type 2, which in most cases is contracted through unprotected sexual contact. Signs of the disease will appear in the child almost immediately, during the first month of life. Infection of the baby occurs mainly during the birth process, when it moves through the birth canal of the infected mother. In some cases, the virus reaches the fetus through the placenta.
When a child’s body is affected by a herpes infection, the consequences are severe:
- pneumonia;
- violation visual function;
- brain damage;
- skin rash;
- heat;
- poor blood clotting;
- jaundice;
- apathy, lack of appetite;
- stillbirth.
Severe cases of infection result in mental retardation, cerebral palsy and a vegetative state.
Herpes simplex virus under a microscope
Intrauterine infection - rubella
This disease is rightfully considered one of the most life-threatening embryos. The route of transmission of the rubella virus is airborne, and infection is possible even over a long distance. The disease, which poses a particularly great threat before the 16th week of pregnancy, “programs” various deformities in the development of the baby:
- low birth weight;
- spontaneous abortion, intrauterine death;
- microcephaly;
- congenital anomalies development of the heart muscle;
- hearing loss;
- cataract;
- various skin diseases;
- pneumonia;
- unnatural enlargement of the liver and spleen;
- meningitis, encephalitis.
Intrauterine infection - parvovirus B19
The presence of this virus in the body provokes the development of a disease known as erythema infectiosum. In adults, the disease does not manifest itself in any way because it is latent. However, the consequences of the pathology for the fetus are more than serious: the child may die before birth, and there is also a threat of spontaneous abortion and intrauterine infection. On average, infected children die in 10 cases out of 100. At 13–28 weeks of pregnancy, the fetus is especially defenseless against this infection.
When infected with parvovirus B19, the following consequences are noted:
- swelling;
- anemia;
- brain damage;
- hepatitis;
- myocardial inflammation;
- peritonitis.
Intrauterine infection - chickenpox
When an expectant mother is infected with chickenpox, the infection also affects the child in 25 out of 100 cases, but symptoms of the disease are not always present.
Congenital chicken pox identified by the following characteristics:
- brain damage;
- pneumonia;
- skin rash;
- delayed development of eyes and limbs;
- optic nerve atrophy.
Newborn babies infected in the womb are not treated for chickenpox, since the clinical picture of the disease does not progress. If a pregnant woman “caught” an infection 5 days before giving birth or later, the baby will be given an injection of immunoglobulin after birth, since there are no maternal antibodies in his body.
Intrauterine infection - hepatitis B
You can get a dangerous virus during sexual intercourse with an infected person in the absence of barrier methods of contraception. The causative agent of the disease penetrates the baby through the placenta. The most dangerous period in terms of infection is from 4 to 9 months of pregnancy. The consequences of infection for a child are:
- hepatitis B, which can be treated with the appropriate approach;
- oncological diseases liver;
- indolent form of hepatitis B;
- acute form of hepatitis B, which provokes the development of liver failure in the child and he dies;
- delay in the development of psychomotor functions;
- hypoxia;
- miscarriage.
Intrauterine infection - human immunodeficiency virus (HIV)
HIV infection is a scourge for special immune lymphocytes. In most cases, infection occurs during sexual intercourse with a sick partner. A child can become infected while in the womb or during birth. Intensive complex treatment is recommended for HIV-infected children, otherwise they will not live even two years - the infection quickly “eats” the weak body. Infected children die from infections that healthy babies do not pose a mortal danger.
To confirm HIV in an infant, the polymerase chain reaction diagnostic method is used. It is also very important to promptly detect the infection in the body of a pregnant woman. If the baby is lucky enough to be born healthy, the mother will not breastfeed him so that the infection is not transmitted to him through milk.
Intrauterine infection - listeriosis
The disease develops as a result of the activity of the Listeria bacterium. The microorganism easily penetrates the fetus through the placenta. Infection of a pregnant woman occurs through unwashed vegetables and a number of food products (milk, eggs, meat). In women, the disease may be asymptomatic, although in some cases fever, vomiting and diarrhea are noted. In an infected baby, the signs of listeriosis are as follows:
- rash and multiple accumulations of pustules on the skin;
- inflammation of the brain;
- refusal of food;
- sepsis;
- spontaneous miscarriage;
- stillbirth of a baby.
If signs of listeriosis become obvious in the first week after birth, then babies die in 60 cases out of 100. After confirmation of listeriosis in a pregnant woman, she is prescribed a two-week course of treatment with Ampicillin.
Intrauterine infection - syphilis
If a pregnant woman has syphilis, which she has not treated, the probability of infecting her child is almost 100%. Out of 10 infected babies, only 4 survive, and those who survive are diagnosed with congenital syphilis. The child will become infected even if the mother’s disease is latent. The results of the infection in the child’s body are as follows:
- tooth decay, damage to the organs of vision and hearing;
- damage to the upper and lower extremities;
- formation of cracks and rashes on the skin;
- anemia;
- jaundice;
- mental retardation;
- premature birth;
- stillbirth.
Intrauterine infection - toxoplasmosis
The main carriers of toxoplasmosis are cats and dogs. The causative agent of the disease enters the body of the expectant mother when she takes care of a pet or, out of habit, tastes meat with an insufficient degree of heat treatment while preparing dinner. Infection during pregnancy poses a great danger to the intrauterine development of the baby - in 50 cases out of 100, the infection overcomes the placental barrier and affects the fetus. The consequences of a child becoming infected are as follows:
- damage to the organs of vision;
- hydrocephalus;
- microcephaly;
- abnormally enlarged liver and spleen;
- inflammation of the brain;
- spontaneous abortion;
- delay in the development of psychomotor functions.
Cytomegalovirus, rubella, toxoplasmosis, herpes, tuberculosis, syphilis and some other diseases are combined into a group of so-called TORCH infections. When planning a pregnancy, future parents undergo tests that help identify these pathological conditions.
Tests for intrauterine infections during pregnancy
Over the course of 9 months, the expectant mother will have to undergo more than one laboratory test so that doctors can make sure that she is healthy. Pregnant women take a blood test for hepatitis B and C, and syphilis. The PRC method is also used for pregnant women, thanks to which it is possible to detect active viruses in the blood, if any. In addition, expectant mothers regularly visit the laboratory to take a vaginal smear for microflora.
Ultrasound examination is of no small importance for successful pregnancy management. This method is absolutely safe for the fetus. And although this procedure is not directly related to the diagnosis of infectious diseases, with its help doctors can detect abnormalities of intrauterine development caused by pathogenic microorganisms. There is every reason to talk about an intrauterine infection if the following symptoms become obvious on an ultrasound:
- Formed developmental pathologies.
- Polyhydramnios or oligohydramnios.
- Swelling of the placenta.
- Enlarged abdomen and unnaturally enlarged structural units of the kidneys.
- Enlarged internal organs: heart, liver, spleen.
- Foci of calcium deposition in the intestines, liver and brain.
- Enlarged ventricles of the brain.
In the diagnostic program for examining expectant mothers belonging to the risk groups we discussed above, a special place is occupied by the seroimmunological method for determining immunoglobulins. As necessary, doctors resort to amniocentesis and cordocentnesis. The first method of research is to study amniotic fluid, the second involves studying umbilical cord blood. These diagnostic methods are very informative in detecting infection. If the presence of an intrauterine infection is suspected in a baby, then the material for research is the baby’s biological fluids - for example, saliva or blood.
Danger of TORCH infections during pregnancy. Video
beremennuyu.ru
Intrauterine infection during pregnancy, risk of IUI
When carrying a child, a woman tries to protect him from unfavorable external influences. The health of a developing baby is the most important thing during this period; all protective mechanisms are aimed at preserving it. But there are situations when the body cannot cope, and the fetus is affected in utero - most often it is an infection. Why it develops, how it manifests itself and what risks it carries for the child - these are the main questions that concern expectant mothers.
Causes
For an infection to occur, including intrauterine infection, several factors must be present: the pathogen, the route of transmission, and the susceptible organism. The direct cause of the disease is considered to be microbes. The list of possible pathogens is very wide and includes various representatives - bacteria, viruses, fungi and protozoa. It should be noted that intrauterine infection is mainly caused by microbial associations, i.e., it is mixed in nature, but monoinfections are also common. Among the common pathogens, it is worth noting the following:
- Bacteria: staphylo-, strepto- and enterococci, Escherichia coli, Klebsiella, Proteus.
- Viruses: herpes, rubella, hepatitis B, HIV.
- Intracellular agents: chlamydia, mycoplasma, ureaplasma.
- Fungi: candida.
- Protozoa: Toxoplasma.
A separate group of infections was identified that, despite all the differences in morphology and biological properties, cause similar symptoms and are associated with persistent developmental defects in the fetus. They are known by the abbreviation TORCH: toxoplasma, rubella, cytomegalovirus, herpes and others. It must also be said that last years There have been certain changes in the structure of intrauterine infections, which is associated with improved diagnostic methods and the identification of new pathogens (for example, listeria).
The infection can reach the child in several ways: through the blood (hematogenously or transplacentally), amniotic fluid (amnial), the mother's genital tract (ascending), from the uterine wall (transmural), through the fallopian tubes (descending) and through direct contact. Accordingly, there are certain risk factors for infection that a woman and a doctor should remember:
- Inflammatory pathology of the gynecological sphere (colpitis, cervicitis, bacterial vaginosis, adnexitis, endometritis).
- Invasive interventions during pregnancy and childbirth (amnio- or cordocentesis, chorionic villus biopsy, cesarean section).
- Abortions and complications in the postpartum period (previous).
- Cervical insufficiency.
- Polyhydramnios.
- Fetoplacental insufficiency.
- Common infectious diseases.
- Foci of chronic inflammation.
- Early onset of sexual activity and promiscuity in sexual relations.
In addition, many infections are characterized by a latent course, undergoing reactivation due to disturbances in metabolic and hormonal processes in female body: hypovitaminosis, anemia, severe physical activity, psycho-emotional stress, endocrine disorders, exacerbation of chronic diseases. Those who have such factors identified are at high risk of intrauterine infection of the fetus. They also show regular monitoring of the condition and preventive actions, aimed at minimizing the likelihood of developing pathology and its consequences.
Intrauterine infection develops when infected with microbes, which is facilitated by many factors from the maternal body.
Mechanisms
The degree of pathological impact is determined by the characteristics of the morphological development of the fetus at a particular stage of pregnancy, its reaction to the infectious process (maturity of the immune system), and the duration of microbial aggression. The severity and nature of the lesion are not always strictly proportional to the virulence of the pathogen (the degree of its pathogenicity). Often, latent infection caused by chlamydial, viral or fungal agents leads to intrauterine death or the birth of a child with serious abnormalities. This is due to the biological tropism of microbes, i.e., the tendency to reproduce in embryonic tissues.
Infectious agents have different effects on the fetus. They can provoke inflammatory process V various organs with the further development of a morphofunctional defect or have a direct teratogenic effect with the appearance structural anomalies and developmental defects. Of no small importance are intoxication of the fetus by products of microbial metabolism, disorders metabolic processes and hemocirculation with hypoxia. As a result, fetal development suffers and differentiation of internal organs is disrupted.
The clinical manifestations and severity of the infection are determined by many factors: the type and characteristics of the pathogen, the mechanism of its transmission, the strength of the immune system and the stage of the pathological process in the pregnant woman, the gestational age at which the infection occurred. IN general view This can be represented as follows (table):
Symptoms of intrauterine infection are noticeable immediately after birth or in the first 3 days. But it should be remembered that some diseases may have a longer incubation (hidden) period or, conversely, appear earlier (for example, in premature babies). Most often, the pathology is manifested by the newborn infection syndrome, manifested by the following symptoms:
- Weakening of reflexes.
- Muscle hypotension.
- Refusal to feed.
- Frequent regurgitation.
- Pale skin with periods of cyanosis.
- Changes in the rhythm and frequency of breathing.
- Muffled heart sounds.
Specific manifestations of pathology include a wide range of disorders. Based on the tissue tropism of the pathogen, intrauterine infection during pregnancy can manifest itself:
- Vesiculopustulosis: a rash on the skin in the form of blisters and pustules.
- Conjunctivitis, otitis and rhinitis.
- Pneumonia: shortness of breath, bluish skin, wheezing in the lungs.
- Enterocolitis: diarrhea, bloating, sluggish sucking, regurgitation.
- Meningitis and encephalitis: weak reflexes, vomiting, hydrocephalus.
Along with the local pathological process, the disease can be widespread - in the form of sepsis. However, its diagnosis in newborns is difficult, which is associated with the low immune reactivity of the child’s body. At first, the clinic is quite sparse, since only symptoms of general intoxication are present, including those already listed above. In addition, the baby is underweight, the umbilical wound does not heal well, jaundice appears, and the liver and spleen are enlarged (hepatosplenomegaly).
Children infected during the prenatal period exhibit disturbances in many vital systems, including the nervous, cardiovascular, respiratory, humoral, and immune systems. Key adaptation mechanisms are disrupted, which is manifested by hypoxic syndrome, malnutrition, cerebral and metabolic disorders.
The clinical picture of intrauterine infections is very diverse - it includes specific and general symptoms.
Cytomegalovirus
Most children infected with cytomegalovirus do not have any visible abnormalities at birth. But later, signs of neurological disorders are revealed: deafness, slowing of neuropsychic development (mild mental retardation). Unfortunately, these disorders are irreversible. They may progress to the development of cerebral palsy or epilepsy. In addition, congenital infection can manifest itself:
- Hepatitis.
- Pneumonia.
- Hemolytic anemia.
- Thrombocytopenia.
These disorders disappear over a certain period even without treatment. Chorioretinopathy may occur, but is rarely accompanied by decreased vision. Severe and life-threatening conditions are very rare.
Herpetic infection
The greatest danger to the fetus is a primary genital infection in the mother or an exacerbation chronic illness. Then the child becomes infected through contact, passing through the affected genital tract during childbirth. Intrauterine infection occurs less frequently; it occurs before the natural end of pregnancy, when the amniotic sac bursts, or at other times - from the first to the third trimester.
Infection of the fetus in the first months of pregnancy is accompanied by heart defects, hydrocephalus, anomalies of the digestive system, intrauterine growth retardation, and spontaneous abortions. In the second and third trimesters, pathology leads to the following abnormalities:
- Anemia.
- Jaundice.
- Hypotrophy.
- Meningoencephalitis.
- Hepatosplenomegaly.
And herpes infection in newborns is diagnosed by blistering (vesicular) lesions of the skin and mucous membranes, chorioretinitis and encephalitis. There are also common forms when pathological process multiple systems and organs are involved.
Rubella
A child can become infected from the mother at any stage of pregnancy, and the clinical manifestations will depend on the time of infection. The disease is accompanied by damage to the placenta and fetus, intrauterine death of the latter, or does not produce any consequences at all. Children born with infection are characterized by quite specific anomalies:
- Cataract.
- Deafness.
- Heart defects.
But in addition to these signs, other structural abnormalities may also occur, for example, microcephaly, cleft palate, skeletal disorders, genitourinary disorders, hepatitis, pneumonia. But in many children born infected, no pathology is detected, and in the first five years of life problems begin - hearing deteriorates, slows down psychomotor development autism appears diabetes.
Rubella has a clear teratogenic effect on the fetus, leading to various abnormalities, or provokes its death (spontaneous abortion).
Toxoplasmosis
Infection with toxoplasmosis in early pregnancy can be accompanied by serious consequences for the fetus. Intrauterine infection provokes the death of the child or the occurrence of multiple anomalies, including hydrocephalus, brain cysts, edema syndrome and destruction of internal organs. Congenital disease often has a widespread nature, manifested by the following symptoms:
- Anemia.
- Hepatosplenomegaly.
- Jaundice.
- Lymphadenopathy (increased lymph nodes).
- Fever.
- Chorioretinitis.
When infected at a later stage, the clinical manifestations are quite sparse and are mainly characterized by decreased vision or unexpressed disorders in the nervous system, which often remain undetected.
Additional diagnostics
Prenatal diagnosis of infectious lesions of the fetus is of great importance. To determine pathology, laboratory and instrumental methods are used to identify the pathogen and identify abnormalities in the development of the child at various stages of pregnancy. If intrauterine infection is suspected, the following is performed:
- Biochemical blood test (antibodies or microbial antigens).
- Analysis of smears from the genital tract and amniotic fluid (microscopy, bacteriology and virology).
- Genetic identification (PCR).
- Ultrasound (fetometry, placentography, Dopplerography).
- Cardiotocography.
After birth, newborns are examined (skin washes, blood tests) and the placenta (histological examination). Comprehensive diagnostics allows you to identify pathology at the preclinical stage and plan further treatment. The nature of the measures taken will be determined by the type of infection, its spread and clinical picture. Prenatal prevention and proper management of pregnancy also play an important role.
flovit.ru
Intrauterine infections - symptoms, treatment, forms, stages, diagnosis
Intrauterine infection (IUI) refers to infectious and inflammatory diseases of the fetus and young children that occur during the antenatal (prenatal) and (or) intranatal (natal) periods with vertical infection from the mother.
It is necessary to distinguish between the concepts of “intrauterine infection” and “intrauterine infection”. Infection implies the penetration of a pathogen into the child’s body without developing a clinical picture, while intrauterine infection is the full implementation of intrauterine infection in the form of a clinical manifestation of an infectious disease.
According to the results of some studies, infection is detected in approximately 50% of full-term and 70% of premature infants. According to more “optimistic” data, every tenth fetus (child) is exposed to pathogenic agents during pregnancy and childbirth.
In 80% of cases, IUI complicates the child’s health with various pathological conditions and developmental defects of varying severity. Based on the results of the autopsy, it is determined that in every third case, perinatal infection was the main cause of death of the newborn, accompanying or complicating the course of the underlying disease.
Long-term studies show that children of the first years of life who have suffered an intrauterine infection have weaker immune capabilities and are more susceptible to infectious and somatic diseases.
In the early 70s of the 20th century, the World Health Organization proposed the name “TORCH syndrome”. This abbreviation reflects the names of the most common intrauterine infections: T - toxoplasmosis, O - others (mycoplasma, syphilis, hepatitis, streptococci, candida, etc.) (Other), R - rubella (Rubella), C - cytomegalovirus (Cytomegalovirus), H – herpes (Herpes). If the etiological factor is not known for certain, they speak of TORCH syndrome.
Causes and risk factors
The main source of infection in IUI, as already noted, is the mother, from whom the pathogen enters the fetus during the ante- and (or) intranatal period (vertical transmission mechanism).
The causative agents of intrauterine infection can be bacteria, fungi, protozoa, and viruses. According to statistical data, the first place in the structure of intrauterine infections is occupied by bacterial diseases(28%), in second place are chlamydial and associated infections (21%).
Infectious agents that are the most common causes of intrauterine infection:
- rubella viruses, herpes simplex, chickenpox, hepatitis B and C, influenza, adenoviruses, enteroviruses, cytomegalovirus;
- pathogenic bacteria (Escherichia, Klebsiella, Proteus and other coliform bacteria, group B streptococci, Haemophylus influenzae, alpha-hemolytic streptococci, non-spore-forming anaerobes);
- intracellular pathogens (toxoplasma, mycoplasma, chlamydia);
- mushrooms of the genus Candida.
Risk factors for intrauterine infection:
- chronic diseases of the urogenital area in the mother (erosive lesions of the cervix, endocervicitis, colpitis, vulvovaginitis, ovarian cyst, urethritis, cystitis, pyelo- and glomerulonephritis, etc.);
- infectious diseases suffered by the mother during pregnancy;
- long waterless period.
Factors indirectly indicating possible intrauterine infection:
- complicated obstetric history (spontaneous abortion, infertility, stillbirth, birth of children with multiple malformations);
- polyhydramnios, the presence of inclusions and impurities in the amniotic fluid;
- fever not accompanied by signs of inflammation in any organ system that developed in the mother during pregnancy or childbirth;
- the birth of a premature baby before the due date;
- intrauterine growth retardation;
- Apgar score 0–4 points in the 1st minute of the child’s life, with unsatisfactory indicators remaining or a deterioration in the score by the 5th minute of life;
- newborn fever of unknown etiology.
Forms of the disease
Depending on the stage of pregnancy at which the infection occurred, there are:
- blastopathy – occurs during the first 14 days of pregnancy;
- embryopathies - appear in the period from 15 days of pregnancy to 8 weeks;
- fetopathy - develops after 9 weeks of pregnancy (early fetopathy - from the 76th to the 180th day of pregnancy, late fetopathy - from the 181st day of pregnancy until the moment of birth).
An intrauterine infection that develops in the first 2 weeks of pregnancy most often leads to the death of the embryo (frozen pregnancy) or the formation of severe systemic malformations, similar to genetic developmental anomalies. Spontaneous termination of pregnancy, as a rule, occurs 2-3 weeks after infection.
Since all organs and systems are formed in the embryonic period, the development of IUI at these stages will lead to the death of the embryo or, as in the previous case, to the formation of malformations of varying severity.
Fetopathies have a number of characteristics:
- congenital defects occur only in those organs whose formation was not completed at the time of the child’s birth;
- infectious processes are more often of a generalized (widespread) nature;
- the infection is often accompanied by the development of thrombohemorrhagic syndrome;
- morphological and functional maturation of organs occurs with a lag.
The World Health Organization (ICD-10) has proposed an extensive classification of intrauterine infections, the main forms of which are:
Symptoms
Often, intrauterine infections do not have characteristic symptoms, so their presence can be suspected by nonspecific signs of an infectious-inflammatory process in a newborn (their similarity is noted in IUI provoked by various pathogens):
- decreased or lack of appetite;
- significant weight loss (decrease in body weight by more than 10% of initial birth weight);
- repeated weight loss, poor restoration of body weight (slow gain, slight gain);
- inflammation of the skin and subcutaneous fat (sclerema);
- lethargy, drowsiness, apathy;
- grayish-pale coloration skin, anemic mucous membranes, possible icteric staining of the skin and mucous membranes, icterus of the sclera;
- edematous syndrome of varying severity and localization;
- respiratory disorders (shortness of breath, short-term episodes of respiratory arrest, involvement of auxiliary muscles in the act of breathing);
- dyspeptic disorders (regurgitation, including heavy regurgitation, unstable stools, enlarged liver and spleen);
- symptoms of cardiovascular involvement (tachycardia, decreased blood pressure, swelling or pastiness, cyanotic coloration of the skin and mucous membranes, marbling of the skin, coldness of the extremities);
- neurological symptoms (hyper- or hypotonicity, dystonia, decreased reflexes (including worsening of the sucking reflex);
- changes in the blood count (leukocytosis, accelerated ESR, anemia, decreased platelet count).
Signs of intrauterine infection often manifest in the first 3 days of a newborn’s life.
Diagnostics
When diagnosing IUI, data from anamnesis, laboratory and instrumental methods research:
- general blood test (leukocytosis with a neutrophilic shift to the left, accelerated ESR);
- biochemical blood test (for markers of acute phase reaction - C-reactive protein, haptoglobin, ceruloplasmin, plasminogen, alpha-1-antitrypsin, antithrombin III, complement C3 fraction, etc.);
- classical microbiological techniques (virological, bacteriological);
- polymerase chain reaction (PCR);
- direct immunofluorescence method using monoclonal antibodies;
- enzyme-linked immunosorbent assay (ELISA) with quantitative determination of specific antibodies of the IgM, IgG classes;
- Ultrasound of organs abdominal cavity, heart, brain.
Treatment
Treatment of intrauterine infection is complex and consists of etiotropic and symptomatic components:
Pregnancy outcomes with IUI:
- intrauterine fetal death;
- stillbirth;
- the birth of a live viable or live non-viable (with developmental defects incompatible with life) child with signs of intrauterine infection.
Complications of intrauterine infection:
- malformations of internal organs;
- secondary immunodeficiency;
- lagging child behind peers in physical and mental development.
Forecast
With timely diagnosis and complex treatment intrauterine infection that occurs in the late stages, the prognosis is generally favorable (the prognosis improves as the gestational age at which the infection occurred increases), although it is purely individual.
Probability favorable outcome disease depends on many characteristics: virulence of the pathogen, its type, method of infection, presence concomitant pathology and aggravating factors on the part of the mother, functional state pregnant woman's body, etc.
When IUI occurs in the early stages, the prognosis is usually unfavorable.
Prevention
Prevention of the development of IUI is as follows:
- prevention of infectious diseases of the mother (sanitation of foci of chronic inflammation, timely vaccination, screening of pregnant women for the presence of TORCH infections);
- antibacterial or antiviral therapy for pregnant women with the development of acute or exacerbation of chronic infectious inflammation;
- examination of newborns from high-risk mothers;
- early vaccination of newborns.
Video from YouTube on the topic of the article:
www.neboleem.net
Intrauterine infections in newborns
intrauterine infection
Currently, a paradoxical situation has arisen in the Russian Federation, when the emerging trend towards an increase in the birth rate and a decrease in perinatal mortality is combined with a deterioration in the quality of health of newborns, an increase in the proportion of congenital defects and infectious pathology among the causes of infant mortality. High infection of the adult population with viruses, protozoa and bacteria determines the significant prevalence of intrauterine infections in newborns. The source of infection for the fetus is always the mother. The pathogen can penetrate the fetus antenatally and intranatally; the result of this penetration can be two clinical situations, called “intrauterine infection” and “intrauterine infection”. These concepts are not identical.
Intrauterine infection should be understood as the alleged fact of intrauterine penetration of microorganisms into the fetus, in which no signs of an infectious disease of the fetus are detected.
Intrauterine infection should be understood as the established fact of intrauterine penetration of microorganisms into the fetus, in which pathophysiological changes characteristic of an infectious disease occurred in the body of the fetus and/or newborn, detected prenatally or shortly after birth.
Most cases of suspected intrauterine infection are not accompanied by the development of an infectious disease. The frequency of clinical manifestation of intrauterine infection in a newborn depends on the properties of the microorganism, the routes and timing of its transmission from the pregnant woman to the fetus and averages about 10% of all cases of intrauterine infection (varying in the range from 5% to 50%).
The high-risk group for intrauterine infection includes: pregnant women with obstetric pathology (threat of miscarriage, spontaneous miscarriages, premature birth, non-developing pregnancy, antenatal death and fetal development abnormalities); women who suffered during pregnancy acute infections having foci chronic infection, especially in the genitourinary area, as well as those who had infectious complications in the early postpartum period.
Risk factors for intrapartum infection are a long anhydrous period, the presence of meconium in the amniotic fluid, fever during labor in the mother, the birth of a child in asphyxia, requiring the use of artificial ventilation lungs.
The clinical picture of intrauterine infection in a newborn depends on a number of factors. Of great importance is the fact of primary maternal illness during pregnancy, when the primary immune response is significantly reduced. In this case, as a rule, a severe, often generalized form of the disease develops; The pathogen penetrates the fetus transplacentally. If a pregnant woman is immune to infection, then intrauterine infection or a mild form of the disease is possible.
The clinical picture of intrauterine infection in a newborn is significantly influenced by the period of penetration of the infectious agent to the fetus. In the case of viral infection of the fetus in the embryonic period of development, antenatal death or multiple developmental defects are observed. At 3-5 months of intrauterine life, infectious fetopathies develop, characterized by a decrease in fetal body weight, tissue malformations, immaturity of the central nervous system, lungs, kidneys, and degenerative disorders in the cells of parenchymal organs. When an infection of the fetus occurs in the II-III trimesters of pregnancy, both signs of infectious damage to individual organs (hepatitis, myocarditis, meningitis, meningoencephalitis, chorioretinitis, etc.) and symptoms of a generalized infection can be detected.
Clinical manifestations of intrauterine infection also depend on the route of penetration of the infectious agent to the fetus. There are:
1) hematogenous (transplacental) route of penetration; as a rule, it leads to the development of a severe, generalized form of the disease and is characterized by severe jaundice, hepatitis, and multiple organ involvement;
2) ascending route of infection - more often with urogenital infection in the mother (for example, chlamydia); the pathogen penetrates the uterine cavity, affects the membranes of the fetus, and enters the amniotic fluid; the newborn develops conjunctivitis, dermatitis, lesions of the gastrointestinal tract, pneumonia, and generalization of the process is possible;
3) descending route of infection - the infectious agent penetrates the fallopian tubes, and then - as with upward path infections;
4) contact path - during the birth process, through natural birth canal, for example, with genital herpes, candidal colpitis; the disease in a newborn develops in the form of lesions of the skin and/or mucous membranes, although it can also subsequently generalize.
The most typical symptoms of intrauterine infection detected in the early neonatal period are: intrauterine growth retardation, hepatosplenomegaly, jaundice, rash, respiratory distress, cardiovascular failure and severe neurological impairment. Considering that the combination of the above symptoms occurs during intrauterine infections of various etiologies, the term “TORCH syndrome” is used in the English literature to refer to the clinical manifestations of intrauterine infection. In this abbreviation, “T” means toxoplasmosis, “R” means rubella, “C” means cytomegaly, “H” means herpes infectio, and “O” means herpes infectio. other infections (other). “Other infections” that manifest themselves in the neonatal period as TORCH syndrome currently include syphilis, listeriosis, viral hepatitis, chicken pox, etc.
In recent years, there has been a trend towards an increase in the frequency of mixed viral-viral and viral-bacterial infections.
Laboratory diagnostics
All newborns with typical manifestations of intrauterine infection, as well as children from a high-risk group, if their condition worsens in the early neonatal period, should undergo a targeted laboratory examination for TORCH infection in order to establish or objectively confirm the etiology of the disease.
The diagnosis of intrauterine infection is always clinical and laboratory. The absence of clinical manifestations of an infectious disease in the perinatal period in most cases makes laboratory testing for TORCH infections inappropriate. An exception may be a routine examination of clinically healthy newborns from mothers with tuberculosis, syphilis and genital herpes (if it worsens shortly before birth).
According to the ability to identify the infectious agent, methods laboratory diagnostics can be divided into two groups: direct, allowing to detect viruses or microorganisms in biological fluids or tissues of the child (fetus), and indirect, allowing to register the specific immune response of the child (fetus) to viruses or microorganisms.
Direct methods include:
- Microscopy (electronic or direct, e.g. dark field)
- Detection of viral or bacterial antigens (including one-step immunoenzyme and immunochromatographic methods)
- Polymerase chain reaction (PCR)
- Culture method.
Direct laboratory diagnostic methods can detect the presence of the pathogen in biological fluids or tissue biopsies of an infected child. However, their sensitivity and specificity significantly depend on the type of pathogen being detected, the quality of laboratory equipment and reagents. Therefore, the results of a child’s examination conducted in different clinical and research laboratories may be different.
Despite the fact that in recent years it has been rapidly developing PCR method, as a highly sensitive and specific, “gold standard” for diagnosing all bacterial and a number of viral infections (including rubella and herpes) is the cultural method. The most reliable method for diagnosing syphilis to date remains the detection of treponemal antigen by the immune fluorescence reaction and the immobilization reaction of treponema pallidum.
Indirect (indirect) include the so-called serological methods, of which the most informative is the enzyme immunoassay method for determining specific IgG, IgM, IgA (ELISA). The sensitivity and specificity of serological methods for detecting infections in newborns is significantly worse than in older children and adults, which is associated with the characteristics of the immune response and the presence of maternal antibodies in their blood. However, from a technical point of view, these methods are quite simple, which makes it possible to use them for primary screening for intrauterine infection.
When using serological diagnostic methods, you should remember:
1) the examination must be carried out before the use of donor blood products in the treatment of a child;
2) the results of the examination of the child must always be compared with the results of the examination of the mother;
3) the presence of specific immunoglobulins of the IgG class in a titer equal to or less than the titer of the corresponding maternal antibodies does not indicate intrauterine infection, but the transplacental transfer of maternal antibodies;
4) the presence of specific immunoglobulins of the IgM class in any titer indicates the primary immune response of the fetus or newborn to the corresponding bacterial/viral antigen and may be indirect sign infections;
5) the absence of specific immunoglobulins of the IgM class in the blood serum of newborns in a number of diseases (including neonatal herpes) does not exclude the possibility of intrauterine (intrapartum) infection.
Emergency care for asphyxia of a newborn
