neonatal sepsis. Sepsis in newborns

Neonatal sepsis- this is a severe infectious process in children of the first four weeks of life, which is due to the introduction of opportunistic microbes into the body and the development of severe acyclic infectious lesions of the whole organism. The basis for the development of sepsis in newborns is the dysfunction of the immune system, mainly its phagocytic link.

The trigger for the development of sepsis in newborns is a purulent focus, from which microorganisms enter the patient's bloodstream due to inadequate anti-infective protection, this is called bacteremia. Bacteria are carried in the bloodstream to other organs. In connection with the development of a systemic inflammatory response, multiple organ failure develops, manifested by violations of the hemostasis system, damage to the microvasculature. In 30-40% of cases, sepsis of newborns leads to death.

Causes of neonatal sepsis

Which pathogen will cause neonatal sepsis will depend on the time of infection, as well as on the site of infection. If this happened during childbirth, it is likely that the opportunistic flora of the intestines and genital organs of the mother served as the cause. The disease in this case starts in the first two - three days after birth.

Late neonatal sepsis is often caused by group B streptococci in the birth canal. Klebsiella, enterobacteria, staphylococci, serrations, Pseudomonas aeruginosa, E. coli are common causative agents of sepsis. Pseudomonas spp., Klebsiella spp., Enterobacter spp. and other gram-negative flora, can cause sepsis in children already in intensive care. Infection occurs through medical equipment, the hands of medical workers, venous lines. Among the viruses that can cause sepsis in newborns, enteroviruses should also be noted. In addition, there is sepsis of fungal etiology. Often there is a change in the predominant pathogen during the illness of the child or even a mixture of flora. If the umbilical wound is the entrance gate for microbes, sepsis is more often of staphylococcal etiology. Less commonly, it is caused by Escherichia coli. Skin sepsis of newborns is more often caused by staphylococci and streptococci. The hospital flora enters the child's body through venous catheters, drains, endotracheal tubes, catheters for sanitation.

After giving birth, the newborn is faced with an abundance of microorganisms around. His skin, mucous membranes, intestines begin to be populated by microbes. But not everyone gets sepsis. Babies born before 37 weeks of gestation and small babies are usually affected. Boys get sick more often. Low scores on the Apagr scale at the fifth minute are also a predisposing factor for infection. Untreated maternal urinary tract infections, as well as carriage of group B streptococcus, increase the risk of sepsis in their children. If a woman in labor had a fever, the waters poured out ahead of time (especially when), and the anhydrous interval was more than 18 hours, then the chance of sepsis in their children is increased.

Symptoms and signs of neonatal sepsis

Regardless of the form of neonatal sepsis, the severity of the child's condition is characteristic. Full-term babies are more likely to have a fever. Sepsis of premature babies, as well as small ones, is more often accompanied by hypothermia. The skin of children is pale, with a dirty gray color. The features of the child's face are pointed. Rapidly progressing jaundice may start early. The child's behavior changes. He can be both lethargic and oppressed, and irritated, restless. Sometimes there are convulsions, some children fall into a coma. Spontaneous bleeding of mucous membranes, bleeding from the places of blood sampling is characteristic. Rapid or rare breathing, weakening of breathing and wheezing indicate the progression of respiratory failure.

An increase or decrease below the norm of heart rate, a drop in blood pressure, edema and indicate an increase. Renal failure manifests itself as a pronounced decrease in diuresis. With sepsis, children do not eat well, their stomach swells, food eaten stagnates in the stomach, there may be frequent regurgitation, vomiting, and. Also characteristic of sepsis is a pronounced venous network on the abdomen, an enlarged spleen. Sometimes with sepsis, intestinal paresis occurs. Various impurities can be found in the stool, such as mucus or greens.

Among the secondary (metastatic) foci of sepsis in newborns, purulent, pneumonia, and enterocolitis are most often. Abscesses of the kidneys and liver, arthritis, mediastinitis, carditis, pyelonephritis and others are less common.

Diagnosis of sepsis in newborns

At the first stage of diagnosing sepsis in newborns, it is necessary to identify foci of infection. It also happens that the primary focus of infection is absent in the mother's body or in the placenta. This is especially true for early neonatal sepsis. Careful collection of anamnesis from the mother, studying the details of the course of childbirth, a detailed examination of the child, assessing the dynamics of symptoms are mandatory stages of diagnosis.

X-ray examination of the chest and abdominal cavity will help to identify pneumonia, carditis, enterocolitis, peritonitis. Spinal puncture is indispensable in the diagnosis of meningitis. X-ray examination will also help to identify or osteomyelitis.

At the second stage of diagnosis, it is necessary to assess the adequacy of the work of all body systems. It is necessary not only to determine the severity of organ failure, but also to monitor vital signs in a timely manner for timely treatment.

One of the first laboratory studies is a detailed blood test. , a decrease or increase in the number of leukocytes and neutrophils, a decrease in platelets are important criteria in the diagnosis of neonatal sepsis.

Be sure to study blood gases. Sepsis is characterized by a decrease in blood oxygen saturation, respiratory or mixed.

An electrocardiographic study of the heart will show electrolyte disturbances. Ultrasound of the heart is characterized by a decrease in cardiac output with the development of heart failure.

You can evaluate the work of the kidneys according to the results of blood tests for urea and creatinine (with renal failure, they increase). It is necessary to carefully evaluate the amount of urine excreted during the day.

Liver failure can be diagnosed by testing for bilirubin and transaminase.

Neurosonography is most often used to study dysfunctions of the nervous system. It makes it possible to see signs of cerebral edema, hydrocephalic syndrome, intraventricular hemorrhages.

It is impossible to do without a coagulogram study in order to identify violations of the hemostasis system that threaten the life of a sick child in time.

Assessment of the systemic inflammatory response (SIR) is the third diagnostic step. Its criteria include temperature in the armpit (above 37.5 ° C or below 36.2 ° C), changes in the general blood test, an increase in C-reactive protein in the child's blood above 6 mg / l, an increase in procalcitonin more than 2 ng / ml as well as an increase in the blood level of interleukin-8 more than 100 pg / ml.

If a child has 3 or more signs of SVR in the first three days of life, then sepsis can be suspected and treatment should be started immediately. In children older than four days of life, the diagnosis of sepsis is made if there are more than three signs of SVR. It is necessary to identify the primary infectious focus, as well as dysfunctions of at least two body systems.

A very important stage in the diagnosis of the disease is the microbiological study of various body environments. To do this, take a blood culture, cerebrospinal fluid, separated from the foci, aspirate from the stomach and trachea. It must be remembered that blood cultures can give false positive and false negative results. It is necessary to take material for research, observing all the rules so that there are fewer errors.

Treatment of neonatal sepsis

All forms of sepsis in newborns are treated in the intensive care unit or neonatal pathology unit.

It is recommended to feed a child with sepsis with breast milk. If his condition allows, then you can put the baby to the chest. If sucking from the breast requires a lot of effort from the baby, then it is worth feeding expressed breast milk from a bottle or beaker. When a baby is unable to suck because of his condition or too small gestational age, then expressed breast milk is injected into the stomach through a tube. If there is no mother's milk, then the child should be fed with milk mixtures. They can be sour-milk, low-lactose, lactose-free, enriched with prebiotics and other components. The mixture is selected depending on how the child absorbs food, whether there is bloating, whether the stool is broken. Premature babies should be fed special milk formulas that contain split protein for better absorption.

At the height of the disease, it is better to place the child in an incubator. Humidity in the incubator is not lower than 60%, and the temperature is not lower than 30°C are important components of proper care for a sick child.

Direct treatment of sepsis in newborns goes simultaneously in two directions. The first is the impact directly on the pathogen that caused the disease. And the second is the correction of violations of the functions of all organs involved in the process.

Antibiotic therapy is given as early as possible. Depending on the form of neonatal sepsis, a choice is made in favor of one or another drug. Until the pathogen is isolated, the antibiotic or combination thereof that will be most effective against the suspected microorganisms is prescribed. When the pathogen is known, the antibiotic is prescribed with a narrower spectrum of action. The choice is made in favor of drugs that easily penetrate into the cerebrospinal fluid, into the substance of the brain, as well as into bone and lung tissue. The least toxic drugs for children are given priority. It is preferable to administer antibiotics intravenously.

Most often, treatment begins with antibiotics belonging to the penicillin class (Oxacillin, Ampicillin, Amoxiclav). Usually they are combined with aminoglycosides, which include Gentamicin, Netromycin, Amikacin. Cephalosporins are also used. In case of ineffectiveness of starting antibiotics, Vancomycin, Meronem, Linezolid are prescribed. You can be sure about the effectiveness of the measures taken, if after two days from the start of treatment the child feels better. If the symptoms of WIR and organ failure persist or worsen, the antibiotic should be changed.

In addition to antibiotics, in sepsis of newborns, therapy is carried out aimed at correcting immunity, intravenous infusions of the required amount of fluid (glucose, salts, vitamins), anti-shock therapy and restoration of impaired functions of internal organs. Human immunoglobulins (Pentaglobin) are used to correct immunity. The mortality of children receiving this treatment is significantly reduced. This is especially significant in sepsis of premature babies, because the immune system is initially weakened. Intravenous infusions of glucose-salt solutions help to compensate for the lack of fluid, improve blood properties. If the food is not absorbed through the mouth, proteins, fats and carbohydrates must be given intravenously to the child, which is called parenteral nutrition.

Antishock treatment of neonatal sepsis includes therapy with drugs that maintain blood pressure at a normal level (Dopamine, Dobutamine, Adrenaline). Sometimes it is necessary to supplement the treatment with hormonal drugs (hydrocortisone). This increases the survival rate of sick children. To correct disorders of the blood coagulation system, children are transfused with fresh frozen plasma. It helps to compensate for the lack of clotting factors, which is observed in sepsis.

In addition to the treatment of life-threatening conditions, treatment with antifungal agents (Duflucan), vitamin therapy, and interferon therapy (Viferon) are simultaneously carried out.

Prevention of neonatal sepsis

Prevention of sepsis in newborns is a whole range of activities that are aimed at preventing infection of the child, starting from pregnancy. Preparing for pregnancy, preventing abortion, examining a woman before conceiving a child - all this will help ensure that this proceeds without complications.

Careful monitoring of the condition of a pregnant woman, detection of bacteria in urine tests and urinary tract infections, carriage of group B streptococci, timely sanitation of foci of infection in the mother's body can reduce the risk of infection of a newborn child. There are recommendations for the introduction of antibacterial drugs to women in labor - carriers of group B streptococcus. Considering that a significant proportion of sick children were born prematurely, it is necessary to prevent the birth of children ahead of time by all means.

One of the most difficult tasks in neonatal intensive care units is the fight against nosocomial infections. To prevent infection of children, it is necessary to strictly observe sanitary and hygienic measures in the hospital. Training of medical personnel, proper handwashing technique, use of skin antiseptics and disposable gloves will reduce the risk of transmitting dangerous microorganisms to the child. The child should be encouraged to stay with the mother, laying it on the mother's stomach after childbirth so that it is seeded with maternal flora from birth, and not hospital. In intensive care, the mother should be involved in caring for the child, feeding him, using the "kangaroo" method for nursing premature babies. Encouragement of breastfeeding, assistance and training of mothers in breastfeeding skills from the first days after birth contribute to the normal formation of anti-infection protection.

The joy of the birth of a child is usually mixed with worries about the illnesses and ailments of the little man. One of the dangerous pathologies is neonatal sepsis. It is important to know the signs of the disease in order to consult a doctor in a timely manner.

The essence of the disease

An infectious pathology of bacterial origin with purulent foci of inflammation is called sepsis. This is an infection of the blood, which leads to a state when the internal organs and systems are not able to work well, support life processes.

The term "sepsis" was coined by Aristotle in the 4th century BC. He also described the process of intoxication of the body, in which tissue decay occurs. It was a common cause of death among newborn children of that time.

The course of the disease is difficult and painful for the child, because the pathogen penetrates the circulatory system, spreads throughout the body. An inflammatory reaction of increased fight against infection begins. But at the same time, damage to their own tissues occurs due to the large scale of the spread of infection.

The causative agent of the disease is most often staphylococci, streptococci. Pseudomonas aeruginosa, Escherichia coli, Klebsiella infection also occurs. In some cases, a mixed infection occurs.

The umbilical wound, skin, lungs of the child become the entrance gate for pathological microorganisms. The infection can penetrate through the auricle, mucous membrane of the eyes, urinary tract. Penetration through the nasal passages or the oral cavity is possible.

Infants at high risk for sepsis:

• receiving nutrition through a vein for a long time;
• having any birth trauma;
• who have been on artificial lung ventilation for a long time;
• born with low weight;
• in which, after birth, the anhydrous period lasted more than 6 hours;
• who often had a catheter placed in the umbilical or central vein;
• who underwent surgery during the neonatal period;
• born prematurely;
• born outside the conditions of the hospital;
• newborns, mothers who have not been treated for bacterial vaginosis, colpitis, endometritis.

Failure to comply with sanitary and hygienic standards in the maternity ward also becomes the basis for the emergence of many diseases of an infectious nature.

The causes of the disease help to understand in which direction to start the fight against pathology. The development of sepsis may be preceded by local inflammation -. Proper care, careful processing in the first days of life will save the baby from a serious illness.

The manifestation of the disease

There are two forms of neonatal sepsis: septicopyemia, septicemia.

Septicopyemia is characterized by the formation of local pustules in internal tissues and organs, as the infection has spread with the bloodstream throughout the body. Ulcers are formed at the points of penetration - in the mouth, auricles, near the eyes, genitals, most often at the umbilical wound, nose.

The septicemic form of neonatal sepsis is distinguished by the absence of such abscesses.

Symptoms of sepsis:

• poor weight gain;
• frequent regurgitation;
• lowering blood pressure;
• poor appetite;
• lethargy;
• suppuration of the umbilical wound;
• phlegmon;
• conjunctivitis;
• body temperature is increased or decreased;
• earthy skin color;
• dryness, yellowness, marble shade of the skin;
• skin rashes;
• bouts of vomiting;
• diarrhea.

Deterioration occurs gradually in neonatal sepsis, with late symptoms appearing around the second week after birth. There are convulsions, shortness of breath, purulent inflammation of the skin. Jaundice intensifies, weight continues to decrease. Breathing may become shallow and staccato. Fecal masses acquire. Sleep becomes restless.

In the mechanism of the appearance and development of pathology (the pathogenesis of sepsis in newborns), an important role is played by immaturity, imperfection of the immune system. It makes it possible for pathogenic microbes to penetrate even through the skin. Vasospasm begins, almost all internal organs and systems are affected.

Kinds

The classification of sepsis in newborns helps to understand how to treat, what causes the onset of the disease.

Depending on the place of development, sepsis happens:

• intrauterine;
• postnatal;

The causative agent of intrauterine sepsis was located outside the child's body. The reason could be, for example, untreated infectious diseases of the mother.

Depending on the time of development, postnatal (bacterial sepsis of the newborn) happens:

• Early neonatal sepsis;
• Late.

Early sepsis begins to develop within the first 6 days of birth. characterized by rapid development. Begins immediately after birth, in most children in the first six hours of life.

Late neonatal sepsis develops after the sixth day. It is characterized by good survival, 2 times more than in the early form.

The table shows the difference in the nature of the flow.

The duration of the pathology can take up to six months. Recurrent sepsis has an undulating course. A chronic form is possible, which lasts up to a year.

Diagnostics

The diagnosis is made by a neonatologist or pediatrician. Fear causes a persistent change in body temperature, which lasts more than three days. The doctor, during examination, sometimes reveals the source of infection, for example, it may be an umbilical wound. Submitted for blood test. With sepsis, there is a sharp decrease in the content of leukocytes or an increase. This suggests that the immune system can not cope with the pathogen, due to weak immunity.

A blood culture will determine the pathogen, this helps to determine the antibiotic for treating the child. Other material (pus, cerebrospinal fluid, urine) is also sown on the nutrient medium. This helps to confirm the type of pathogen.

The sepsis clinic has the same symptoms with some pathologies. It is important to differentiate it from peritonitis, meningitis, purulent pneumonia, osteomelitis, and some other viral infections.

Directions of treatment

A sick baby is placed in a hospital; such diseases are not treated at home. The main directions in the treatment of sepsis for newborns will be:

1. Strengthening the immune defense;
2. Suppression of the activity of pathogenic microbes;
3. Elimination of the source of infection.

Breastfeeding will be a great support for a small child. Usually newborns arrive in an incubator, a special incubator, where special conditions are created - sterility, humidity, temperature.

Medicines strengthen immune cells, improve metabolism, antibacterial therapy is of great benefit. The duration of treatment is up to two weeks. After treatment with antibiotics, he undergoes a course of restorative therapy.

Umbilical sepsis is more often observed (penetration of infection through the umbilical wound). Great importance is given to the treatment of this area. Reduced swelling, discharge, suppuration from the wound. Moms are taught the proper treatment of a damaged surface.

The child often has an allergic reaction. To suppress it, special drugs are used, hormones are rarely used, only in extreme cases.

To improve the body, vitamins of group B are prescribed. For the treatment of the heart, blood vessels, and lungs, special mixtures are introduced, and an artificial lung ventilation system is used.

During the recovery period, the baby is waiting for a special massage, therapeutic baths, homeopathic remedies, gymnastic exercises. Children who have been ill with blood poisoning are not vaccinated until they are one year old.

Disease Prevention

The medical staff of maternity hospitals is regularly tested for the carriage of infections. A study of tools, all material for the content of a pathologically dangerous infection is also being carried out. Sterile disposable materials are used during childbirth, operations.

During childbirth, they try to cut the umbilical cord with sterile instruments, process it quickly, with disposable materials. If necessary, treatment with ultraviolet rays, fumigation is applied. This helps prevent umbilical sepsis.

Great importance is given to the disinfection of rooms for women in labor, mothers with newborns. Regular quartzing and airing is carried out. Care for women and children is carried out with sterile equipment.

Forecast

Neonatal sepsis is a serious disease. Treatment requires a lot of strength and patience. Due to the rapid development of the pathology and the severity of the course, the mortality from the disease is high - half of the sick people die in infancy.

Septic shock can be a serious complication of infected newborns. This is a condition in which the body's systems cease to work normally, smoothly, blood pressure drops to zero. With timely medical care, negative consequences do not threaten the baby. Proper treatment, careful care, help to cope with the disease.

Conclusion

Any disease of the baby is difficult to tolerate by a small organism. Sepsis is especially dangerous in a newborn, as the blood becomes infected. Often the infection affects the most unprotected, weakened premature babies. Parents need to take care of the health of the baby in advance, even from the time of pregnancy. Be attentive to the recommendations of doctors. Then the diseases will not be terrible for the born children.

Sepsis of newborns, the causes of which are the effects of microbes on the child's body, often manifests itself during the first months of life. This is due to the lack of full function of the immune system. Infants born prematurely or with immunodeficiency pathology are most often affected. Due to the immaturity of the mucous membranes, the infection enters the child's body without obstacles.

Bacterial sepsis of a newborn is caused by pathogens of opportunistic microbes. These include Pseudomonas aeruginosa and Escherichia coli. The defeat of the crumbs occurs during improper labor (in case of non-compliance with hygiene standards), in the process of gestation, if the mother has had this infection, at home or on the street, if the baby had contact with patients with sepsis.

Mom, take note! If the mother suffers from a number of chronic inflammatory diseases, the fetus is at risk. Also, the baby can be infected due to a long anhydrous period at the time of birth, as well as oxygen deficiency. These factors increase the likelihood of bacterial diseases and infectious diseases.

In addition, the most common cause of sepsis in newborns, causing damage to the body, is the following phenomena:

• (particularly intracranial);
• violation of the integrity of the skin due to obstetric activities;
• venous catheterization (incorrect placement of catheters for the administration of drugs);
• tracheal incubation (connection to an oxygen machine);
• infection in the placenta or other organ of the pregnant woman (this is how congenital sepsis in a child manifests itself).

Regardless of the influencing factors and the reasons why sepsis of newborns appeared, it is almost impossible to determine at what point and how the infection occurred.

Diagnosis of purulent-inflammatory sepsis in newborns and symptoms

Diagnosis of sepsis in newborns occurs exclusively on an outpatient basis by collecting appropriate tests, as well as based on the external symptoms of diseases and the general condition of the baby. With the progression of an infectious disease in the body of a child up to a year, the following symptoms are revealed:

• refusal of the breast and, accordingly, lack of appetite;
• change in skin color (pallor or blueness);
• late healing of the umbilical wound;
• may be accompanied by sluggish breast sucking, regular, underweight (very rare).

According to such signs, neonatal sepsis and acquired are determined. In the photo you can see the symptoms of inflammation.

Important! When infected, inexplicable irritability often manifests itself. The disease proceeds in an acute form and is protracted (to be treated for more than 6 months). In infancy, skin sepsis, ear, umbilical sepsis in children, blood and intestinal sepsis occur. For each of these types, individual treatment is selected.

Doctors consider the prognosis of such a diagnosis to be poor, but with proper therapy it is not hopeless. If the treatment of sepsis in infants is started late, the chances of recovery and full adaptation of the child to the environment are significantly reduced.

Etiology of sepsis in newborns

When pathogens affect the child's body, an inflammatory reaction (sepsis of newborns) occurs, during which cytokines are released in large quantities. The inflammatory process affects the elements that make up the blood (leukocytes, erythrocytes, proteins). With a negative effect on the body, necrosis and leukemia can occur. Blood clotting is impaired.

The excess composition of cytokines contributes to the development of pathogen cells in the body of the baby, as a result of which sepsis is formed. At this point, cortisol increases significantly, due to which there is a decrease in the activity of the thyroid gland.

The kids are talking! We are traveling by bus with my daughter (4 years old). The driver announces stops:
- Next stop Gorky.
Alla grimaced and closed her eyes. I ask her:
- What's the matter, what happened?
- Uncle bitter stop.

At the last stage of infection development, multiple organ failure is formed, thrombocytosis is formed, provoking a homeostasis disorder, which often leads to death.

If a pregnant woman has obvious abnormalities in the development of the uterus, accompanied by polyhydramnios, there is a risk that the child will develop neonatal sepsis.

Watch a video about the development of sepsis in newborns.

Attention parents! High neonatal mortality is most often associated with the influence of negative factors that cause sepsis in newborns, so the disease should be diagnosed in time.

Treatment of sepsis in newborns: effective actions

It is imperative to take care of a sick child, he is hospitalized in the pathology department for infants. Doctors recommend during this period the mother is next to the child and practice breastfeeding.

In the treatment of neonatal sepsis, the use of antibiotics is recommended, the classification of which allows dividing drugs into primary and secondary, depending on the form of neonatal sepsis. Tetracycline, Erythromycin, Tetraolen are used in the age dosage. It is important that they are properly selected, as many children have intolerance to certain medications. The state of the microflora of the infant is monitored, for this, accompaniment is prescribed in the form of bifidus and lactobacilli.

For premature babies, sometimes the use of certain antibiotics is considered ineffective, so more adequate therapy is selected. Babies with a similar diagnosis are injected with drugs intramuscularly, with a weak effect - intravenously. If Tetracycline does not help, within two days it is replaced with Imex.

Attention! After the course of treatment with antibacterial drugs, preventive measures are required to avoid complications of therapeutic therapy (disturbances in the intestinal and stomach microflora).For this, the child is prescribed Bifiform or Linex.

If the body has severe forms of neonatal sepsis, corticosteroid hormones are prescribed. As medicines, children are prescribed: Reopoliglyukin, Plasma, Hemodez, Glucose solution 10%. Phytotherapy, physiotherapy exercises, massage and homeopathic medicines are used as rehabilitation appointments. The transferred infectious process by newborns is a signal to ban vaccination for 1 year.

Complications after sepsis in newborns

As a rule, the consequences of any disease in infants, including sepsis, appear only in case of inadequate treatment.

1. In neonatal sepsis, the liver is damaged by toxins, which is accompanied by a serious form of jaundice. On the basis of this, there is constant vomiting and lack of appetite.
2. There are hemorrhages in the internal organs of the child, which is considered an unfavorable sign and is rarely treatable, especially if severe forms of neonatal sepsis are diagnosed.
3. The skin becomes blue at the fingertips and the nasolabial triangle.
4. Such infection of a child at a newborn age turns into purulent meningitis, which also needs to be treated in a timely manner.
5. The lethal outcome occurs due to mass intoxication of the infant's body, accompanied by the release of blood under the skin and a violation of the functions of the immune system.

Children's humor! Grandmother in the hearts of the antics of her granddaughter:

Woe is mine!
Vika (4 years):
- Your grief, and mother's happiness!

To avoid these complications and protect the life of the baby, doctors recommend adhering to preventive measures for the disease itself and caring for the child. The most common cause of sepsis in newborns is associated with an unfavorable course of pregnancy.

Prevention of neonatal sepsis

First of all, preventive measures are aimed at eliminating acute infectious diseases in women planning a pregnancy. If an infection is found in the process of bearing a fetus, treatment begins from the second trimester, with a primary infection up to 15 weeks, women are recommended to terminate the pregnancy.

Physicians must observe sanitary standards and a special hygienic regimen during childbirth. To prevent sepsis from finding you at home, you must:

• wash your hands regularly with soap;
• monitor the cleanliness of the bed and underwear of the newborn;
• do not wash the child's things with adults;
• do not allow contact of a newborn child with sick children and relatives (ARI, influenza, infectious manifestations);
• store all baby toys separately;
• regularly disinfect cupboards and drawers for storing baby supplies;
• Do wet cleaning in the house at least 2 times a day.

Carrying out prophylaxis at home and in medical institutions reduces the risk of newborns being affected by various infections. If you have any questions, you can contact the medical forum and discuss the topic with experienced parents.

In conclusion, we propose to study the video material on the causes of sepsis in infants.

- generalized purulent-septic infection, characterized by the presence of a primary focus and the circulation of infection in the blood. Sepsis of newborns is manifested by signs of infectious toxicosis (temperature reaction, lethargy, dyspepsia, earthy coloration of the skin) and the formation of purulent metastatic foci in various organs (meninges, lungs, bones, liver, etc.). The diagnosis of sepsis in newborns is established on the basis of clinical criteria and isolation of the pathogen during bacteriological blood culture. Treatment of neonatal sepsis includes systemic antibiotic therapy, sanitation of primary and metastatic purulent foci, and post-syndromic therapy.

Neonatal sepsis is a common infectious process caused by the entry of opportunistic and pyogenic microflora from local foci into the bloodstream and is accompanied by severe systemic manifestations. According to foreign pediatrics, the frequency of neonatal sepsis is 0.1-0.8%; among premature babies and children with perinatal pathology in the ICU - 14%. Neonatal mortality due to neonatal sepsis is high and stable - about 30-40%. The development of sepsis is facilitated by the insufficient formation of barrier mechanisms and immunity in newborns, the borderline conditions of the neonatal period, the pathological course of the perinatal period, and the complexity of early diagnosis of septic conditions.

Causes of neonatal sepsis

Currently, the dominant place (about 50%) among the causative agents of neonatal sepsis belongs to gram-positive flora (mainly staphylococci, group A hemolytic streptococcus). A little less often (up to 40% of cases), gram-negative microflora is detected (E. coli, Pseudomonas aeruginosa, Klebsiella, etc.); in 10%, etiological agents are mixed flora (often an association of staphylococcus with Candida fungi).

The entry gates of infection can be the skin and mucous membranes, the umbilical wound, the gastrointestinal tract, and the urinary tract. The primary foci of infection leading to the development of sepsis in newborns are more often omphalitis, pyoderma, conjunctivitis, otitis media, pharyngitis, bronchitis, urinary tract infections, enteritis, dysbacteriosis, etc. At risk for the development of sepsis in newborns are children with prematurity, intrauterine hypoxia, intrauterine infections, intracranial birth trauma; staying in the ICU, long-term ventilators; receiving parenteral nutrition, infusion and transfusion therapy; who underwent catheterization of the umbilical and central veins, surgical interventions in the first days of life.

On the part of the mother, factors contributing to bacterial contamination of the newborn are bacterial vaginosis, colpitis, endometritis. Of great importance is the degree and nature of immunosuppression in the newborn, which may be associated with malnutrition or medication of the pregnant woman, hereditary immunodeficiency, or HIV infection. In some cases, the cause of outbreaks of neonatal sepsis is non-compliance with the sanitary regime in the maternity or children's departments.

Classification of neonatal sepsis

By the time of development, intrauterine and postnatal (early neonatal and late neonatal) sepsis of newborns are distinguished. Intrauterine sepsis involves antenatal or intranatal infection of the fetus; at the same time, the primary purulent-septic focus is located outside the child's body (most often placentitis, chorionitis, chorioamnionitis, etc., play its role). In the case of postnatal sepsis, the primary purulent-inflammatory focus is always located in the body of the newborn.

Early neonatal sepsis of newborns develops in the first 4 days of a child's life. The clinical course of the disease is usually fulminant, with the rapid development of multiple organ failure, fatal in 5-20% of cases. Late neonatal sepsis of newborns manifests on the 5th day and later. It is characterized by a slowly progressive course, the occurrence of secondary septic foci, 5-10% mortality.

The course of neonatal sepsis can be fulminant (3-7 days), acute (up to 4-8 weeks), subacute (up to 1.5-3 months), protracted (more than 3 months). Taking into account the localization of the primary septic focus and the entrance gate, there are: umbilical, skin, pulmonary, rhinopharyngeal, otogenic, rhinoconjunctival, intestinal, urogenic, catheterization, and other types of neonatal sepsis. Neonatal sepsis can occur in the form of septicemia or septicopyemia.

Symptoms of neonatal sepsis

Septicemia or sepsis of newborns without metastases usually develops against the background of a previous weeping navel, conjunctivitis, pustular rash, diaper rash, stomatitis. Signs of neonatal sepsis may include lethargy or restlessness, loss of appetite, profuse regurgitation, and poor weight gain. During the peak period, a temperature reaction develops (hyper- or hypothermia), edematous syndrome or exsicosis, malnutrition. A characteristic sign of sepsis in newborns is a dirty gray (earthy) shade of the skin, yellowness, marbling of the skin, and a rash.

Due to toxic damage to various organs, hepatosplenomegaly, pneumopathy (tachypnea, cyanosis), cardiopathy (tachycardia or bradycardia, arterial hypotension), dyspepsia, urinary syndrome (oliguria, anuria, acute renal failure), hemorrhagic syndrome, adrenal insufficiency occur. Most often, septicemia is complicated by the addition of pneumonia, which acts as an independent intercurrent disease.

Septicopyemia or sepsis of newborns with purulent metastases is characterized by the appearance of secondary foci of dropouts in the meninges, lungs, bones, liver, and other organs against the background of intoxication. Most often, septicopyemia occurs with the development of purulent meningitis, abscess pneumonia, osteomyelitis; less often - with the formation of a liver abscess, purulent arthritis, panophthalmitis, mediastinitis, phlegmon of the stomach or intestines. In the recovery period, there is a sanitation of pyemic foci, subsidence of toxicosis, a gradual restoration of impaired functions.

The fulminant form of sepsis in newborns proceeds with the development of septic shock: a rapid deterioration in the child's condition, a decrease in body temperature, bradycardia, bleeding, pulmonary edema, acute renal failure. Lethal outcome in fulminant neonatal sepsis occurs within 3-5 days.

Diagnosis of sepsis in newborns

The diagnosis of neonatal sepsis may be suspected by a neonatologist or pediatrician based on fever for more than 3 days or progressive hypothermia; hyperleukocytosis, followed by leukopenia; an increase in the blood levels of markers of the infectious process (CRP, interleukin-8, procalcitonin).

The fact of bacteremia in neonatal sepsis is confirmed by blood culture for sterility. It is important to identify the primary purulent focus and metastatic foci, microbiological examination of the discharge from them (bacteriological examination of a smear from the conjunctiva, urine for microflora, scraping / discharge from the skin for microflora, a swab from the pharynx, feces for dysbacteriosis, etc.).

Differential diagnosis of sepsis in newborns is carried out with localized purulent-inflammatory diseases (pneumonia, mediastinitis, peritonitis, meningitis, enterocolitis), generalized viral infections (cytomegaly, herpes, enterovirus infection) and mycoses (candidiasis, aspergillosis), etc. Additional laboratory methods are used for this. – PCR, ELISA, microscopy.

Treatment of neonatal sepsis

Therapy for neonatal sepsis is carried out simultaneously in several directions and includes the sanitation of septic and pyemic foci, suppression of the pathogen circulation in the blood, and correction of impaired functions.

The basis of the etiological treatment of neonatal sepsis is antibiotic therapy: empirical combined until the nature of the microflora is clarified) and targeted after receiving an antibiogram. Antimicrobial drugs are administered intravenously, in the maximum age dosages for 10-15 days, followed by a change. Most often in clinical practice, cephalosporins, aminoglycosides, aminopenicillins, carbapenems, etc. are used in various combinations for the treatment of neonatal sepsis.

For the purpose of local treatment of purulent foci, boils are opened and massage, carried out in the first days of life, is decided on an individual basis.

The term "sepsis" was coined as early as the 4th century BC. Aristotle. So he described the intoxication of the body and the decay of tissues, leading to death. Although in the 1980s there was a trend towards a decrease in septic lesions in infants due to the expanding spectrum of antibiotics, today the situation is not so rosy. According to some reports, the frequency of neonatal sepsis has again increased to 0.2-1.2% of cases. The most susceptible to the disease are premature babies who have immunodeficiency.

The seriousness of the disease is evidenced by the fact that more than 30% of infected children die. Therefore, we should be interested in the question of how to prevent the spread of sepsis? And if infection does occur, what treatment will be most effective.

Sepsis and its classification

So, sepsis in newborns is an infectious disease of a bacterial nature, which has purulent-focal inflammation. Due to blood poisoning, inflammation occurs throughout the body, leading to multiple organ failure - a serious condition when several organs or body systems cannot perform their function and support life at once. Runs acyclically.

Sepsis, depending on the time of development, can be:

• early neonatal; characterized by lightning-fast development during the first 6 days of a newborn's life;
• late neonatal; occurs after the 6th day of life. The survival rate is 2 times higher.

The course of sepsis can be:

• lightning fast (up to 7 days);
• acute (1-2 months);
• subacute (up to 3 months);
• protracted (more than 3 months).

The penetration of the pathogen into the bloodstream causes a systemic inflammatory response aimed at fighting the stranger. However, due to damage to their own tissues and the scale of the lesion, sepsis is difficult and lengthy.

There are the following clinical forms:

• septicemia - sepsis without metastatic ulcers;
• septicopyemia - local abscesses form in various organs and tissues.

Reasons for development

A septic lesion occurs due to the ingress of an infectious pathogen into the blood. The leading positions are occupied by gram-positive bacteria: staphylococci and streptococci. They are followed by gram-negative microorganisms, which are Pseudomonas aeruginosa and Escherichia coli, Klebsiella, etc. In 10% of cases, they speak of a mixed infection.

Often, the pathogen is largely determined by the incoming gate of infection. For example, ventilated children are most likely to become infected with Pseudomonas spp. and Klebsiella spp.

Entrance gates can be:

• umbilical wound;
• lungs;
• skin covering;
• conjunctiva of the eye;
• urinary tract;
• Auricle;
• nasal passages and oral cavity;
• through a catheter.

Children get into:

• born with low body weight;
• appeared ahead of time;
• in the presence or hypoxia;
• with intracranial;
• born in out-of-hospital conditions;
• in whom at birth the anhydrous period lasted more than 6 hours;
• with a long stay on artificial lung ventilation;
• long-term receiving parenteral nutrition;
• who underwent surgical treatment in the neonatal period;
• babies whose mothers had untreated bacterial vaginosis, endometritis, colpitis.

Separately, we can single out the reasons, which are based on non-compliance with the sanitary and epidemiological regime in the maternity and postnatal departments.

Symptoms

The harbingers of the disease are the baby's lethargic state, poor weight gain, frequent regurgitation, and decreased appetite. Usually, all this is accompanied by an infectious focus: suppuration of the navel, phlegmon, pyoderma, conjunctivitis, etc. This is followed by a thermal reaction, and the temperature can be either increased or decreased. The skin becomes earthy in color, inelastic, sometimes there is yellowness, marble color, rashes. If vomiting or diarrhea joins the symptoms, signs of dehydration rapidly increase.

Quite often, the development of sepsis is preceded by local inflammation, for example, of the umbilical wound. Therefore, pay enough attention to its proper handling during the first week of a baby's life.

More often the disease proceeds in the form of septicemia. This means that there are microbes in the blood with secreted toxins, which cause intoxication of the body, but there is no formation of purulent foci. In laboratory studies, one pathogen is sown.

Describing the clinical picture of a patient with sepsis, the doctor may use the following terms.

Systemic inflammatory response syndrome (SIR)- the response of the body to the invasion of infection by the production of a large number of cytokines. So he tries to adapt and destroy alien bacteria. There is hypo- or hyperthermia, an increase in heart rate more than 90 times per minute, leukocytosis, the leukocyte formula shifts to the left. When there are too many neutrophilic granulocytes, they neutralize not only enemy cells, but also harm their own tissues. This leads to the development of organ failure and impaired hemostasis.

Septic shock is a very serious condition with rapid progression of symptoms:

• pallor of the skin;
• rapid or muffled heartbeat;
• severe hypothermia;
• shortness of breath, while there are no special changes in the lungs on the x-ray;
• a rapid drop in blood pressure;
• tissue swelling;
• unconditioned reflexes are depressed;
• bleeding of mucous membranes;
• DIC (blood clotting, changes in its properties, which is incompatible with the normal functioning of the body);
• tissue necrosis.

Organ failure is manifested mainly by symptoms associated with damage to a particular organ. So, if there is pulmonary insufficiency, breathing is depressed, shortness of breath is present, the skin becomes cyanotic due to lack of oxygen, etc.

Diagnostics

Diagnosis of sepsis is based on the presence of several of the above symptoms, especially when temperature readings have changed for more than 3 days.

Be sure to do a general detailed analysis of blood and urine and pay attention to the signs of the inflammatory process. Blood culture allows you to isolate the pathogen for further targeted treatment.

Differential diagnosis is carried out with other diseases, since purulent-inflammatory processes are also characteristic of the development of:

• peritonitis;
• meningitis;
• osteomyelitis;
• purulent pneumonia.

In these diseases, SVR also develops, but it is closely related to the localization of the purulent focus and quickly stops after treatment of the infected area.

Diagnosis of sepsis necessarily includes bacteriological and serological blood tests.

Symptoms may be similar to the development of viral infections (cytomegalovirus, herpetic), immunodeficiency or hereditary diseases when amino acid metabolism fails.

Treatment

Therapy of septic lesions is divided into two categories: etiological and pathogenetic.

Etiological therapy

It is prescribed immediately after the diagnosis is established or even earlier, when there is a clear need for the use of antibiotics. Until a specific pathogen is identified (and tests for tank flora are not done in one day), a systemic antibacterial drug or a combination of several with a bactericidal effect is prescribed.

After identifying the microflora, antibiotic therapy is adjusted, directing it to fight a specific "enemy". When choosing which treatment to prescribe, consider:

• route of infection
• the place of occurrence (in the hospital or outside the hospital); an important point, since resistant strains usually live in the hospital;
• drug toxicity;
• the age of the child;
• the state of his immune system;
• whether there are allergic reactions;
• how the kidneys work.

The primary combination of antimicrobials is advisable, since it is impossible to immediately determine exactly whether we are dealing with gram-positive or gram-negative strains of infection. In addition, both representatives are often found. Also, there may be resistance to one of the drugs, and there is no time to lose.

All antibacterial agents can be divided into 3 groups:

1. First choice drugs. They are used in mild situations, when, most likely, there should not be resistance to them. This group includes aminoglycosides of the 1st generation, semi-synthetic penicillins, cephalosporins of the 1st generation.
2. Second choice drugs. They are prescribed when the fight against resistant strains is underway. Representatives: aminoglycosides and cephalosporins III and IV generation, macrolides.
3. Third choice drugs. They are also called reserves. They are used in extreme cases when it comes to the most severe course of the disease or polyresistance. These include carbapenems.

The drug is administered mainly intravenously in the maximum allowable doses. Start with starting drugs. If within 48 hours the clinical picture does not improve, the antibiotic is changed to second-choice drugs. It is important to remember that the fight against gram-negative microflora is accompanied by the release of endotoxin into the blood (a product of dying bacteria), and the general condition of the child may worsen. As for premature babies, they almost always begin treatment with antibiotics of the II group of choice.

Treatment of septic lesions necessarily includes the administration of antibacterial drugs by intravenous administration.

Treatment takes place in a hospital with a stay in a separate box and constant monitoring. Antibacterial course lasts a long time, usually not less than 3-4 weeks with a periodic change of antibiotic. The cancellation of such drugs is justified when the purulent foci have been successfully sanitized, no new metastatic foci of inflammation are observed, there are no signs of a systemic inflammatory reaction, and the baby is gaining weight well.

Prevention of dysbacteriosis

With a good prognosis, the full recovery of all organs and systems occurs closer to the 6th week from the start of drug therapy. However, due to the long antibiotic effect, drugs with a probiotic and antifungal effect are prescribed in parallel.

In the neonatal period, of the probiotics, linex, bifiform baby, etc. are most often used. Fluconazole is often used as an antimycotic drug.

In such a difficult period of life for a newborn, breastfeeding is fundamentally important. It contributes to the rapid strengthening of the immune system. If the sucking function is weakened, expressed milk is administered through a tube. In the case when there is no breast milk, a highly adapted mixture is selected for feeding, in this case, preferably, containing bifidobacteria.

Strengthening the internal forces of the body is necessary to cope with the infection. For these purposes, immunocorrection is carried out

Pathogenetic therapy

The task of pathogenetic treatment is to suppress the pathological mechanisms of the development of the disease. It has several key aspects:

1. Immunocorrection. Since a small weakened organism often lacks its protective forces, intravenous administration of immunoglobulins or human leukocyte interferon is indicated. Today, more and more people are talking about the advisability of using recombinant interferons obtained not from human blood, but through genetic engineering. In terms of efficiency, they are in no way inferior, but at times safer. The representative of this series of drugs is viferon.
2. Detoxification. The introduction of intravenous glucose-salt solutions or fresh frozen plasma allows you to "dilute" the concentration of microbes in the blood and reduce the symptoms of intoxication. Oxygen therapy is actively practiced. Sometimes amino acid "cocktails" are injected into the baby intraperitoneally.
3. Antishock Therapy. Septic shock requires urgent action, as half of the cases are fatal. First, immunocorrection is carried out. Thus, the concentration of pro-inflammatory cytokines in the circulatory system is reduced. Then glucocorticoids are administered in small doses. In the acute period of the disease, the child is placed in a special incubator with controlled temperature and humidity, the concentration of hemoglobin and hematocrit in the blood is monitored daily.
4. Recovery period. After the signs of intoxication disappear, and there is progress in treatment, the child is placed with the mother in a separate room and rehabilitation therapy begins. Breastfeeding is still relevant. The main emphasis is on eliminating dysbiotic phenomena and colonizing the intestines with beneficial microflora. To restore metabolic processes, enzyme preparations, multivitamins and amino acids are prescribed. It is important to restore the intracellular work of all organs.

Forecasts

If there is no adequate treatment, the prognosis is always unfavorable: death. In cases of lightning-fast development of septic shock, death occurs in 4-5 days. If there was no septic shock or it turned out to be stopped, the disease passes in an acute clinical form for 2 months, and in 80% ends with recovery.

A dangerous period is also the 3-4th week of the disease, when multiple organ failure increases.

With a favorable course of the disease, acute symptoms of intoxication are observed during the first two weeks, after which they fade away, and slowly the body begins to recover. It should be remembered that antibiotic therapy cannot be abruptly canceled, since its insufficient implementation will lead to a relapse.

The recovery period is insidious with a very weakened state of the body, as a result of which the risk of developing superinfection increases. Therefore, you can not relax throughout the entire period of treatment.

A pregnant woman should be interested in the health of her unborn child, so you should visit a gynecologist in a disciplined manner and treat any foci of infection in a timely manner

Prevention

Prevention of the development of sepsis in infants begins from the moment a woman finds out that she is pregnant, and should be carried out throughout the neonatal period. Precautions include:

1. Timely visit by a pregnant woman to a local gynecologist, passing all the necessary tests to identify hidden diseases.
2. The expectant mother should monitor her diet, make it healthy and balanced, and also follow hygiene rules.
3. If a pregnant woman has foci of infection, they need to be stopped as soon as possible. Women in labor who have had an infectious disease the day before, for example, tonsillitis or pyoderma, are placed in an isolated delivery room, and the newborn is under special supervision.
4. The staff of maternity hospitals is regularly checked for the carriage of resistant forms of staphylococci. From time to time, a bacteriological examination of the air, equipment, bed linen is carried out.
5. At birth, the umbilical cord is cut off quickly using sterile instruments and dressings. Monitor the correct imposition of Rogovin's brackets. UV treatment or fumigation is possible to prevent infection. Later, at home, the umbilical wound is treated using antiseptics.
6. As a preventive measure for the development of omphalitis, it is recommended that newborns take baths with a weak solution of potassium permanganate.
7. Much attention is paid to the disinfection of rooms in which there are women in labor and mothers with newborns. There should not be too many mothers in the ward. Also, the premises should be regularly ventilated.
8. Items for the care of women in labor and the necessary equipment are sterilized.
9. A newborn is isolated if he has been diagnosed with a staph infection, even in a mild form.
10. Maternity hospitals maintain close ties with polyclinics, which makes it possible to detect cases of infection in time and prevent their epidemic development.

So, neonatal sepsis is a dangerous and serious disease that is treated exclusively in a hospital setting and can have serious consequences, including death. To avoid such infections, you should take your health seriously, especially when it comes to a pregnant woman, lead a healthy lifestyle and take a responsible approach to treatment if the infection has somehow entered the body.