Neonatal sepsis: causes of infection and effective control. Sepsis in newborns: what is it, symptoms, treatment, causes, signs

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.

- 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 skin coloration) 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 difficulty 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 sepsis in newborns. 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, and 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.

Umbilical sepsis is a disease exclusively of newborns, in which pathogenic viruses begin to enter the child's bloodstream through the umbilical wound.

Staphylococci are the main cause of this type of sepsis. Infection of the child usually occurs in the process of demarcation of the umbilical cord and until the moment of complete healing of the umbilical wound in the baby. This period is from 2 to 12 days. Not only the umbilical fossa, but also the umbilical arteries can act as foci of infection.

The development and course of the umbilical form of sepsis can be purulent (the formation of a significant number of local abscesses, on which the course of the pathology directly depends) or abscess-free, which occurs with severe symptoms.

In medical practice, it is customary to distinguish three types of umbilical sepsis at once:

subacute;

chronic.

Also, this pathology is usually classified according to other criteria:

the presence of complications;

the course of pathology;

the period of the disease;

types of pathogen.

Three factors are immediately distinguished that affect the development of umbilical sepsis. The first factor is the state of the baby's immune system. The second factor is the external features of the child's environment. The third factor is the number of microorganisms that have penetrated the wound and the severity of their pathology.

The course of the disease can take place in two forms: septicopyemic (acute symptoms), septicemic (in premature newborns due to the weakness of their immune system).

Symptoms

With the development of umbilical sepsis in a newborn, the symptoms in most cases are pronounced. The child does not want to eat, vomits profusely and constantly, body temperature rises, diarrhea develops. The body becomes dehydrated, and the weight begins to drop dramatically. The skin begins to lose elasticity, the dryness of the skin reaches its limit, acquiring an earthy color. In some cases, suppuration is observed in the umbilical region, deep phlegmons and abscesses are visualized, which have different localizations.

In the presence of a septicemic form of the course of the pathology, symptoms of general intoxication of the body are observed: symptoms of multiple organ failure, changes in the clinical picture of the blood, and extremely pronounced toxicosis.

In the presence of a septicopyemic form, in addition to the main focus of pathology, foci of screenings in the liver, bones and lungs begin to appear. At the first stage, the child's reflex activity and motor activity begin to be disturbed. Convulsions may develop, thermoregulation suffers, jaundice begins to increase, lymph nodes, spleen and liver increase significantly in size. The weight of the child does not grow, which is associated with profuse regurgitation, which are observed quite often.

At the peak stage of the development of the disease, signs of pathological syndromes begin to appear. First, there may be symptoms of a syndrome of functional disorders of the central nervous system (central nervous system). Secondly, cardiovascular and respiratory syndrome. Thirdly, anemic hemorrhagic syndrome develops together with dystrophic and icteric. Without adequate and professional treatment of umbilical sepsis, the prognosis for survival is poor.

Diagnostics

In order to diagnose the development of umbilical sepsis, you need to do a series of studies in the clinical laboratory. First of all, blood is taken for general biological and clinical analysis, the results of studies indicate an increase or decrease in the level of leukocytes, an increase in ESR, a shift in the leukocyte formula towards young forms, toxic granularity, anemia (a drop in hemoglobin levels). Also determine the type of pathogen, the degree of its sensitivity to certain drugs, antibacterial action.

The next stage of diagnosis is the study of the urine of the child. It contains erythrocytes, leukocytes and protein.

Also, in the process of diagnosing umbilical sepsis in newborns, the method of coagulogram and immunograms is used, which allow fixing pathological changes.

In the presence of lesions of the internal organs, an ultrasound examination or x-ray examination is performed.

Prevention

Prevention of umbilical sepsis in a newborn primarily consists in measures to maintain the health of the expectant mother. A pregnant woman can be a source of infection for a newborn if she suffers pyelitis, influenza, tonsillitis or other skin pustular diseases during pregnancy.

The second category of preventive measures for umbilical sepsis is the strict observance of the rules of asepsis and antisepsis in the process of caring for a newborn. All relatives with the presence of purulent processes in the body should be removed from the process of caring for the baby.

Treatment

The first step in the treatment of umbilical sepsis is the immediate hospitalization of the newborn in a specialized department of a maternity hospital or children's hospital. With the rapid course of sepsis and the need for surgical intervention, the child is transferred to the surgical department.

It is also necessary to ensure the organization of adequate feeding of the baby (ideally, mother's breast milk, otherwise artificial mixtures containing bifidobacteria).

The main role in the treatment of umbilical sepsis is played by antibiotic therapy. In this case, broad-spectrum antibiotics are used, taking into account individual characteristics and the degree of sensitivity of the body to such drugs.

In this direction of therapy, it was found that the best effect is brought by rationally selected combinations of antibacterial drugs.

Together with the use of antibiotics, eubiotics must be prescribed without fail, which allow maintaining the intestinal microflora and preventing the development of dysbacteriosis.

Also, in the process of treating umbilical sepsis, immunocorrective therapy, sanitation of the area around the umbilical wound and the wound itself, and infusion therapy can be used.

After such therapy for this pathology, the child must be registered, and specialists observe the baby for one year.

Sepsis is an acyclic disease (that is, leading to death without treatment), which is based on a systemic inflammatory response of an immunocompromising organism to a bacterial, usually conditionally pathogenic (often hospital-acquired) infection, leading to generalized damage to the endothelium of the vascular bed, persistent microcirculation disorders , disorders of hemostasis with obligatory DIC and further multiple organ failure.

Etiology. The causative agents of sepsis, which begins in the first 4-5 days of life, are most often group B streptococci, enterococci, and less often listeria, i.e., the bacterial flora of the mother's birth canal. In neonatal sepsis, which began later, pathogens that got to the child as a result of cross-infection through the hands of personnel, equipment, care items (gram-negative bacteria - Klebsiella, Escherichia, blue-green pus bacillus, akinetobacter, proteas) dominate. Meanwhile, in recent years, staphylococci aureus and coagulase-negative epidermal have been increasingly detected in sepsis.

The most significant risk factors for neonatal sepsis are:

Death of previous children in the family due to systemic bacterial infections under the age of 3 months (suspected hereditary immunodeficiency).

Numerous abortions in history. Preeclampsia in the mother, which lasted more than 4 weeks.

Clinically diagnosed bacterial vaginosis in the mother during pregnancy and childbirth.

Clinically pronounced bacterial infectious processes in the mother immediately before and during childbirth, including pyelonephritis, chorioamnionitis.

Detection of streptococcus B or its antigens in the mother in the birth canal.

Anhydrous interval more than 12 hours.

The birth of a child with very low and especially extremely low body weight.

Fetal tachycardia without maternal fever, hypotension, blood loss, or medication that causes tachycardia.

Birth asphyxia or other pathology that required resuscitation benefits and prolonged abstinence from enteral nutrition.

Surgical operations, especially with extensive tissue trauma.

Congenital malformations with damaged skin, burns.

Type I SDR syndrome and pulmonary edema.

Multi-day catheterization of the umbilical and central veins.

intrauterine infections.

Multiple malformations or stigmas of dysembryogenesis.

clinical picture. There are no specific clinical symptoms of sepsis. The most common symptoms of sepsis include: loss of communication skills, lethargy or hyperexcitability, hypo- or hyperthermia, anorexia, lack of weight gain, bloating, regurgitation, diarrhea, respiratory disturbances and apnea, tachycardia, peripheral circulatory disorders, hypotension, jaundice, skin rashes , lactic acidosis, unstable blood glucose levels (hyperglycemia or hypoglycemia).

Based on an integrative assessment of body reactions (functions of organs, blood and connective tissue systems, immunity, metabolic processes), our experience allowed us to identify two variants of sepsis in newborns: hypoergic and hyperergic.

What do we mean by the concepts of hypoergic and hyperergic sepsis? In case of hypoergic, there is no hyperplastic reaction adequate to the infectious process on the part of the organs of hematopoiesis and immunogenesis, there is no or minimally expressed local vascular-proliferative component of inflammation, an adequate reaction of the neuroendocrine system, and there are also severe metabolic disorders, and especially energy. Characteristic is the predominance of destructive changes in the focus of inflammation, oppression and degenerative changes in the hematopoietic organs and in peripheral blood cells. Typical hypoergic sepsis develops in children with very low birth weight (it has been shown that with a body weight of less than 1.5 kg, sepsis occurs 10 times more often), IUGR of hypoplastic and dysplastic types, or primary hereditary immunodeficiencies, deep neutropenia of various origins . In full-term children, examples of the hypoergic variant of sepsis can be Candida sepsis, Pseudomonas aeruginosa sepsis.

In hyperergic sepsis, the proliferative reaction of the connective tissue and blood is most pronounced, reactions of excessive activation of the production of pro-inflammatory cytokines and the cascade of plasma proteases (“proteolytic explosion”), granulocytes, platelets, and endothelium dominate. This variant of sepsis often develops in full-term children and those weighing more than 1.5 kg. Hyperergic sepsis is often caused by Streptococcus B, Listeria, Escherichia. Hyperergic sepsis usually occurs under the influence of supervirulent, special strains of microbes.

Transitions from one form of sepsis to another are possible, in particular, with inadequate antibacterial, hormonal and immune therapy. Possible hyperergic variant in low birth weight infants rarely.

Diagnosis. In neonates, a distinction must be made between clinical and laboratory criteria for a systemic inflammatory response (SIR).

Clinical criteria for SVR:

1. Disorder of temperature homeostat (hyperthermia or hypothermia).

Shortness of breath or tachypnea more than 60 in 1 minute.

Tachycardia more than 160 in 1 minute or bradycardia less than 100 in 1 minute.

Loss of communication skills, anorexia, depression and/or seizures.

5. Oliguria for 6 hours or more against the background of adequate infusion therapy (diuresis less than 1 ml/kg/h).

Laboratory signs of SVR in newborns:

Sudden onset of severe metabolic lactic acidosis with hypocapnia (the latter in the absence of lung involvement).

Leukocytosis (the number of leukocytes in children on the first day of life is more than 30,000, in children aged 2-7 days of life - more than 15,000, in older children - over 15,000 in 1 μl of capillary blood) or leukopenia (the number of leukocytes in 1 μl of blood is less than 5,000) with neutrophilia (the number of neutrophils in 1 μl of capillary blood in children on the first day of life is more than 20,000, from 2 to 7 days of life - more than 7,000, from 8 days of life and older - more than 6,000) or neutropenia (respectively, on the above days, the number of neutrophils - less than 5000, 2000 and 1750 in 1 µl of capillary blood). The criteria for assessing the main shifts in the hemogram are presented in Table 3.18.

Regenerative or regenerative-degenerative shift of the leukocyte formula with the number of stab and younger forms of more than 2000 per μl (on the first day of life - more than 5000 per μl).

Toxic granularity of neutrophils.

thrombocytopenia.

7. Sudden shortening or lengthening of activated partial thromboplastin time (APTT) or prothrombin time (PTT).

Increased levels of CR protein or other acute phase proteins.

Increase in ESR more than 10 mm/h.

bacteremia.

Hyperglycemia more than 6.5 mmol / l.

Criteria for diagnosis. Sepsis should be diagnosed in children with high-risk factors who have 4 clinical and 4 laboratory signs of SVR. If a child has a clinically obvious focus of infection or bacteremia, then four clinical and three laboratory signs of SVR are sufficient to diagnose sepsis.

The most important in the diagnosis of sepsis is a rational and thorough bacteriological examination. The volume of bacteriological examination is very significant, including three blood cultures (the amount of blood for culture is at least 1 ml), urine cultures and all the substrate that needs to be obtained from the patient - the contents of the respiratory tract, cerebrospinal fluid, pus, etc. In various maternity different causative agents of sepsis can dominate in homes and pathology departments of newborns, but it is most typical that sepsis in the first days of life is more often caused by group B streptococci, in later periods - gram-negative microbes - Escherichia, Klebsiella, blue-green pus bacillus. In recent years, the frequency of isolation of staphylococci, especially coagulase-negative ones, as the causative agents of neonatal sepsis, has again increased.

Premature infants with suspected sepsis should be screened for intrauterine infections (at least cytomegalovirus, herpetic, mycoplasmal, chlamydial, and toxoplasmic infections).

Treatment- rational choice of antibiotics, asepsis and natural feeding, specific passive immunotherapy. With the early appearance of signs of a severe bacterial infection (in the first three days of life), they begin with the appointment of ampicillin (active against B streptococci, enterococci - D streptococci). Further, the antibiotic is chosen depending on the identified pathogen, but more often "protected penicillins" (aminopenicillins + beta-lactamase inhibitors) are prescribed in combination with III-IV generation cephalosporins or aminoglycosides. Very rarely (according to vital indications) carbopenems, ciprofloxacin are used.

In the hypoergic variant with granulocytopenia, transfusion of granulocytic mass, the use of granulocytic hematopoietin, and sometimes transfusion of fresh blood are especially indicated, which is important not only in terms of correcting a defect in the phagocytic link (newborns have 4 times less granulocytic reserve than in young children) , but also replenishment of blood coagulation factors and antithrombin III, that is, the therapy of DIC.

With hyperergic sepsis, extracorporeal detoxification methods are highly effective, in particular plasmapheresis, hemosorption, which apparently reduce the level of cytokines, circulating immune complexes and proteolysis products.

The effectiveness of glucocorticoids is unconditional in the complication of sepsis by adrenal insufficiency, i.e., as a replacement therapy. As for the use of large doses of hormones that affect many metabolic processes, membranes, lymphoid tissue, at present this issue cannot be considered scientifically developed, rather it is of an empirical nature.

Prevention of purulent-septic diseases in newborns begins with the timely detection and sanitation of foci of chronic inflammation (especially in the urogenital area) in a pregnant woman, the prevention of acute infections in her, with her dynamic observations in the antenatal clinic, the creation of conditions for a favorable course of pregnancy and early correction of disorders, prevention of miscarriage.

Compliance by staff in maternity hospitals and departments of pathology of newborn children's hospitals with the developed standards for anti-epidemic measures - with The most important of them is hand washing (!!!) nurses and doctors with antiseptic soap each time before and after contact with a newborn baby. You can use soap with chlorhexidine or betadine. It is necessary to use disposable needles, syringes, nipples, care items, gloves. Diagnostic equipment, equipment for assisting the newborn and for monitoring his condition must be carefully processed in accordance with established rules. All solutions for infusion therapy, bottles with nutrition should be prepared and sterilized centrally and delivered to the ward in disposable packages for direct use in a particular child. Attaching the baby to the mother's breast within half an hour after birth- a very important measure to reduce the frequency of purulent-inflammatory diseases in both the newborn and the puerperal. Personnel with SARS, other acute infectious diseases (in particular, herpes simplex on the lips) should not be allowed to work, and with minimal signs of illness, they should wear a mask and wash their hands thoroughly. Careful, local accounting and analysis of all pyoinflammatory morbidity newborns.

Bacterial sepsis of a newborn is a blood poisoning, an extremely serious infectious disease with purulent inflammation of the organs and a violation of their functioning. With sepsis, harmful bacteria circulate in the blood. The disease occurs in children of the first month of life and is one of the causes of death of a newborn child.

Sepsis can manifest itself before the birth of a child (intrauterine infection), on the fourth day after birth (late neonatal), in the first month of life (neonatal), in the first three days after birth (early neonatal).

Sepsis in children occurs due to the influence of pathogenic bacteria on the body. Infection of a child occurs after birth, during childbirth or in utero.

Intrauterine sepsis may occur due to the presence of acute or chronic diseases in a pregnant woman. Infectious diseases, the presence of purulent-inflammatory processes can provoke infection of the child. The causes of intrauterine sepsis of the newborn originate from various obstetric interventions, toxicosis during pregnancy and a long anhydrous period.

neonatal sepsis manifests itself in the first 28 days of a child's life, the gateway for infection often becomes:

Artificial lung ventilation apparatus;
surgical intervention;
urinary tract of a newborn;
ears and eyes of a child;
damage to the skin;
intracranial trauma during childbirth;
immaturity of the immune system of premature infants. Sepsis is ten times more common in premature babies;
, hypoxia (lack of oxygen);
acute viral infections.

Umbilical and fungal sepsis in a newborn occur due to infection of the blood with pathogenic microbes that have entered through the umbilical wound. Infection can occur:

With numerous catheterizations of the umbilical and central veins;
With the introduction of drug solutions into the umbilical vein (with blood transfusion);
Due to the high permeability of the skin (especially in premature babies);
With insufficient maturity of the vessels of the umbilical cord.

Umbilical sepsis of a newborn often occurs with unfavorable sanitary and epidemiological conditions in the maternity hospital.

The causes of the disease lie in factors that affect the protective functions of natural pathways, significantly reducing the body's resistance to infection. From the infection zone, the bacteria spread through the child's body with the blood stream. Once in the organs (kidneys, liver, brain, etc.), they cause acute purulent inflammation.

Sepsis is extremely dangerous for babies born prematurely. The immune system of premature babies is more than vulnerable to infections.

Symptoms

Early symptoms of sepsis in newborns can be identified by an extremely serious condition:

Increase in body temperature;
Skin with significant dermatitis and pale gray coloration;
Dehydration of the body;
Puffiness;
Hemorrhagic rash;
(the disease is typical for most premature babies, but with sepsis, the skin has a greenish or waxy tint);
regurgitation;
low blood pressure;
Vomit;
Large primary weight loss, which is especially dangerous for premature babies;
Amniotic fluid with a greenish color;
Enlargement of the liver and spleen.

Late symptoms of neonatal sepsis develop in stages, worsening occurs in the first or second week after the birth of the baby:

for a long time;
Paleness of the skin with a gradual acquisition of gray or greenish hues;
restlessness, poor sleep;
Lethargy, poor mobility;
Pointed facial features;
Greenish stool with mucus;
Refusal to eat, extinction of the sucking reflex;
Redness in the navel (bleeding), poor healing of the umbilical wound;
Vomiting (profuse regurgitation);
convulsions;
Decrease in body weight;
Dyspnea;
Increased severity and prolonged duration of jaundice;
Pustular rashes on mucous membranes;
Shallow, jerky breathing;
Swelling of the limbs and abdominal wall;
Purulent inflammation of the skin.

Symptoms of neonatal sepsis may be vague and only manifest as regurgitation, low sucking reflex, and slight weight gain.

Diagnostics

Diagnostic methods:

General blood analysis;
General urine analysis;
Bacteriological research;
Blood chemistry;
Bacteriological analysis of urine, feces, cerebrospinal fluid;
Ultrasound diagnostics, electrocardiogram.

Complications

The most dangerous for a child is septic shock, in which the condition is extremely critical. Under the influence of infection, there is a violation of blood circulation in the body of the child.

Syndromes characteristic of septic shock:

Syndrome of violations in the central nervous system. The child appears: anxiety, lethargy, decreased innate reflexes, convulsions, low muscle tone, the child may fall into a coma;
renal syndrome. Scanty urination of the child or complete absence;
Respiratory failure syndrome. Caused by noisy breathing, moist rales, cyanosis of the skin (due to lack of oxygen);
Syndrome of non-specific violation of the hemostasis system (increased blood clotting in the vessels);
Violation of blood circulation. Due to the increased blood supply to the brain and heart, important organs are excluded from the circulation: kidneys, muscles, skin.

Symptoms of circulatory disorders:

Decreased blood pressure;
Decrease in body temperature;
pale skin;
Preservation of the pulse only on the carotid artery;
Tachycardia;
Coldness of extremities.

A blood test shows an increase or decrease in the number of white blood cells. Anemia and the presence of an inflammatory process in the blood are detected. Analysis of pus from the focus of inflammation allows you to establish the presence of pathogenic microorganisms, the type and reaction to antibiotics.

The consequences of sepsis in a newborn child are often irreversible. Septic shock affects all vital organs and increases the likelihood of death, especially in premature babies.

Pathology is capable of a transient course, affecting all the important organs and systems of the baby's vital activity. The lethal outcome of premature babies occurs within one to two days. In addition to the severe course of the disease, there are: acute, subacute and recurrent sepsis.

The duration of the course of the disease varies from 1 month to 6 months, and recurrent sepsis is capable of an undulating course. The normal state of health of the child can be replaced by an exacerbation of the disease. Chronic sepsis can last more than a year.

Treatment

Sick children are urgently hospitalized in the pathology department or in the surgical department for newborns. The main directions in the treatment of sepsis are: strengthening the patient's immunity, suppressing the vital activity of pathogenic microbes, treating the focus of infection. A sick baby needs to be fed with breast milk (expressed milk or breast).

Preparations

Treatment occurs with the help of measures that stimulate immune mechanisms. Through the use of antibodies, artificial immunity is created. Synthetic drugs enhance the effect on immune cells, and metabolism improves.

Antibiotics are used to fight infection. For the treatment of premature babies, stronger means of combating the characteristics of the infectious process are used. Antibiotics are administered intravenously or intramuscularly. The duration of therapy lasts until the onset of a stable therapeutic effect and usually ranges from 7 to 14 days.

In infectious diseases, allergic reactions often occur. To combat them, anti-allergic drugs and hormonal drugs are used. Only extreme cases are required for hormone treatment:

Violent reactions to infectious diseases;
Insufficient natural production of hormones;
The use of hormone therapy before the disease;
Treatment with antibiotics or antibacterial drugs in large doses;
Severe allergic reaction to harmful microorganisms;
Extremely severe disease.

To normalize metabolism and affected organs, the child is prescribed additional B vitamins. To normalize blood circulation in the brain, sedatives are used.

Physiotherapy

The respiratory and cardiovascular systems are being treated. The patient is injected with energy mixtures, connected to artificial lung ventilation, the blood is purified and applied. During the rehabilitation period, it is recommended to undergo physiotherapy, massage, apply therapeutic exercises and drink a course of homeopathic medicines.

Vaccination of children who have had blood poisoning is prohibited until one year after recovery.

Prevention

A woman during the period of bearing a child, it is necessary to attend a consultation with a gynecologist, observe the daily routine, eat right, monitor the course of the disease. If a blood test indicates inflammation in the body, it is necessary to undergo treatment.