Intrauterine infection in newborns consequences. Intrauterine infections: measles, rubella, syphilis and AIDS - how do they threaten a child? Treatment of intrauterine infections

Intrauterine infection is called a viral, bacterial, fungal infection of the embryo, fetus or newborn during gestation or during childbirth. Depending on the type and severity of infection, this condition can lead to severe malformations of mental and physical development, hypoxia, death of the unborn child and, as a result, to premature birth.

Causes of intrauterine infection of the fetus

The pathological process can be caused by such microorganisms:

bacteria (damage by staphylococcus, streptococcus, tetanus, diphtheria bacillus);

viruses (rubella, chickenpox, influenza, cytomegalovirus, herpes);

fungi (for example, the genus Candida);

less often - protozoa (toxoplasma).

All these microorganisms can disrupt the normal development of an unborn baby during an acute or chronic illness of the mother, by:

transplacental penetration (herpes virus, cytomegalovirus, toxoplasmosis);

ascending infection (STDs, chlamydia, vaginal candidiasis);

descending infection (any inflammatory diseases of the ovaries and fallopian tubes);

direct contact (HIV/AIDS, hepatitis B, C).

Symptoms of intrauterine infection

Intrauterine infection is always the result of a mother's disease, which may be overt or latent. For example, a fetus can get a small amount of the rubella virus even if the mother is not sick but has been in contact with a sick person.

The same picture is typical for the defeat of the embryo by Toxoplasma - the mother is only a carrier of the simplest, which at the initial stage of the disease is very dangerous for the unborn child. In this case, there is a threat of intrauterine infection in the newborn.

Both individual facts and their combination can speak about congenital infection:

at a gestational age of up to 12 weeks: the threat of miscarriage, uterine hypertonicity, miscarriage, freezing of the embryo, diagnosing pathologies based on ultrasound results (malformations of the neural tube);

at a gestation period of 13-40 weeks: uterine hypertonicity, fetal death, the threat of premature birth, diagnosing pathologies based on ultrasound results (heart defects, myocarditis, brain malformations, congenital pyelonephritis and pneumonia, the level of development of internal organs does not correspond to the gestational age).

In some cases, the child may be born on time and be declared healthy, however, after a while, he may show signs of intrauterine infection - sepsis, osteomyelitis, progressive cataract, hepatitis.

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This is due to the possibility of transmission of microorganisms during childbirth or the so-called delayed pathology, the cause of which lies in infection during gestation.

How intrauterine infection affects preterm birth

Premature birth - delivery that began between 22 and 37 completed weeks of pregnancy; such a process can be early (22-27 weeks), middle (23-33 weeks) and late (33-37 weeks). The presence of infection in the fetus can provoke this pathology for 2 reasons:

any deviations in the development of the unborn child is a process that contradicts the basic law of nature about the survival of the fittest. The body of a woman often reacts violently to deviations of the unborn child caused by intrauterine infection, therefore she tries in every possible way to get rid of the defective fetus, and in this case a premature baby may be born;

when an unborn child is infected due to the fact that the pregnant woman has suffered an acute or chronic form of a sexually transmitted disease (syphilis, gonorrhea), premature birth can cause a violation of the muscle tone of the uterus or loss of elasticity

Diagnosis and treatment

Intrauterine infection of a child can only be assumed based on the combination of the following indicators:

data on specific diseases suffered by a pregnant woman at a certain stage of pregnancy;

the results of laboratory studies of the mother's physiological fluids, including amniotic fluid and a blood test for ToRCH infection (detection of rubella, herpes, cytomegalovirus, toxoplasma and pale spirochete viruses - the causative agent of syphilis);

ultrasound examination data that indicate pathologies of fetal development;

the results of the study of parts of the umbilical cord and placenta, as well as the blood and cerebrospinal fluid of the child (if the newborn is infected by contact).

Therapeutic tactics for various intrauterine infections are different and depend on the gestation period, the condition of the woman, the condition of the fetus, the nature and severity of the disease.

Not much time has passed since death from infectious diseases in the first year of life was depressingly common, and in underdeveloped regions of the world the situation has not changed to this day. Fortunately, modern medicine has completely changed this picture in Western European society. Antibiotics, which came into general use in the 1940s, revolutionized the treatment of infectious diseases in infants; there has also been a significant increase in information on how to deal with infectious diseases in general.

Infant mortality, that is, the mortality rate for children under one year old, is now a tenth of what it used to be, and infectious diseases, which used to be the main cause of infant mortality, now rank lower on the list.

Universal immunization, mandatory in the UK by law, has prevented terrible epidemics. After the introduction in 1950 of a vaccine against polio, a formerly terrifying disease that maimed and killed thousands of children every year, it became a disease of the past. Measles, which until a few years ago was practically recognizable at first sight, has become so rare that today's medical students are not able to make this diagnosis. Postnatal care, sterilization of artificial milk, infant formula, and technological advances in treatment have halted the spread and reduced the severity of infectious diseases in newborns.

But for certain groups of infants, infections are at particular risk. Some babies cannot make antibodies, others have chronic conditions such as cystic fibrosis, and premature babies are particularly susceptible to infections in the first weeks.

Soon after birth, microorganisms, natural flora, begin to accumulate in the baby's body, which form harmless colonies of bacteria on the baby's skin, in the mouth, in the throat and in the intestines. A healthy person is able to live with this horde of completely ordinary bacteria, as long as they do not multiply too rapidly and get into parts of the body where they are not supposed to be. We all have natural flora. Of course, these bacteria should be distinguished from the less common and much more dangerous ones, which we classify as pathogens, since they can cause illness, and we try to protect the child from them, strengthening his immunity.

Cystic fibrosis (cystic fibrosis) is an inherited disorder with no known cause; occurs in about one in two thousand cases. This is a general disorder in the glands of the body that produce abnormal cells, which manifests itself in excessive sweating, intestinal obstruction and respiratory complications. The pancreas, located next to the liver, is affected in 80% of cases, which makes normal digestion and absorption of fats impossible and leads to malnutrition of the body.
ma, why the child does not gain weight. Often ends fatally; average life expectancy - twelve to sixteen years; the risk of recurrence of the disease in a child of the same sex is 1:4.

The stock of antibodies in a newborn child is greater than that of the mother. The child receives comparatively more antibodies that fight viral infections, and less of those that fight certain types of bacterial infections. When one or another bacterium firmly holds its position, it is usually found that the child has not received enough antibodies against it. If anything, nature's bookkeeping seems to have miscalculated. Of course, if the mother herself does not have antibodies of a certain type, she cannot pass them on to her child. For example, the child of a mother who has been ill with or vaccinated against measles is born with a supply of antibodies that will protect him in the first four to six months. A child born to a mother who has never had measles and has not been vaccinated is susceptible to this disease from birth.

The stock of antibodies in the newborn gradually decreases, and by the end of the fourth to sixth months there is only a very small amount left that will fight infection for the next four to five months. At the age of about three months, the child begins to produce the same antibodies that he received from the mother, and by the age of three or four years, the production of antibodies will reach normal levels. Thus, if a child comes into contact with familiar or unfamiliar bacteria in the environment, his body produces its own antibodies.

Some of these infections are very mild and therefore do not show any symptoms despite the fact that antibodies are produced. Against those dangerous bacteria from which the child is not protected, because he received little or no antibodies from the mother, immunization is required. A good example is whooping cough, or spasmodic cough. The whooping cough, diphtheria, and tetanus vaccine given to a child on one of the pediatrician's first visits stimulates the production of antibodies against these organisms. If a child is not immunized, he will be vulnerable to infectious diseases and will not be armed enough to fight them. Some antibodies, such as those against measles, remain in the body for nine to ten months and provide immunity during this period. For this reason, measles vaccination is often delayed until the time when maternal antibodies have dropped to a certain level.

When can a child become infected?

Firstly, this can happen during the prenatal period, when the baby is still in the womb, and secondly, during or after childbirth. It has long been known about the possibility of intrauterine infection before the rupture of the amniotic membranes. In these cases, the infection crosses the placenta from the mother's blood supply into the baby's bloodstream.

The classic example of this kind of mother-to-child transmission is, of course, syphilis. Despite the fact that this disease has become quite rare, there has been a slight increase in cases of infection. Another disease transmitted by a mother to her child during the prenatal period of life is typhoid fever. But most contagious bacterial diseases are well controlled.

Transmission of infectious diseases during fetal development came to the fore at the end of World War II, when it became clear that the rubella virus could damage the fetus in the first few weeks of pregnancy. A significant number of children whose mothers become infected with rubella in the first three months of pregnancy may become infected with the disease. Mothers themselves may not show symptoms.

The fetus can also be attacked by cytomegalovirus in the second half of pregnancy. Infection can occur through the placenta, and possibly when the child passes through the affected cervix during childbirth. As with rubella, an infected baby can produce the virus for many months after birth and be a source of infection for others. A child in the womb is also vulnerable to microorganisms, one of which is the causative agent of toxoplasmosis.

After the baby is born, infection from the amniotic fluid and amniotic membranes can be passed directly to the baby. This can happen if the shells have burst, and labor has not begun. That's why it's so important that the hospital knows you've had a ruptured membrane and can tell you when to come to the hospital. In many departments, there are different opinions about how long to wait for the onset of labor after a rupture of the membranes. Usually, contractions and childbirth begin a few hours after the water breaks. But it still happens that nothing happens.

It is generally accepted that if six hours after the sudden rupture of the membranes, contractions do not begin, it is worthwhile to stimulate labor activity with an intravenous infusion of oxytocin. The reason for this is that the more time passes since the rupture of the membranes, the more opportunities for microorganisms to enter the uterus. A swab is usually taken and antibiotics are sometimes prescribed, but only if labor has not started twelve hours after the membranes have ruptured.

It is worth emphasizing once again that in every maternity hospital, in every clinic, and every gynecologist and obstetrician has their own scheme of action. However, today in every maternity hospital obstetricians make records of births in order to fix the sequence of actions in certain circumstances. Keeping these records should be continued, as they allow the decision-making process to rely on the highest standards recorded in them.

Infection during childbirth used to happen very often, but the precautions taken by modern obstetricians have significantly reduced the risk of infection. Most babies are born in sterile delivery rooms and then transported to a nursery where the motto is absolute cleanliness; here they are bathed in antiseptic solutions and the umbilical cord is treated with chemicals to reduce the growth of pathogenic bacteria.

After discharge from the hospital, the child finds himself in a completely different situation. All families are susceptible to infectious diseases that can be passed on to the child, but fortunately, most of these diseases do not cause serious concern. Virus-induced colds, sore throats, diarrhea, and so on are common, and a newborn baby is not immune from these ailments, but for reasons that are not well understood, these illnesses cause much milder symptoms in the first few months of life.

Newborn babies are prone to urinary tract infections, respiratory diseases, skin meningitis or skin infections. In other words, they are susceptible to the same types of infectious diseases as adults. The difference lies in the rate at which the disease spreads in the newborn. As a result, a disease that is easily curable in older children and adults is usually more of a concern when the patient is an infant. A doctor is more likely to hospitalize an infant with a urinary tract infection, severe diarrhea, or high fever without any specific symptoms. Many infections, even very dangerous ones, can cause non-specific symptoms in a newborn.

Sometimes an infection can be found in the bloodstream; this disease is known as sepsis; happens extremely rarely. Another possible target for infection is the stump of the umbilical cord, which is cut off from the bloodstream and not protected enough to withstand the onslaught of bacteria. This inflammation, which is of great concern in underdeveloped countries, is called omphalitis. Proper care of the umbilical cord is mandatory in maternity hospitals, and sanitary conditions have significantly reduced the incidence of this inflammation.

Bowel obstruction

There are many different causes of bowel obstruction, even in young children. A foreign body, local inflammation, a tumor can block the passage of the intestine. With early detection, most causes of bowel obstruction can be detected and completely eliminated.

Although bowel obstruction is rare, the symptoms need to be known. These are spasmodic pains in the abdomen that cause the infant to cry violently, vomit, flatulence (bloating due to flatulence), and gradual dehydration, manifested by the usual signs of fluid loss such as dry tongue, wrinkled skin, and sunken eyeballs. and so on. Whatever the cause of the obstruction, surgical treatment is required.

One of the common causes of obstruction is the so-called meconium ileus (impaired passage of contents through the intestines), which is a rare manifestation of cystic fibrosis. With this disease, something happens during fetal development with the pancreas, and the normal movement of the contents of the intestines of the child becomes impossible. The contents become so sticky that the intestines are unable to push them through, and there is a blockage of the intestinal lumen in several places.

Other causes are intestinal volvulus and nodulation, sometimes in the form of a hernia. In young children, one section of the intestine may be embedded in the adjacent one (intussusception - see below). It should be emphasized that these diseases are rare, all can be treated surgically and usually do not cause problems in the future.

Intussusception

This is a rare bowel disease that occurs predominantly in infants and young children. Requires medical supervision and surgical intervention. The child cries out in severe pain, and his stool resembles lumps of currant jelly. Mucus mixed with blood gives this unmistakable appearance to the stool. The section of the intestine is suddenly introduced into the neighboring one. Imagine holding a heavy flexible hose or hose with both hands and then bringing your hands together to force the hose to fold. This illustrates with sufficient accuracy what happens during invagination: a small section of the intestine is inserted inside, and with subsequent spasms, an increasing length of the intestine gets inside. The blood vessels are also ingested, the blood supply
is disturbed, swelling and necrosis of the area of the intestine that has undergone invagination are formed.

Obviously, the pain is very strong. It can be intermittent, with lull intervals, and is usually a good reason for parents to contact a doctor. Gelatinous stools will confirm the diagnosis if needed. The treatment is either an enema, which can straighten the bowel, or, if this method does not work, surgery, which will be the only way out. During the operation, either straighten or remove a small section of the intestine. The prognosis is positive.

Jaundice

This is not a disease, but a symptom that can indicate various diseases and appear at any age. Jaundice is a characteristic yellowing of the skin and eyes, and mild jaundice is common enough in newborns to be considered normal. More than 50% of all newborns have jaundice within a few days: yellowing usually appears on the second or third day and gradually disappears by the end of the first week. This so-called normal (or physiological) jaundice does not bother the baby in any way and may not attract the attention of the mother, but doctors and nurses in the maternity hospital keep a close eye on this manifestation.

However, jaundice can be caused by diseases that are more serious. The actual physiological cause of jaundice is a yellow pigment called bilirubin, which is usually present in small amounts in the blood of any person.

This chemical is actually a breakdown product of hemoglobin, the red pigment in blood cells that transports oxygen. The body continuously undergoes the process of formation and destruction of red blood cells. They are formed in the bone marrow and live for approximately 120 days. Old cells, that is, those that have lived for more than 100 days, are then destroyed and removed from the circulation. These old cells break down and the hemoglobin undergoes chemical changes - the product of this chemical breakdown is bilirubin, which causes jaundice. Bilirubin is then transported by the bloodstream to the liver for further processing, and here, with the exception of a small amount, it enters the bile. Bile enters the bile duct into the duodenum, into the contents of the intestine and is excreted from the body.

The remaining bilirubin in the body is again taken from the liver into the bloodstream. The amount of bilirubin normally present in the body is small, but it can be measured. A chemical analysis, or blood test, can distinguish bilirubin bound for the liver from bilirubin that has already been processed and returned to the blood, and it is the amount of this bilirubin that reaches the critical level in jaundice.

Hepatitis is a disease that most people associate with adult jaundice. At the same time, the liver becomes inflamed and cannot fully do its job of processing bilirubin, which was formed during the normal decay of old cells. Therefore, bilirubin accumulates in the blood, and the patient develops yellowing. Another cause is gallstones blocking the gallbladder or ducts; and some types of anemia, in which red blood cells are destroyed so quickly that the liver cannot handle all the bilirubin.

The kind of jaundice that often occurs in a baby in the first week of life is caused by the fact that the baby's liver has only a limited ability to process bilirubin, because it is not yet mature enough. Doctors and nurses can tell just by the color of their skin how bad a baby's jaundice is. If there is still any doubt, a laboratory test can be done that will show the level of bilirubin, and this test can be repeated several times to check for changes over the next few days.

In premature babies, again due to the immaturity of the liver, the content of bilirubin in the blood increases and yellowing occurs. Breastfed babies are more likely to develop jaundice than formula-fed babies, but this is because a breastfeeding mother produces more of the hormone than usual and it passes through her milk to her baby. The child's liver removes this hormone, but the load on the same enzyme that is involved in the processing of bilirubin increases.

Another cause of neonatal jaundice, often a very serious one, is an incompatibility between mother and baby's blood types (Rhesus incompatibility).

And finally, as a result of a very high level of bilirubin, or, in other words, excessive jaundice, a disease occurs that is called kernicterus. Not all children with high bilirubin levels develop kernicterus, but there is a strong relationship between the two. If the level of jaundice becomes very high, degenerative changes can occur, severe damage to parts of the brain, resulting in cerebral palsy and deafness. Needless to say, this is extremely rare and jaundice is not allowed to reach a critical level. Obviously, the primary task of the physician is not only to discover the underlying cause of the jaundice, but also to keep the jaundice within safe limits.

Pulmonary collapse

Sometimes air enters the pleural cavity and remains between the lungs, chest and diaphragm; This disease is called pneumothorax. In a newborn, pneumothorax can cause breathing difficulties due to airway obstruction.

The air present in the pleural cavity can also press on the lungs and thereby decrease the volume of the lungs when inhaled. As a result, rapid breathing and blue eyes may occur. A doctor may diagnose pneumothorax by listening to the chest and x-ray if the child is having difficulty breathing. Treatment depends on the cause: for example, antibiotics if there is an infection, or sometimes air can be expelled by inserting a small tube between the ribs and the air cavity.

Moniliasis (thrush)

This common fungal infection is very common in the vagina in women, and especially during pregnancy. It can also occur in a child, often in the mouth; the child can catch the disease "on the way." It is easy to treat and does not cause serious problems.

Phenylketonuria

This disease, relatively rare, affects one in ten thousand children, but it is very often talked about. First of all, the practice of testing all newborns for phenylketonuria is widespread; secondly, this disease is a typical example of the genetic transmission of disorders; thirdly, this disease demonstrates the complete interdependence of body and spirit.

Phenylketonuria is a metabolic disorder, or digestion (assimilation) by the body of one of the constituent proteins (proteins), which are called amino acids, - phenylalanine. Think of amino acids as building blocks needed to build all proteins, and the process of digestion as the breakdown of proteins into these small components. Each amino acid is essential for a specific step in the normal growth and development process.

In phenylketonuria, the body is unable to convert phenylalanine to tyrosine due to a deficiency or defect in the production of a certain enzyme. This can be detected by a routine blood test, which is taken from the baby's heel around the third or fourth day. If this substance, phenylalanine, is not properly processed, it remains in the body in large quantities and its derivatives can damage the brain, causing developmental delays and seizures. Moreover, it can affect the overall physical development and well-being of the child. Children in whom the disease has taken a severe course do not eat well, they vomit and do not gain weight.

This disease is easily treatable, which consists in transferring to a special diet containing exactly as much of this amino acid as the body needs and no more. For example, vegetables and fruits are low in phenylalanine, and artificial milk has been developed to contain all the essential amino acids and a reduced amount of phenylalanine. But still, since treatment is necessary and observation is fraught with difficulties, it was considered necessary to establish treatment centers on the ground. Today, PKU treatment for most children can be fully completed by school time.

Pyloric stenosis (narrowing of the pylorus)

This means that the muscular valve that ensures the outflow of food mixed with gastric juices from the stomach to the beginning of the small intestine (to the duodenum) thickens and partially or completely blocks the lumen. Since in this case milk and other food has no other way out of the stomach, except through the mouth, the child vomits. Vomiting during or immediately after a feed is the first symptom a parent will see, but spitting up small amounts of milk during a feed is common in some babies.

Usually vomiting prompt - a fountain. In this it differs from ordinary regurgitation, in which milk flows out in a weak trickle. If this gushing vomiting continues, signs of dehydration and starvation develop. Vomiting often begins a few weeks after the baby has left the hospital and is much more common in firstborns and boys. Diagnosis is made on examination and confirmed by x-ray. The treatment is quite simple, consisting of a small surgical operation, well tolerated by infants, during which a small incision is made in the stomach muscle under general anesthesia in order to ensure the patency of the gastrointestinal tract. The child usually wakes up after a few hours.

And finally, there is no significant hereditary influence; therefore, if one child in the family has the condition, subsequent children are only marginally more likely to develop it than any other child.

Defects of the spinal column

Think of the spinal column as stacked bony rings, connected together by ropes, or ligaments, and adjacent to each other in such a way that together they can lean forward, backward or sideways. The spinal cord passes through a tube or channel formed by rings placed one on top of the other, which at the base of the skull connects to the brain. The spinal cord can be compared to a biological cable of nerve endings connecting the control centers of the brain to the web of nerves that entangles the entire body. Signals in the form of encoded pulses travel along this cable in both directions.

At all levels, from the cervical to the lumbar, nerves branch out from the spinal cord through spaces between rings of bone called vertebrae. The spinal cord, like the brain, floats in a fluid called the cerebrospinal fluid and is located under membranes called the meninges. Thus, the fluid and membrane together form a protective cushion that protects the fragile brain and spinal cord.

Sometimes (the actual cause is unknown) there is a cleft in the bone ring of the vertebra, the ring does not close and there remains a defect in the spinal column, the so-called spina bifida, while there is a hole in the spinal column, the length of which can vary from one to five or even six vertebrae.

Spina bifida can be very small and is only discovered when, on examination, the doctor notices a small indentation in the skin of the lower back at the site of the defect, which is sometimes completely normal. But in more severe cases, there is a defect in the skin and you can see how the membranes protrude from the cleft, and even see the cerebrospinal fluid through the transparent membrane. This is called a meningocele. Some of these cases can be corrected with surgery, while others, unfortunately, can cause disorders of varying severity, from mild disability to complete dysfunction of the intestines and urinary system.

Thirty years ago, the diagnosis could only be made after the birth of a child, but now this disease is detected with a sufficient degree of accuracy in two ways. First, with a blood test, usually done after the sixteenth week at the same time as a Down's disease blood test, which measures a substance called alpha-fetaprotein. It is the content of this substance that increases to a high level in the case of spina bifida and sometimes in some cases of hydrocephalus. This analysis is not entirely accurate, but if it does not reveal the disease, today most women in our country undergo a mandatory ultrasound examination during the sixteen to nineteen weeks of pregnancy, in which such defects can be detected and, together with the parents, decide on further actions.

In severe cases, when there is, for example, spina bifida and at the same time hydrocephalus and the prognosis for the child is very unfavorable, it is possible
but, it is worth going for an abortion. If not, antenatal diagnosis may be beneficial either by ensuring delivery is carried out in an intensive care unit, where all the facilities necessary for performing a surgical operation are available, or by having various specialists present during delivery, so so that the situation can be assessed as early as possible.

Unfortunately, to this day we do not know why this disease occurs, and once it happens, it often recurs in a future pregnancy.

Fistula of the trachea of the esophagus

Some children have a congenital surgical condition in which the grachea and esophagus are connected. This is a rare birth defect that can take many forms, but always requires surgical treatment.

If you press at the base of your throat just below the Adam's apple, you can feel the windpipe. It starts from the pharynx, or glottis, and ends in the chest a few inches below the clavicle. At its lower end, the trachea divides into two large branches called bronchi, through which the air you inhale passes into the right and left lungs. Directly behind the trachea is the esophagus, and normally these two tubes, of course, do not communicate. If, however, due to a developmental defect, these two tubes communicate, or if the esophagus ends, as sometimes happens, in a blind cul-de-sac, then nothing swallowed - food, liquid or saliva - can enter the stomach.

A child with this condition is in serious danger, and to make matters worse, stomach acid is expelled through the esophagus into the trachea and lungs, causing a violent reaction with pneumonia. Children with this disease cannot eat and are prone to lung infections; they regurgitate food back, choke and choke; rapidly developing serious condition. This disease, no doubt, requires surgical treatment in the first few days of life. The results are usually very satisfactory.

Undescended testicles

The testicles in a male child are formed early in fetal development, but first they are located high in the abdominal cavity and remain there until late in pregnancy. In most boys, the testicles descend into the scrotum at the time of delivery, but sometimes one or both testicles remain outside the scrotum, and when the doctor examines the newborn, the testicles in the scrotum are not groped.

We don't know why this is happening. This may be due to underdevelopment of the testicles and is more common in premature babies. It should be noted that testicles that remain in the abdomen after puberty will almost certainly not be able to produce sperm, even if surgery lowers them to their normal location, the scrotum. Therefore, the treatment consists in a relatively simple operation, which requires hospitalization for several days, and the prognosis is favorable. The duration of the operation will depend on a number of factors. Unless one testicle is descended, it must be operated on no later than the onset of puberty, but usually between five and twelve years of age. If both testicles are not lowered, usually one is operated on in infancy and the other at the age of five or six years.

Urinary system defects

Birth defects of the urinary system are quite common, and since a blockage at any site can have serious consequences for the entire system, and because urine is the body's primary means of excretion, the importance of this topic is obvious.

What do we mean by urinary system? There are two kidneys, ureters, bladder and urethra (urethra). Urine is formed in the kidneys, or more specifically, in the nephrons of the kidneys, and accumulates in the cavities of the kidneys, which are called the renal pelvis. The pelvis is drained through a long tube through which urine flows down to the bladder, where it accumulates until it is excreted from the body through the urethra. In women, the urethra is very short, while in men it runs the entire length of the penis.

It is not difficult to imagine that obstruction of the urinary tract at any site will increase the load on other parts of the urinary system. Suppose, for example, that a blockage occurs between the bladder and urethra. The accumulated urine would stretch the bladder, the bladder would contract to get rid of the urine, thickening its muscular wall, the ureters would have to work harder trying to push the urine into the already full bladder, the urine would return from the bladder up and then into kidneys. Under the increasing pressure of the returned urine, the kidneys would begin to stretch, and this chain of degenerative changes could end in kidney failure. A similar picture would arise if there was a blockage in any other area.

How can a urinary tract obstruction be diagnosed?

Sometimes this can be detected by palpation: in the lateral part of the abdomen of the newborn, you can feel the kidney, which is much larger than it should be. But in some cases, problems arise only after an infection enters the urinary system: difficulty urinating, a thin trickle dripping and the complete impossibility of potty training - these are the signals that require attention. Frequent urination, high fever, abdominal pain, nausea, vomiting, and cloudy or blood-mixed urine are all symptoms of a possible urinary tract infection.

There are many tests to determine whether and where the obstruction is located. Today, the fetal urinary tract can easily be seen on maternal abdominal ultrasound, and abnormalities are often found. Most of the abnormalities in question can be corrected with surgery in the first few years of life.

Source Sanders P. All about pregnancy: day by day. - M.: Eksmo Publishing House, 2005.

Intrauterine infectious diseases pose a great danger to the health and life of the child, as they lead to a delay in the development of the fetus, various defects and diseases.

Intrauterine infection in a newborn is an infectious disease that occurs as a result of infection in the womb or during childbirth. The consequences can be very different - from the formation of congenital malformations to the death of a child.

The clinical manifestations of such infections depend on a large number of different factors. For the most part, they depend on acute illnesses of the mother in the prenatal and birth periods. Symptoms are completely different and not always the clinical picture helps to identify the presence of the disease. Therefore, proper monitoring of a woman during pregnancy helps either to eliminate the risk completely, or to eliminate all the consequences.

In newborns, they occur due to infection of the fetus with a pathogen during pregnancy or during childbirth. Most often, the infection of the child comes from the mother. Much less often, cases of infection are possible with specific types of maternal diagnosis (invasive prenatal diagnosis), the introduction of various blood products through the umbilical cord to the child, and other ways.

During the period of intrauterine development of a child, various viruses (rubella, HIV, herpes, hepatitis B, hepatitis C, cytomegaly) and intracellular microorganisms (mycoplasmosis, toxoplasmosis) most often occur as infectious agents.

During the birth period, the degree of infection directly depends on the state of the mother's birth canal. Provided the integrity and healthy functionality of the placenta, the child is inaccessible to the simplest viruses and most of the harmful bacteria. True, with placental insufficiency or various injuries, there is a high probability of infection of the child.

The severity of the course of the disease depends on the time of infection and on the type of pathogen. Infection during the first ten weeks of intrauterine development guarantees a high probability of spontaneous miscarriage.

Infection with the pathogen in the first fourteen weeks leads to stillbirth and the occurrence of severe defects and disorders in the development of the child. The disease in the second and third trimesters causes damage to individual organs or a widespread infection.

It is possible that the clinical manifestation of infection in the mother may not coincide with the symptoms or severity of the infection in the child. The low intensity of symptoms or the asymptomatic course of the disease in a pregnant woman often causes severe consequences that affect the fetus - from pathologies to death.

Symptoms

It is possible to identify intrauterine infection even during childbirth. Signs of infection can be:

unpleasant odor and turbidity of amniotic fluid;
unsatisfactory condition of the placenta;
asphyxia in a newborn.

In the future, other manifestations of the disease can be diagnosed:

enlargement of some internal organs (liver);
microcephaly;
jaundice;
sudden febrile syndrome;
pyoderma;
different pigmentation on the skin;
convulsions.

Manifestations of intrauterine infection can be a grayish skin color of a newborn, a syndrome of depression of the central nervous system and profuse regurgitation. In the future, in a protracted period of development, infections can cause osteomyelitis, various types of encephalitis and meningitis.

Congenital toxoplasmosis

Acute manifestations begin in the first days of life after birth and are characterized by inflammation in the organs, nephritis, various manifestations of diarrhea, jaundice, and fever. Convulsions and edematous syndrome are possible.

The chronic form leads to strabismus, microcephaly, atrophy of the optic nerves and iridocyclitis. Much less often there are cases of monosymptomatic and latent forms of the disease. Late complications entail blindness, epilepsy, mental retardation.

congenital rubella

Rubella disease of a pregnant woman in different periods of pregnancy with varying degrees guarantees the possibility of infection of the child. When infected during the first eight weeks, the disease in the fetus is 80% and the consequences have a high degree of risk - up to spontaneous miscarriage. The disease in the second trimester will reduce the risk by up to 20%, and in the third by up to 8%.

A baby with rubella is often born low birth weight or premature. The typical clinical presentation includes congenital heart disease, auditory nerve and eye lesions. Deafness may develop.

Atypical manifestations and consequences may develop:

hepatitis
hydrocephalus;
microcephaly;
cleft palate;
skeletal anomalies;
vices of various systems;
mental or physical developmental delay.

Cytomegaly

Defeat by pathogens of cytomegalovirus infection often leads to damage and abnormalities in the development of various internal organs, impaired functioning of the immune system, and various complications.

Most often there are congenital pathologies that manifest themselves:

cataract;
retinopathy;
microphthalmia;
microgyria;
microcephaly and other serious diseases.

In the future, cirrhosis of the liver, blindness, pneumosclerosis, encephalopathy, and deafness may develop.

herpetic infection

This disease occurs in three forms - wide, mucocutaneous and neurological. The broad form of the disease is characterized by toxicosis, jaundice, hepatomegaly, pneumonia, and distress syndrome. Other forms occur with the manifestation of rashes and encephalitis. Sepsis may develop.

Hepatitis can cause defects of varying severity - dwarfism, retinopathy, microcephaly. Later complications are developmental delay, blindness, deafness.

Diagnostics

For modern medicine, one of the most urgent tasks is in the initial stages. To do this, a wide range of different analyzes is carried out in order to identify pathologies - smears and cultures for the flora from the vagina of a pregnant woman, PCR diagnostics, specialized laboratory tests for a complex of intrauterine diseases in newborns.

The method of identifying specialized markers using widely used ultrasound is often used. This method allows you to determine low and polyhydramnios, turbidity of amniotic fluid, developmental disorders and damage to the placenta, various fetal pathologies and developmental disorders of various organ systems of the child.

In the postpartum period, a complex of various laboratory tests is carried out in order to confirm or refute the presence of intrauterine infections. Tests for microorganisms, viruses and bacteria are widely used. The molecular biological research method based on DNA, serological and histological analyzes are used.

In the first days of life, if an infection is suspected, the child should be examined by specialists in various fields - cardiology, neurology, ophthalmology and other fields. It is recommended to carry out various studies on the reactions of the child's body.

Treatment

Treatment of intrauterine infections is a complex of multidirectional therapies that together help to cope with the disease. The main types of treatment are aimed at ridding the body of pathogens, restoring the full spectrum of the functioning of the immune system, and restoring the body after a disease.

To strengthen the immune system, immunomodulators and immunoglobulins are prescribed. Most antibiotics for newborns and pregnant women help fight viruses and bacteria. Restoration of the body consists in getting rid of the residual symptoms of intrauterine infections.

Prevention

First of all, preventive examination of partners at the stage of pregnancy planning will help to avoid the occurrence of intrauterine infections. Very often, vaccination is used to prevent the occurrence of herpes viruses.

An important element of prevention is the full and unconditional observance of the rules of personal and general hygiene, maintaining a healthy lifestyle, regular examinations for various infectious diseases.

To date, the lion's share of pathologies in newborns is provoked precisely by intrauterine infection. But the most deplorable thing is that such an infection very often leads to serious problems with the health of the child, and even to disability or to the death of the baby. Timely treatment can help avoid serious consequences.

Often, a mother who leads a healthy lifestyle, avoids any harmful influence, has a child with serious pathologies. Why? Doctors explain this by low immunity - under any circumstances, it decreases during the gestation period. Against the background of poor reactivity of the body, latent infectious diseases begin to appear. More often, such a picture in a woman is observed in the first three months of pregnancy.

What exactly can threaten a newborn baby? Today, the most dangerous for the fetus are viruses:

Rubella.
Cytomegalovirus.
Hepatitis B.
Chicken pox.
Herpes.
Bacteria that cause syphilis, tuberculosis, listeriosis.

An extremely dangerous representative of the kingdom of protozoa is Toxoplasma.

Let us consider in more detail each of them and the consequences of intrauterine infection in newborns.

Rubella

As for this virus, it rarely causes serious pathologies in an adult, but it is very dangerous for an unformed baby in the womb. The biggest risk for the baby is when infected for up to 4 months.

The expectant mother can become infected with this virus by airborne droplets. If the fetus is infected, then the child may develop complications:

Eye damage.
Underdevelopment of the brain.
Meningitis (that is, inflammation of the meninges).
Pathologies of the cardiovascular system.
congenital deafness.
Enlargement of the liver.
Intradermal hemorrhages.
Enlargement of the spleen.
Pneumonia.
Stillbirth.
Miscarriage.

It is impossible to cure a child while he is in the womb. Therefore, it is worth checking the immunity for the presence of antibodies to this virus even at the preparatory stage for pregnancy and during it.

If the mother does not have immunity to rubella, then it is worth getting vaccinated while planning to conceive a child.

Cytomegalovirus

The main route of transmission of CMV is sexual. There is also the possibility of infection through saliva, blood. To the child, this virus migrates only through the placenta. And it is very dangerous for the fetus in case of infection in the last months of pregnancy.

Possible pathologies with intrauterine infection with CMV:

Hearing loss or lack thereof.
Hydrocephalus (excess fluid that presses on the brain) and microcephaly.
Enlargement of the liver and spleen.
Pneumonia.
Blindness.
Stillbirth.
Miscarriage.

The consequences of intrauterine infection in newborns depend on the degree of infection: in case of severe damage, the prognosis is unfavorable - for 30% of children, death occurs in the first year of life. If severe infection has been avoided, then a completely healthy child is likely to be born.

AIDS virus

To date, doctors have ensured that an HIV-infected mother can give birth to a completely healthy baby. However, there is a risk of infection of the fetus.

Children with congenital HIV infection have a very weak immune system, and without proper therapy they do not live up to a year. It is not HIV itself that kills them, but concomitant infections. Therefore, it is very important to identify the disease in a pregnant woman in time and start therapy.

Hepatitis B

The virus that causes this disease can enter the mother's body through sexual contact or through the blood. It freely crosses the placenta to the baby.

Complications in a newborn caused by the hepatitis B virus:

Diseases of the liver.
Retardation of mental and physical development.
miscarriage or stillbirth.

It must be remembered that in the absence of symptoms in a pregnant woman, the disease is transmitted to the baby.

Chicken pox

It would seem that this is a harmless disease that almost all of us have had in childhood. But chickenpox can cause severe complications if a pregnant woman becomes infected with it. The risk is especially high when transferring the disease in the third trimester.

Intrauterine infection with chickenpox threatens:

characteristic rash.
Blindness (due to atrophy of the optic nerve).
Underdevelopment of the limbs.
Inflammation of the lungs.
Underdevelopment of the CNS.

The above pathologies are referred to as congenital varicella syndrome. A woman can become infected with chickenpox through airborne infection.

If at one time the expectant mother already had chickenpox, then upon contact with a person who has all the symptoms, she will transfer immunoglobulins to the child - she will create passive immunity.

Herpes

The herpes virus, acquired by the mother through sexual contact, is transmitted to the child when it passes through the birth canal.

Consequences caused by this disease:

characteristic rash.
Increase in body temperature.
Pneumonia.
Yellowness of the skin.
Congenital malformations of the eye.
Pathology of the brain.
Miscarriage and stillbirth.

The herpes virus carries a great danger to the central nervous system of the baby. If brain damage occurs, then meningitis, encephalitis, hydrocephalus, etc. develop. These children have an increased risk of developing cerebral palsy. Congenital herpes infection in this case does not appear immediately, but after about a month.

This virus is also characterized by transplacental transmission.

Syphilis

When a pregnant woman is infected with syphilis, there is a maximum chance that the fetus will also be infected. The expectant mother can catch the disease only through sexual contact. If, with the appearance of a hard chancre (the first stage of syphilis), you do not immediately start treatment, then the following consequences are possible for the child:

Delayed mental and physical development.
Yellowness of the skin.
Rash.
Pathology of the eyeballs of the ears, as a result - deafness and blindness.
Underdevelopment of the limbs.
Damage to the teeth.
Premature birth, stillbirth.

Even in the absence of obvious signs of syphilis, a woman can become infected with the fetus, so monitoring the health of the mother is mandatory both when planning pregnancy and at all its stages.

Tuberculosis

One of the most dangerous infections for a child is the causative agent of tuberculosis. If the mother was already ill with tuberculosis before pregnancy, then it is possible to bear and give birth to a healthy child only under careful medical supervision. Many forms of tuberculosis and its combination with other diseases are the reason for abortion for medical reasons.

In the case of infection of a woman during pregnancy (tuberculosis is spread by airborne droplets), there is a chance of giving birth to a child already sick with tuberculosis.

Listeriosis

A pregnant woman can meet with listeriosis when eating low-quality meat and dairy products, unwashed vegetables, and through dirty hands after contact with animals. If for the mother, listeria infection can go unnoticed or with minor intestinal disorders, then penetrating the placenta, this bacterium causes a number of complications in the baby:

Rash, ulcers on the skin.
Sepsis.
Brain damage.
Premature birth and stillbirth.

With any manifestations of such an infection in newborns, the prognosis is disappointing (about 40% of infants survive).

Toxoplasmosis

Consequences of toxoplasmosis in pregnant women:

Brain damage (meningitis, encephalitis, hydrocephalus).
Blindness.
Hepatomegaly, splenomegaly.
Delayed mental and physical development.
Premature birth, spontaneous abortion, miscarriage.

It is easy to avoid any of these infections - it is enough to take a responsible approach to the choice of sexual partners, maintain your immunity and visit the doctor regularly during pregnancy planning and the entire period of its management. Timely tests will help prevent the development of such terrible consequences.

Even after a completely successful birth, the condition of the baby during the first weeks of life can deteriorate dramatically. Apathy, lethargy, constant regurgitation, lack of appetite, weight problems - this is an approximate list of alarming symptoms that most often manifest infections in newborns.

Intrauterine infection in newborns

In the female body at different stages of life, pathogens of various diseases, including sexual infections, can live. This is especially true for employees of hazardous industries and owners of chronic pathologies. If the infection attacked a woman during pregnancy, there is a high risk of its transmission to the child even at the stage of his intrauterine life. The blood flow shared with the mother, the ingestion of amniotic fluid are possible ways of infection. In addition, infection often occurs directly during the passage of the baby through the birth canal.

Viral infections provoke diseases such as herpes, rubella, cytomegaly, influenza. Of the bacterial pathogens, chlamydia, treponema, streptococci, E. coli, etc. are known. Even fungi and protozoa can become the cause of intrauterine infection in a newborn baby.

Cytomegalovirus infection in newborns

Cytomegalovirus infection in newborns is considered relatively harmless, it rarely provokes developmental pathologies, so medications for its treatment are prescribed in exceptional situations. For the expectant mother, the development of cytomegaly goes unnoticed at all. Nevertheless, the presence of the cytomegalovirus itself in the body of a pregnant woman provokes a weakening of the protective forces, as a result, the immune system cannot properly protect the woman and the baby.

The herpes virus is a close relative of the cytomegalovirus, but its activity is much more destructive. If a herpes infection is detected in the amniotic fluid, the pregnant woman is sent for a planned caesarean section. If the herpes pathogen still attacks the child, he will need appropriate therapy, the purpose of which is to minimize the negative impact of the infection on the nervous system.

Staphylococcal infection in newborns

Staphylococci live side by side with humans: they can be found in milk and derived products, on household items, plants and simply in the air. Of the whole family of Staphylococcaceae, only three species are provocateurs of infectious diseases.

The most dangerous staphylococcus aureus. The presence of this pathogen in the child's body can be assumed by purulent inflammation on the skin, including suppuration of the umbilical wound, as well as the formation of boils and impetigo. Staphylococcal infection in newborns can lead to very sad consequences: from meningitis, osteomyelitis and pyelonephritis to sepsis and toxic shock; from laryngitis and pneumonia to epidermal necrolysis.

Of course, with such a large-scale threat to health, it is impossible to hesitate to consult a doctor. It is better to try to get an appointment with a qualified specialist, because the attack of staphylococci requires a decent response in the form of a whole cocktail of antibacterial agents, vitamins, probiotics and enzymes.

Intestinal infections in newborns

An intestinal infection is rarely able to bring an adult person out of the usual rhythm of life (except for a few days), but for a small person, especially a newborn, intestinal problems can cause death. And we are not talking about some special cases: for a third of the children who died under the age of three, the diagnosis of "intestinal infection" became fatal. Poisoning the body with toxins produced by harmful microflora, as well as dehydration that occurs as a result of attempts by a small body to remove all unnecessary objects, are detrimental factors.