Neonatal pneumonia is a common disease, and the four seasons are prone to winter and spring for more than. Such as the treatment is not complete, easy to recurrent impact child development. The clinical manifestations of pneumonia in children are fever, cough, dyspnea, without fever and cough re-The main cause of children factors like eating sweet, salty, fried food, causing Sushi stagnation while the raw heat, phlegm dampness, the occasional cold lung undeclared, both as cause and effect and pneumonia.
Neonatal pneumonia - the cause of
(A) of neonatal pneumonia - causes
An aspiration pneumonia is usually caused by inhaled meconium, amniotic fluid, breast milk, can also be due to immature swallowing reflex, swallowing incoordination, esophageal reflux, or cleft palate, and other factors that cause milk or secretions caused by the inhalation. Premature child and the brain and sick children swallowing function and lack of coordination, poor or absence of reflection, is prone to vomit, milk aspiration pneumonia.
Infectious pneumonia, infectious pneumonia is divided into intrauterine, intrapartum and postnatal infection infection.
(1) antenatal, intrapartum infection pneumonia: the case of the fetus in utero infection, the infection, mostly the mother spread through the blood line. Production of infectious pneumonia and obstetric factors.
(1) prenatal infection: the mother during pregnancy by the virus (such as cytomegalovirus, herpes simplex virus, rubella virus), bacteria, protozoa (eg, toxoplasmosis), chlamydia and mycoplasma infection, pathogens, blood line through the placenta and amniotic membrane invasion the fetus.
② labor infection: premature rupture of membranes more than 6h, amniotic fluid may be contaminated, if premature rupture of membranes more than 24h, the incidence of infection may reach 30%, or amniotic chorioamnionitis, birth canal, bacteria such as Escherichia coli, Klebsiella, Listeria monocytogenes, B streptococcus, upstream lead to infection, or the fetus in utero inhalation of contaminated amniotic fluid and disease. In addition, radical production, prolonged labor or birth canal is not thoroughly disinfected, etc., fetal pneumonia by inhalation of contaminated secretions in the birth canal during delivery.
(2) after the birth of infectious pneumonia:
① respiratory ways: by contact with newborns suffering from respiratory infections, the pathogens can be transmitted through droplets from infants on respiratory tract is propagated down to the lung; can also be due to the decline of infant resistance (such as cold, etc.), its downstream upper respiratory tract infection caused by pneumonia .
② of hematogenous spread of infection: risk of omphalitis, skin infections, sepsis, pathogens, blood line spread to the lungs and cause pneumonia. Pathogen group B hemolytic streptococcus, Staphylococcus aureus, Escherichia coli and cytomegalovirus, respiratory syncytial virus are common.
(3) iatrogenic spread of infection: iatrogenic infection caused by Pseudomonas aeruginosa, anaerobes, and some of the low virulence of bacteria. Medical equipment such as suction, atomization, oxygen masks, endotracheal intubation, such as disinfection lax incubator humidity is so high that aquatic bacteria is easy to breed, or a ventilator for too long cause pneumonia; wards crowded, disinfection system of strict, health care workers wash their hands do, will bring the pathogens of children with other newborns; broad-spectrum antibiotic used for a long time prone to fungal pneumonia. Late-onset pneumonia is most common in the neonatal care units, neonatal chronic lung disease require long-term intubation.
3 other inappropriate care, cold, etc., is also the occurrence of pneumonia incentives.
(B) of neonatal pneumonia - pathogenesis
Aspiration pneumonia due to lack of oxygen to stimulate fetal breathing leaving the amniotic fluid, meconium, or vaginal secretions, inhaled, causing aspiration pneumonia. Meconium aspiration pneumonia is the most serious, see meconium aspiration syndrome. Milk inhalation is common in swallowing function was incomplete, sucking vomiting, esophageal atresia and cleft lip and palate.
Infectious pneumonia pathological change in the widely intrauterine, birth, alveolar exudate containing multinucleated cells, monocytes and a small amount of red blood cells. Microscopy can be seen in the amniotic fluid sediment, such as keratinized epithelial cells, fetal sebum and pathogens. Infectious pneumonia pathological changes after the birth of bronchial pneumonia and interstitial pneumonia, scattered lesions, affecting leaf or several leaves, sometimes fused into large areas of lesions, atelectasis, and emphysema are more prone to. Microscopic lesions exist at different stages of the inflammatory response. Different etiology, pathological changes are also different
Neonatal pneumonia - SymptomsNeonatal pneumonia and pneumonia in children What are the performance and how to diagnose?(A) light bronchial pneumonia.
A fever: Most higher.
Cough: a frequent irritant dry cough, followed by the throat, sputum, cough, vomiting, choking.
Faster, breathing shallow, nose fan some of the children perioral, mild nail cyanosis.
In addition to respiratory symptoms in children may be associated with listlessness, irritability, loss of appetite, shaking, diarrhea and other systemic symptoms.
(B) severe pneumonia: in addition to the performance of mild pneumonia increased, sustained high fever, symptoms of systemic poisoning is serious and associated with other organ dysfunction.
Respiratory symptoms: superficial breathing, shortness of breath, more than 80 times per minute, nasal flap, there are three depressions, groaning breath, facial and extremities obvious cyanosis, worse pale or greenish-blue. Lungs could be heard and intensive fine wet rales.
2, the symptoms of the circulatory system: infant pneumonia is often accompanied by ventricular dysfunction.
Nervous system symptoms (1) irritability, drowsiness, gaze, strabismus, eye Upward. (2) lethargy and even coma, convulsions. (3) the bulbar conjunctiva edema. (4) pupil change and unresponsive to light or disappear. (5) respiratory rhythm is not the whole. (6) fontanelle expansion meningeal stimulation levy, cerebrospinal fluid in addition to increased pressure were normal as toxic encephalopathy, severe cases, intracranial pressure, herniation can occur.
Digestive symptoms: children with loss of appetite, vomiting, diarrhea, abdominal distension, severe vomit is brown or blood in the stool, bowel sounds disappear in paralytic ileus, and toxic hepatitis.
5, metabolic acidosis, respiratory acidosis, can also be mixed acidosis.
Neonatal pneumonia - CheckNeonatal pneumonia in children with pneumonia should do what?(1) to check white blood cell: cell pneumonia, increased WBC count, about 15 ~ 20 × 109 / L Severe Staphylococcus aureus pneumonia and influenza bacillus pneumonia, and sometimes the total number of leukocytes but reduced. Viral pneumonia, white blood cell count is normal or reduced, increase in the proportion of lymphoid number, the number of neutrophils without increased.
(2) C-reactive protein test in the bacterial infections, sepsis, and this value increased, increased in direct proportion with the severity of the infection. Virus and mycoplasma infection does not increase.
(3) cell pathologic examination.
(4) The viral etiology of inspection.
(5) chest X-ray examination.
Neonatal pneumonia - TreatmentChildren with pneumonia should be treated?
The principle of treatment of pneumonia is the application of anti-inflammatory drugs, and kill the pathogen. Selected according to different pathogens sensitive to the drug, early treatment, the full course of treatment, according to the disease, treatment options should also be given to taking the antipyretic symptomatic treatment such as fever, cough should given Huatanzhike drugs, severe pneumonia should be promptly hospitalization to the hospital.
(A) general care and supportive therapy:
The room temperature should be maintained at about 20 ℃ is appropriate, and 55-65% relative humidity to prevent the respiratory secretions dry, difficult to expectorate. Prevent cross-infection.
2, attention to nutrition and water supply; should try breastfeeding, if artificial feeding according to its digestive function and disease decision milk and concentration, and if diarrhea be given skimmed milk for infants and young children should supply light, easy to digest, rich a variety of vitamins diet, recovering from sick children should be given to nutrient-rich, high-calorie foods. Intravenous fluid replacement for critically ill children can not eat, heat and moisture.
3, to maintain airway patency: nose scab, nasal secretions, and respiratory sputum should be promptly removed. Improve ventilatory function, increased alveolar ventilation to correct hypoxia, reduce CO2 retention. Phlegm and thin, you can repeatedly stand up to shoot back in order to facilitate sputum discharge. Oral expectorant drug ammonium chloride mixture. Thick phlegm difficult to expectorate, suctioning or use of ultrasonic atomizing inhalation.
Antibiotics (b) anti-infectives.An antibiotic of choice.
(1), pulmonary gram-positive bacterial infections: pneumococcal pneumonia, penicillin remains the first choice. Change drops erythromycin allergic to penicillin.
(2), pulmonary gram-negative bacilli infections, generally available ampicillin or aminoglycoside antibiotics. Pseudomonas aeruginosa pneumonia can be used to re-Fortum, ceftriaxone, and so on.
(3) Mycoplasma pneumonia: use of erythromycin for 2 weeks is appropriate.
(4) clear bacterial pneumonia, according to the disease choose broad-spectrum antibiotic combination therapy (one should be emphasis on drugs in Gram-negative bacteria).
Two antiviral drugs.
Interferon and ribavirin.
(C) oxygen therapy:
(D) symptomatic treatment:
1, fever, and calm.
2, expectorant cough and asthma.
(5) important organ damage processing.
Pay attention to weather changes at any time to change clothes, children bedroom Do not smoke, should not be placed or to avoid exposure to fumes, paint, gas, dichlorvos harmful objects and cage. Prevalence during the Eat sweet, salty, spicy greasy Atsumi. The indoor temperature is not too high, not too dry; normally open doors and windows to keep the air fresh.Neonatal pneumonia - to identifyChildren with pneumonia and the diseases easily confused?
Neonatal pneumonia, bronchitis, systemic mild symptoms, usually without symptoms of dyspnea and hypoxia, the lungs could be heard and dry rales in coarse moist rales, not fixed, often with cough or postural change and disappear.2, the abrupt onset of acute miliary tuberculosis in children is often accompanied by fever, chills, body discomfort, shortness of breath, cyanosis and other symptoms of systemic poisoning resembles the bronchitis, but the lungs are often no obvious signs or fine wet rales scattered in the lungs, and found the end of the suction. X-ray findings and bronchial pneumonia are similar. According to the history of exposure to tuberculosis, clinical symptoms, positive tuberculin test, ESR, sputum or washing the gastric juice and check TB and X-ray follow up can be identified.
, Caseous pneumonia lesions mostly in the weak or the lower the resistance of children to X-ray showed a lung segment as well as leaf most of the lungs showed dense consolidation than the vague outline, usually can be seen more translucent liquefaction areas, and even opaque hollow. Combining history, tuberculin test, easy to identify with bronchial pneumonia.
Bronchial foreign body in the history of foreign body aspiration, or choking history. Clinical and light and heavy different disease duration ranging. Prolonged course of secondary infection can be recurrent fever, cough, lungs could be heard and moist rales with pneumonia, and sometimes to auscultation smell and trachea slap sound can be helpful in the diagnosis, but the diagnosis rely on fiber air passenger microscopy.
5, bronchiolitis and acute pneumonia phase 0 seems, but this disease to wheezing. Lungs wheeze and fine moist rales could be heard. Seriously ill children with hypoxia, X-ray only lungs transmittance enhancement, the diaphragm down, emphysema was a change, a small number of sick children have a little blotchy shadow.
Neonatal pneumonia - PreventionNeonatal pneumonia in children with pneumonia should be how to prevent it?Risk of pneumonia among children, parents should be careful, careful attention to the child's body temperature and breathing, to keep indoor air fresh, quiet, and let the child rest well. In the diet, eat digestible, high-calorie and vitamin-rich food, soft food is best, gastrointestinal absorption. Pat on the back of the child's cough is conducive to the discharge of sputum from the bottom up shoot shoot back, the room should not be too dry, children should be appropriate to drinking water, mucus, is conducive to the discharge of phlegm.
Pneumonia recovered, and do not take it lightly, with particular attention to the prevention of upper respiratory tract infection, or prone to repeated infections. Attention to strengthening exercises and proper exercise, according to age. If the child into yao living room doors and windows closed, and the ability to adapt to the outside air backward. Outdoor activities, pay attention to the appropriate increase in clothes. Flu epidemic in the community, do not take their child to public places to The home was suffering from a cold, do not contact with the children.
Prevention: family prevention of pneumonia, the main is to enable children to adhere to exercise and strengthen resistance to disease, while paying attention to climate change, at any time to change clothes to the children, to prevent colds. Reasonable feeding to prevent malnutrition. Education children to develop good health habits, and do not spit, so that infants and young children more than the sun. Continue to enhance the infant's resistance to disease is the key to preventing this disease.
Neonatal pneumonia - complicationsChildren with pneumonia complicated by the diseases?
Neonatal pneumonia and pneumonia in children with timely detection and effective treatment of sick children can be quickly recovered. But severe prone to the following complications if not treated in time, a poor prognosis.① heart failure: the onset of pediatric restless, dyspnea, and cyanosis, rapid heart rate, 180 beats / min, shortness of breath,> 60 beats / min, increased liver, lower extremity edema, should take immediate measures to control its development, the use of tonic, diuretic therapy.
② respiratory failure: Pediatric irritability, dyspnea, and cyanosis, respiratory early to speed up the weight when you slow down, moaning breathing and respiratory rhythm changes. Speed up or slow down the heart rate in critically ill, and can be followed by coma and convulsions.
③ pus pneumothorax: Staphylococcus aureus pneumonia, high incidence of pus pneumothorax. At this point, the persistent high fever or body temperature decreased and then rise again, frequent coughing, shortness of breath, can not do it lying full side of the thorax.
④ hypoxic encephalopathy: pneumonia, difficulty breathing, hypoxia weight, children vomiting, headache, lethargy or irritability, followed by coma and convulsions. More acute encephalopathy, ferocious, dangerous condition, often interlaced with a variety of complications appear, influence each other, so that the disease has become more complex, and high mortality.
⑤ toxic shock, the sudden jump in temperature up to 40 ~ 41 ℃ or plunged, chills, pale gray, irritability, or coma, sweating, skin was marble pattern changes, blood pressure, or could not be determined, and multiple organ function changes The symptoms of danger.
⑥ toxic intestinal paralysis: the performance of a high degree of abdominal distension, vomiting, constipation and anal exhaust (not fart). Abdominal distension and oppression of the heart and lungs, making breathing difficulties more serious. Bread pale gray, abdominal percussion was the drum sound, bowel sounds disappear, the vomit was brown or stool-like material, x-ray examination found that intestinal dilatation, wall thinning of the diaphragm up the intestine, the liquid surface.
In addition, children with pneumonia complicated by atelectasis, emphysema, bullae, bronchiectasis, psychosis, so that both children with pneumonia is a common disease, but also as a dangerous disease, so the parents can not pay no attention to prevention and care.
