Infectious inflammation of the lung tissue of the fetus or intrauterine pneumonia is a rare and dangerous disease that occurs late in pregnancy or during childbirth. Infection occurs through the amniotic fluid or hematogenous from mother to child, leads to a serious condition of the newborn, and also threatens with serious deviations in physical and mental health.
Development ways
The modern level of development of medicine has made it possible to reduce the incidence of pathology to single indicators, which at the beginning of the century was the cause of high infant mortality. The causative agent of infection is viruses or bacteria that can enter the child’s body in two ways:
- Ascending route of infection. The presence of inflammatory processes in the birth canal and pelvic organs of a woman increases the risk of intrauterine pneumonia in a child. During childbirth, the transmission of pathogens that cause infection of the newborn occurs. Cystitis, vaginitis, endometritis – these pathologies pose the greatest risk, therefore, if a woman is diagnosed with an infectious disease shortly before childbirth, then doctors recommend a cesarean section.
- Hematogenous route of infection. Infection with the subsequent development of pneumonia occurs through the hematoplacental barrier. The general blood flow system, through which nutrition, respiration and metabolism of the fetus take place, is vulnerable to pathogens and, when circulating in the woman’s blood, transmission to the child is possible.
Since the baby’s lungs begin to function only outside the mother’s womb, the activation of the pathological process occurs at the moment of inhalation. The supply of oxygen and increased blood flow triggers a rapid inflammatory response, which is especially pronounced in the first days of a newborn’s life.
The reasons
Analysis of the nature of the development of the disease made it possible to identify the most probable types of pathogens that cause intrauterine pneumonia. Staphylococci, causative agents of herpes, rubella, chlamydia, ureaplasmosis , toxoplasmosis, listeriosis most often cause pneumonia in a newborn.
Among the risk factors in the development of pneumonia, doctors distinguish several pathological conditions during pregnancy and preparation for it:
- Acute infections that occurred during gestation. ARI, ARVI, rubella, cystitis and other diseases can lead to infection of the fetus.
- Exacerbation of chronic diseases or the presence of a focus of inflammation in the body. Caries, inflammatory diseases of the joints, lungs and organs of the genitourinary system pose a threat, therefore, women with such diagnoses are under the close attention of doctors throughout pregnancy.
- Weakening of the immune system of the expectant mother as a result of sudden stress or against the background of autoimmune diseases can cause pneumonia in a newborn.
- Pathologies of pregnancy, childbirth and fetal malformations – prematurity, prolonged labor, hypoxia, aspiration syndrome, underdevelopment of the lungs, also increase the risk of fetal infection.
Premature babies are more vulnerable because the respiratory system does not have time to fully form, and the immune defense is reduced. Women from disadvantaged strata of the population – drug addicts with alcohol dependence, suffering from tuberculosis, HIV infection, hepatitis – fall into the group of particular risk.
Clinical manifestations
Signs of intrauterine pneumonia in infants are determined at birth or at 5-7 days of life. The clinical manifestations of the disease are pronounced, and further examination confirms the disappointing diagnosis.
Pneumonia symptoms:
- Breathing is shallow, wheezing is clearly defined in the lungs, and in the most severe cases the nasal cavity is filled with purulent contents.
- The Apgar score of the child indicates the symptoms of hypoxia, the most obvious of which are cyanosis of the skin, attacks of apnea and a weak reaction to external stimuli.
- High body temperature is one of the clear signs of infection, but when a baby is born earlier than expected, lower values may be determined.
- In addition to discoloration of the skin, the baby has swelling of the limbs.
- Cardiac examination indicates tachycardia and signs of insufficient blood supply, and in premature babies, low blood pressure is determined.
- Due to intoxication, the liver may be enlarged, and there is a rash on the baby’s skin.
Neurological symptoms of the infectious process – an increase or decrease in muscle tone, throwing the head back – are considered an unfavorable sign and speak of the generalization of pneumonia with the development of a lung abscess, meningitis, sepsis or other complications.
Diagnostics
Laboratory and instrumental examination methods are carried out to clarify the nature of the pathology, provide emergency assistance and to draw up a treatment plan. The diagnostic criterion is an X-ray of the lungs, in which, with intrauterine pneumonia, an enhanced pulmonary pattern, areas of infiltration and foci with altered structure are determined. Laboratory tests of blood, sputum and urine can determine the prevalence of the infectious process, identify the type of pathogen and prescribe treatment. The mother must be examined in order to establish the cause of the infection of the child and the route of infection.
Treatment
The outcome of intrauterine pneumonia is largely determined by the speed of emergency care in the intensive care unit and neonatal intensive care unit. The main tasks at the initial stage are the restoration of respiratory function and the fight against hypoxia. The long-term consequences of oxygen deficiency adversely affect the physical and mental development of the child, therefore , depending on the situation, ventilators and medicines are used to eliminate the hypoxic syndrome.
The plan for further treatment provides for the fight against infection, intoxication, ensuring airway patency, as well as the introduction of drugs for symptomatic therapy. Complex pathology is difficult to treat, when pneumonia is caused by exposure to several types of pathogen.
The prognosis depends on the prevalence of the infectious process, the type of pathogen and the severity of the course. Septic complications increase the likelihood of death, and with meningitis there is a risk of neurological pathologies.
Prophylaxis
The recommendations of doctors for the prevention of intrauterine pneumonia are summarized in a mandatory routine examination of a woman in preparation for pregnancy, during gestation and before childbirth. It is useful for parents to know that latent sexually transmitted infections may not appear in any way in an adult, but pose a threat to the life of a newborn child.
The readiness of medical personnel to provide emergency care in the delivery room, good equipment of the medical institution with modern equipment and high-quality diagnostics help to reduce mortality and reduce the severity of long-term consequences in intrauterine pneumonia.