Intrauterine infection in newborns consequences. Infectious diseases in newborns. Blood tests for all pregnant women

Not much time has passed since death from infectious diseases in the first year of life was depressingly frequent, and in the 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 became ubiquitous in the 1940s, revolutionized the treatment of infectious diseases in infants; information on how to deal with infectious diseases in general has also expanded significantly.

The mortality rate among infants, that is, the mortality rate of children under one year old, is now a tenth of the previous figure, and infectious diseases, which used to be the main cause of child mortality, now occupy lower positions on the list.

Universal immunization, which is mandatory in the UK by law, has prevented dire epidemics. With the introduction in 1950 of the polio vaccine, which was previously terrifying and annually crippled and killed thousands of children, it has become a disease of the past. Measles, which until a few years ago was practically recognized at first sight, has become so rare that today's medical students are not able to make this diagnosis. Postpartum care, artificial milk sterilization, infant formula and technological advances in treatment have stopped the spread and reduced the severity of infectious diseases in newborns.

But for some groups of infants, infections carry particular risks. Some babies cannot make antibodies, others have chronic conditions such as cystic fibrosis, and premature babies are especially susceptible to infections in the first weeks.

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

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

The supply of antibodies in a newborn baby is greater than that of a mother. The child receives relatively more antibodies that fight viral infections, and less antibodies that fight some types of bacterial infections. When a particular bacterium is firmly in position, it is usually found that the child has not received enough antibodies against it. Nature's accounting department seems to have miscalculated, if you will. Of course, if the mother herself does not have a certain type of antibodies, she cannot pass them on to her child. For example, a child of a mother who has had measles or is vaccinated against measles is born with a supply of antibodies that will protect him for 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 newborn's antibody supply is gradually decreasing, and by the end of the fourth to sixth month, only a very small amount remains that will fight the infection for the next four to five months. At about three months of age, the baby begins to develop the same antibodies that it received from the mother, and by the age of three to 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 no symptoms are observed even though antibodies are being produced. Against those dangerous bacteria from which the child is not protected, since he received little or no antibodies from the mother, immunization is required. Whooping cough, or spastic cough, is a good example. The vaccine against whooping cough, diphtheria and tetanus, which is given to a child on one of the first visits to the pediatrician, stimulates the production of antibodies against these microorganisms. If a child is not immunized, it will be vulnerable to infectious diseases and not be sufficiently armed 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 maternal antibody count has dropped to a certain level.

When can a child become infected?

Firstly, it 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 rupture of the amniotic membranes. In these cases, the infection crosses the placenta from the mother's blood supply to the baby's bloodstream.

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

Infection with infectious diseases during fetal development came to the fore at the end of World War II, when it became clear that rubella virus can damage the fetus in the first few weeks of pregnancy. A significant number of children whose mothers contract rubella in the first three months of pregnancy can become infected with rubella. The 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, or possibly when the baby passes through the affected cervix during childbirth. As with rubella, an infected baby can develop the virus for many months after birth and be a source of infection for others. The baby in the womb is also vulnerable to microorganisms, one of which is the causative agent of toxoplasmosis.

After a baby is born, infection from the amniotic fluid and amniotic membranes can be passed on directly to the baby. This can happen if the membranes have burst and labor has not begun. That is why it is so important that the hospital knows that you have ruptured membranes and can advise when to come to the hospital. There are differing opinions in many departments about how long to wait for labor to begin after rupture of the membranes. Usually, contractions and childbirth begin a few hours after the waters leave. But it still happens that nothing happens.

It is generally accepted that if, six hours after the sudden rupture of the membranes, the contractions have not begun, it is worth undertaking the stimulation of labor with an intravenous infusion of oxytocin. The reason for this is that the more time elapses from the moment the amniotic membranes rupture, the more microorganisms have the opportunity to penetrate into the uterus. Usually a smear is taken and antibiotics are sometimes prescribed, but only if labor has not begun twelve hours after the membranes have ruptured.

It is worth emphasizing once again that every maternity hospital, every clinic and every gynecologist and obstetrician has their own scheme of actions. Nevertheless, today, in every maternity hospital, obstetricians keep records of the delivery in order to record the sequence of actions in certain circumstances. The maintenance of these records should be continued, as they allow in the decision-making process to rely on the highest samples recorded in them.

Infection during childbirth used to be very common, but the precautions taken by modern obstetricians have significantly reduced the risk of infection. Most babies are born in delivery rooms under sterile conditions, and then transported to the 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 being discharged 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 are not a cause for serious concern. Virus-induced colds, sore throats, diarrhea, and so on are common, and a baby who has just arrived from the hospital is not protected from these ailments, but for reasons not completely understood, these diseases 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 prone 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 treatable in older children and adults is usually more of a concern when the patient is a nursing infant. A doctor is more likely to hospitalize an infant with a urinary tract infection, severe diarrhea, or high fever without any particular symptoms. Many infections, even very dangerous ones, can cause nonspecific symptoms in the newborn.

Sometimes an infection can be found in the bloodstream; this condition is known as sepsis; happens very rarely. Another possible target for infection is the umbilical cord stump, which is cut off from the bloodstream and is not sufficiently protected to withstand the onset of bacteria. This inflammation of great concern in underdeveloped countries is called omphalitis. Adequate umbilical cord care is required 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. Foreign body, local inflammation, swelling can block the intestinal passage. With early detection, most of the causes of intestinal obstruction can be detected and completely eliminated.

Although bowel obstruction is rare, the symptoms are important to be aware of. These are spasmodic pains in the abdomen, causing the infant to cry violently, vomiting, flatulence (bloating due to gas) and gradual dehydration, which manifests itself in the usual signs of a decrease in the amount of fluid in the body, such as a dry tongue, wrinkled skin, sunken eyeballs. etc. Whatever the cause of the obstruction, surgical treatment is required.

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

Other causes are volvulus and nodulation, sometimes in the form of a hernia. In young children, one part of the intestine can be nested in the neighboring one (intussusception - see below). It should be emphasized that these diseases are rare, all amenable to surgical treatment and usually do not cause problems in the future.

Intussusception

It is a rare bowel disorder that occurs primarily in infants and young children. Requires medical supervision and surgery. The child cries out in severe pain, and his stool resembles lumps of currant jelly. This unmistakable appearance of the stool is given by mucus mixed with blood. A section of the intestine is suddenly introduced into the adjacent 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 with intussusception: a small section of the intestine is inserted inside, and with subsequent spasms, an ever greater length of the intestine gets inside. The blood vessels also get inside, the blood supply
is disturbed, swelling and necrosis of the part of the intestine that has undergone intussusception are formed.

The pain is obviously very intense. It can be intermittent, at intervals of calm, and is usually a good reason for parents to contact a doctor. Jelly-like stools will confirm the diagnosis, if needed. Treatment consists either in the administration of an enema, which can straighten the bowel, or, if this method does not work, in a surgical operation, which will be the only option. During the operation, a small section of the intestine is either straightened or removed. The forecast is positive.

Jaundice

This is not a disease, but a symptom that can indicate various diseases and appear at any age. Jaundice manifests itself as a characteristic yellowing of the skin and sclera of the eyes, and mild jaundice is common enough in newborns to be considered normal. More than 50% of all newborns experience 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 mother's attention, but doctors and nurses at the hospital are closely monitoring 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 found 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 is in a continuous 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 disintegrate and the hemoglobin undergoes chemical changes - the product of this chemical breakdown is bilirubin, which causes jaundice. Then bilirubin is 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 through 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 returned from the liver to the bloodstream. The amount of bilirubin normally present in the body is small, but measurable. A chemical analysis, or blood test, can distinguish bilirubin going to the liver from bilirubin, which has already been processed and returned to the blood, and it is the amount of this bilirubin that reaches a critical level in jaundice.

Hepatitis is a disease that most people associate with jaundice in adults. In this case, the liver becomes inflamed and cannot fully carry out its work of processing bilirubin, formed during the usual decay of old cells. Therefore, bilirubin accumulates in the blood and the patient experiences yellowing. Another cause is gallstones that block the gallbladder or ducts; and some types of anemia, in which red blood cells break down so quickly that the liver cannot handle all the bilirubin.

The type of jaundice that is often noted in a child in the first week of life is caused by the fact that the child's liver has only a limited ability to process bilirubin, since it is not yet mature enough. Doctors and nurses can tell by skin color alone how bad a baby is having jaundice. If there is any doubt, a laboratory test can be done to show the bilirubin level, and this test can be repeated several times to identify changes that have occurred over the next few days.

In premature babies, again due to the immaturity of the liver, the level of bilirubin in the blood rises and yellowing occurs. Breastfed babies are more likely to develop jaundice than bottle-fed babies, but this is because the breastfeeding mother produces more hormone than usual and it is passed through the milk to the baby. The child's liver removes this hormone, but the load on the same enzyme that is used to process bilirubin increases.

Another cause of neonatal jaundice, which is often very serious, is the incompatibility of the blood types of the mother and the baby (Rh incompatibility).

Finally, very high levels of bilirubin, or in other words, excessive jaundice, result in a disease 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 and, as a result, cerebral palsy and deafness. Needless to say, this is extremely rare and the jaundice is prevented from reaching critical levels. Obviously, the primary task of the physician is not only to find the underlying cause of jaundice, but also to keep the jaundice within safe limits.

Pulmonary collapse

Sometimes air enters the pleural space 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.

Air in the pleural space can also press on the lungs and thereby reduce the volume of the lungs when you inhale. As a result, rapid breathing and blue discoloration may occur. A doctor may diagnose pneumothorax after listening to the chest and x-rays if the baby is having difficulty breathing. Treatment depends on the cause: for example, antibiotics if there is an infection, or sometimes air can be released by inserting a small tube between the ribs and the air cavity.

Monilias (thrush)

This common fungal infection is very often found 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 "along 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, it is widespread practice to test all newborns for phenylketonuria; 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 the body's digestion (assimilation) of one of the constituent proteins (proteins) called amino acids - phenylalanine. Think of amino acids as the building blocks of all proteins, and digestion is the breakdown of proteins into these little pieces. Each amino acid is essential for a specific stage in the normal growth and development process.

In phenylketonuria, the body is unable to convert phenylalanine to tyrosine due to a lack or impairment of the production of a certain enzyme. This can be detected by routine blood tests taken from the child's heel around the third or fourth day. If this substance, phenylalanine, is not processed properly, 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 general physical development and well-being of the child. Children with severe illness eat poorly, vomiting and no weight gain.

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 not more. For example, vegetables and fruits are low in phenylalanine, and artificial milk has been developed that contains all the essential amino acids and a reduced amount of phenylalanine. However, since the need for treatment and observation is fraught with difficulties, it was considered necessary to organize treatment centers locally. Today, PKU treatment for most children can be fully completed by the time of school.

Pyloric stenosis (narrowing of the gatekeeper)

This means that the muscle valve, which ensures the outflow of food mixed with gastric juices, from the stomach to the beginning of the small intestine (into 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 opens up vomiting. Vomiting during or immediately after a feed is the first symptom a parent will see, but spitting up a small amount of milk during a feed is common in some babies.

Usually vomiting is rapid - a fountain. This differs from normal regurgitation, in which milk flows out in a weak stream. If this gushing vomiting continues, signs of dehydration and starvation develop. Very often, vomiting begins several weeks after the child leaves the hospital, and is much more common in first-borns and in boys. Diagnosis is by physical examination and confirmed by x-ray. Treatment is quite simple, a small surgical procedure that is well tolerated by infants, during which, under general anesthesia, a small incision is made in the muscle of the stomach in order to keep the gastrointestinal tract open. Usually the child wakes up after a few hours.

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

Spinal column defects

Think of the spinal column as a column of bony rings held together by cords or ligaments, and adjacent to each other in such a way that together they can tilt forward, backward, or to the sides. The spinal cord passes through the tube, or channel, formed by the rings placed one on top of the other, which connects to the brain at the base of the skull. The spinal cord can be compared to a biological cable made up of nerve endings that connect the control centers of the brain with a 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 off from the spinal cord through the spaces between the bony rings called the vertebrae. The spinal cord, like the brain, floats in a fluid called cerebrospinal fluid, which 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 reason is unknown) there is a non-closure in the bony ring of the vertebra, the ring does not close and a defect of the spinal column remains, the so-called spina bifida, while there is an opening in the spinal column, the length of which can vary from one to five or even six vertebrae.

A spina bifida can be very small and is detected only when, on examination, the doctor notices a slight depression 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 skin defect and you can notice how the membranes protrude from the cleft, and even see through the transparent membrane of the cerebrospinal fluid. 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 be made only 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, which is usually done after sixteen weeks at the same time as a blood test for Down's disease, and during which the amount of a substance called alpha-fetaprotein is measured. 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 detect diseases, today most women in our country undergo a compulsory ultrasound examination during the period of pregnancy sixteen to nineteen weeks, during 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 hydrocephalus at the same time and the prognosis for the child is very unfavorable, it is possible
but, it is worth going to terminate the pregnancy. If not, then prenatal diagnosis can be useful either by ensuring that labor is carried out in the intensive care unit, where all the conditions necessary for performing a surgical operation are available, or heme, that various specialists will be present during labor, so so that an assessment of the situation is made as early as possible.

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

Fistula of the trachea of ​​the esophagus

Some children have a congenital surgical disease, which consists in the fact that the grachea and the esophagus are connected to each other. 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 at the pharynx, or glottis, and ends in the chest a few inches below the clavicle. At its bottom, the trachea divides into two large branches called the bronchi, through which the air you breathe passes into the right and left lungs. The esophagus is located directly behind the trachea, and normally these two tubes, of course, do not communicate. If, due to a developmental abnormality, these two tubes communicate or if the esophagus ends, as sometimes happens, in a blind dead end, then nothing swallowed - food, liquid or saliva - can enter the stomach.

A child with this condition is in serious danger, and to further complicate matters, gastric juice is expelled through the esophagus into the trachea and lungs, causing a violent reaction with pneumonia. Children with this condition cannot eat and are prone to lung infections; they belch food back, choke and choke; a serious condition develops rapidly. 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 form at the beginning of intrauterine development, but at 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 by the time of delivery, but sometimes one or both testicles remain outside the scrotum, and when the doctor examines the newborn, the testicles are not found in the scrotum.

We do not know why this is happening. This may be due to underdeveloped testicles and is more common in premature babies. It should be noted that the 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, into the scrotum. Therefore, the treatment consists of a relatively simple operation, which requires hospitalization for several days, and the prognosis is favorable. The length of your surgery will depend on a number of factors. Unless one testicle is lowered, it should be operated on no later than puberty, but usually between the ages of five and twelve. If both testicles are not descended, usually one is operated at infancy, and the other at the age of five to six years.

Defects of the urinary system

Congenital defects of the urinary system are quite common, and since obstruction in any area can have serious consequences for the entire system, and also because urine is the main way of eliminating waste from the body, the importance of this topic is obvious.

What do we mean by the urinary system? There are two kidneys, the ureters, the bladder, and the urethra (urethra). Urine is produced in the kidneys, or more precisely, in the nephrons of the kidneys, and accumulates in the cavities of the kidneys, 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 along the entire length of the penis.

It is not hard to imagine that obstruction of the urinary tract in any area will increase the load on other parts of the urinary system. Suppose, for example, that a blockage occurs between the bladder and urethra. The accumulating urine would stretch the bladder, the bladder would contract to get rid of urine, thickening its muscle wall, the ureters would have to work harder to push urine into an already overflowing bladder, urine would return from the bladder upwards 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 result in renal failure. A similar pattern would arise if the blockage was present in any other area.

How can a urinary obstruction be diagnosed?

Sometimes this can be detected by palpation: in the lateral part of the newborn's abdomen, you can feel a 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 dripping trickle and the complete impossibility of potty training - these are the signals that require attention. Too frequent urination, high fever, abdominal pain, nausea, vomiting, cloudy or bloody urine are all symptoms of a possible urinary tract infection.

There are many tests to determine if there is an obstruction and where it is located. Today, the urinary tract of the fetus can be easily seen on ultrasound examination of the abdominal cavity of the mother, and abnormalities are often found. Most of the abnormalities in question can be corrected with surgery in the first few years of life.

A source Sanders P. All About Pregnancy: Day by Day. - M .: Publishing house Eksmo, 2005.

Sometimes it happens that the pregnancy seemed to be proceeding well, and the birth went well, and the baby immediately screamed after birth, but suddenly on the second or third day of life, the doctor says that the child's condition worsened somewhat. The baby has become lethargic, pale, eats poorly, spits up, does not gain weight. A serious and incomprehensible diagnosis sounds: intrauterine infection... What is intrauterine infection, where does it come from and how to cope with it?

Intrauterine infections are those diseases that occur when a fetus is infected from an infected mother during pregnancy or during childbirth. Predisposing factors for the development of intrauterine infection are various chronic diseases of the mother, especially inflammatory processes of the kidneys and pelvic organs (cystitis, pyelonephritis, vaginitis, inflammation of the uterine appendages, etc.). Occupational hazards, stress, bad habits and unhealthy diet are also of great importance. The causative agents of intrauterine infection can be viruses (herpes, cytomegaly, influenza, rubella), bacteria (streptococci, E. coli, treponema pale, chlamydia), fungi (Candida) and protozoa (toxoplasma). When a pregnant woman first encounters an infection, the likelihood of infecting her baby increases dramatically.

The period at which infection occurs is crucial and determines the further course of pregnancy. At 3-12 weeks of pregnancy, intrauterine infection can lead to abortion or to the formation of fetal malformations. When infected at the 11-28th week of pregnancy, intrauterine growth retardation occurs, the child is born with a low body weight. Infection at a later date affects the already formed internal organs: the central nervous system is the most vulnerable, and the heart, liver, and lungs are also often affected. An intrauterine infection often leads to premature birth, which also affects the condition of the baby.

Also, intrauterine infection can occur during childbirth, for example, by ingestion of infected amniotic fluid, the contents of the birth canal and by contact (through the skin and mucous membranes). In this case, the baby will feel good at birth, and signs of infection - lethargy, pallor, decreased appetite, increased regurgitation, respiratory failure, etc. - may appear only after some time, but no later than on the third day of life.

The outcomes of intrauterine infection are different and again depend on the time when the infection occurred, and on the specific pathogen. If a child falls ill long before birth, then the entire infectious process takes place in utero, the child can be born healthy, but with low body weight. But long-term consequences are also possible (especially for viral infections): for example, disorders in the development of any organs, tissues; various cysts of the brain, etc. If contact with an infection occurred shortly before childbirth, then the child may be born with the course of the infectious process in the form of pneumonia, enterocolitis, meningitis, etc.

Diagnosis of intrauterine infections difficult due to the lack of specific clinical manifestations. That is, almost all intrauterine infections in a child manifest themselves in the same way: intrauterine growth retardation, enlarged liver and spleen, jaundice, rash, respiratory disorders, cardiovascular failure and neurological disorders. For diagnostics during pregnancy and after the birth of a baby, they use the determination of specific antibodies to a particular pathogen, the search for the pathogen itself in the blood, urine or cerebrospinal fluid of the child and / or mother. Also, many conventional examination methods, such as a complete blood count, urine analysis, biochemical blood test, ultrasound examination of the brain and internal organs, x-rays, help in making a diagnosis.

Treatment of intrauterine infections in newborns depends on the pathogen that caused the disease, and the manifestation of the disease. Usually, antibacterial, antiviral, immunostimulating, restorative drugs are prescribed.

The most effective is prevention of intrauterine infections... Even before the onset of pregnancy, it is worth being examined for some infections, since many of them can have a latent, sluggish course and appear only during pregnancy. If a woman has not had rubella, then when planning a pregnancy (at least 3 months in advance), it is advisable to get vaccinated against this infection, since infection with rubella in the early stages can lead to serious malformations in the child. In addition, it is advisable for the expectant mother to observe certain sanitary and hygienic rules: to exclude contact with sick relatives, to examine pets (cats for the presence of toxoplasmosis), and also to be examined and treated in a timely manner when carrying any infections. It is worth paying attention to nutrition: avoiding fast food, eating well-done meat and fish and not getting carried away with exotic cuisine - these simple measures are an excellent prevention of toxoplasmosis and listeriosis.

Intrauterine infections are infections that infect the fetus itself even before birth. According to the general data, about ten percent of newborns are born with congenital infections. And now this is a very urgent problem in pediatric practice, because such infections lead to the death of babies.

This kind of infection affects the fetus mainly in the prenatal period or during the birth itself. In most cases, the infection is transmitted to the child from the mother herself. This can occur through the amniotic fluid or by contact.

In more rare cases, the infection can get to the fetus with any diagnostic methods. For example, with amniocentesis, chorionic villus sampling, etc. Or when the fetus needs to inject blood products through the umbilical cord vessels, which include plasma, red blood cells, etc.

In the internatal period, infection largely depends on the state of the mother's birth canal. Most often these are various kinds of bacterial infections, which usually include group B streptococci, gonococci, enterobacteria, Pseudomonas aeruginosa, etc. Thus, the infection of the fetus in the womb occurs in several ways:

• transplacental, which includes viruses of different types. More often the fetus is affected in the first trimester and the pathogen enters it through the placenta, causing irreversible changes, malformations and deformities. If the virus is infected in the third trimester, then the newborn may show signs of an acute infection;
• ascending, which includes chlamydia, herpes, in which the infection passes from the genital tract of the mother to the baby. More often this happens during childbirth when the membranes are ruptured;
• descending, in which the infection reaches the fetus through the fallopian tubes. This happens with oophoritis or adnexitis.

The predominance of pathogens in the female body, which tend to provoke inflammatory processes in the genitals and other systems, is called intrauterine infection (IUI). The most negative of the disease is the possibility of infecting the future fetus in the female body. The factor of infection of the fetus is the blood that circulates through the body of a woman and a conceived child.

This is the most basic route of infection, but the likelihood of an infection in the body of a conceived child through the birth canal is not excluded. Mostly the disease is detected in women who lead an antihygienic lifestyle, but not in all cases. So, let's consider what types of infections are and how they enter the body of the embryo?

Intrauterine infectious diseases in newborns occur due to infection of the fetus with the 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 diagnosis of the mother (invasive prenatal diagnosis), the introduction of various blood products through the umbilical cord to the child and other routes.

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

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

Infection with the pathogen in the first fourteen weeks leads to stillbirth and the occurrence of severe malformations and disorders in the development of the child. Disease in the second and third trimesters causes individual organ damage or widespread infection.

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

Infection of infants with intestinal infections occurs mainly by the oral-fecal method, when bacterial pathogens from the feces fall on the hands and various household items. Considering that children are trying to suck everything that gets into their palms into their mouths, the penetration of bacteria or viruses is not such a rare occurrence.

Usually, the reason for the penetration of pathogenic microflora into the child's body is the banal neglect by parents of the rules of personal hygiene when caring for a baby. For example, an unclean bottle or unwashed hands after the street, etc., can act as the cause of infection.

Also, infection occurs through the mother's body, if she is a carrier or has become infected with intestinal infections in the process of carrying a child.

The very fact of infection can occur even in the mother's womb, when the fetus swallows amniotic fluid or through the common circulatory system between the mother and the baby, or the baby becomes infected when it passes through the birth canal.

It is possible to detect intrauterine infection even during childbirth. Clear signs of infection can be:

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

In the future, you can diagnose other manifestations of the disease:

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

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

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

The chronic form leads to strabismus, microcephaly, optic atrophy and iridocyclitis. Cases of monosymptomatic and latent forms of the disease occur much less frequently. Late complications lead to blindness, epilepsy, and 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 of the disease in the fetus is 80% and the consequences have a high degree of risk - up to spontaneous miscarriage. Getting sick in the second trimester will reduce the risk by up to 20%, and in the third trimester by up to 8%.

A baby with rubella is often born with a low birth weight or premature birth. The typical clinical presentation includes congenital heart disease, auditory nerve and ocular 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

The defeat of the causative agents 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:

• cataracts;
• retinopathy;
• microphthalmia;
• microgyria;
• microcephaly and other serious diseases.

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

This disease occurs in three forms - broad, mucocutaneous and neurological. The wide 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.

It is shortness of breath and varying degrees of impaired blood circulation in the child, and manifests itself immediately after childbirth, leading to oxygen deficiency.

Asphyxia is distinguished between congenital and acquired.

• Congenital occurs due to impaired placental circulation, gestosis, umbilical cord entanglement of the fetus... A child is born with a slow heartbeat, weak muscle tone, bluish skin color.
• Acquired asphyxia is the result of difficult childbirth, entanglement with the umbilical cord, spasm of the muscles of the birth canal of a woman in labor.

Almost every fifth baby is born with this diagnosis, and most of them cope with this problem themselves. There are times when you cannot do without resuscitation procedures. In any case, the doctors of the maternity hospital do everything possible for the child so that he does not have neurological problems in the future.

It is anemia, in which red blood cells are destroyed in the body of a newborn.

This is a serious illness, which leads to the incompatibility of the blood of the fetus and the mother. If the mother has a negative Rh factor, and the unborn child has a positive one, then there is a possibility of a Rh conflict, since antibodies can form in the mother's body that can destroy red blood cells in the fetal blood.

• hereditary factor;
• difficult pregnancy;
• birth trauma;
• Rh-conflict between the mother and the unborn child;
• toxicosis and gestosis during pregnancy;
• lack of vitamins and minerals during pregnancy, improper nutrition of the expectant mother;
• non-observance of the rules of personal hygiene and hygiene of the baby;
• infection with staphylococcal and streptococcal infections in the maternity ward.

Frequent causative agents of intrauterine transplacental infection

In children, most often intestinal infections are of a bacterial or viral nature.

The most common such infections are considered to be rotavirus, better known among the population as intestinal flu, shigellosis or dysentery. Also, the causative agents of pathology can be salmonella, escherichia, yersinia, staphylococcus, etc.

Often in infants, opportunistic pathogens that belong to the normal flora, but under some circumstances provoke infectious lesions, act as causative agents of AEI.

Such circumstances include the immaturity of the immune defense, the use of antibacterial drugs, etc.

Most viruses and bacteria known to man are capable of penetrating the fetus and causing various damage to it. But some of them are especially infectious or pose an increased danger to the child. Some of the viruses (almost all that cause ARVI) are not transmitted to the baby, but are dangerous only with a strong increase in the temperature of the pregnant woman.

Diagnostics

The method of detecting specialized markers using widespread ultrasound is often used. This method allows you to determine low and polyhydramnios, opacity of amniotic fluid, developmental disorders and damage to the placenta, various fetal pathologies and disorders in the development 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 widespread. Molecular biological research method based on DNA, serological and histological analyzes are used.

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

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

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 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. The restoration of the body consists in getting rid of the residual symptoms of intrauterine infections.

Symptoms of intrauterine infection in a newborn and during pregnancy

In a pregnant state, it is not easy to detect an infection in the fetus, so doctors do their best to do this. It is not in vain that a pregnant woman has to take so many different tests several times a month.

The presence of intrauterine infection can be determined by tests. Even a stand-up smear taken on a chair can show some picture of the presence of infections, however, they do not always lead to intrauterine infection of the fetus.

When an intrauterine infection affects a baby shortly before delivery, it can manifest itself in diseases such as pneumonia, meningitis, enterocolitis, or another disease.

The signs described above may not appear immediately after birth, but only on the third day from the moment of birth, and only if the infection affects the child while moving along the birth canal, doctors can notice its manifestation almost immediately.

Mommy should sound the alarm already at the very first signs of infection of the crumbs. These include:

• Sharp hyperthermic reaction. In infants, it is almost impossible to miss this moment, because as a result of the rise in temperature, their face turns red, and their eyes begin to shine feverishly.
• Another characteristic manifestation of intestinal infection in infants is the occurrence of repeated vomiting. The kid can completely refuse to eat, spit out and bite the breast, be capricious, because everything that he eats is immediately outside.
• Intestinal activity is disturbed, which is accompanied by severe painful sensations, which force the baby to cry, twist its legs and press the knees to the tummy.
• The feces also change. If it is normally yellow and mushy, then with intestinal infections it becomes liquid and green interspersed with mucus or blood, pus, etc.

When these symptoms appear, it is necessary to urgently consult a doctor, while the disease has not yet become complicated and has not spread throughout the body.

With the intrauterine penetration of infectious agents, miscarriages, pregnancy fading, antenatal fetal death and stillbirth often occur. Surviving fetuses may experience the following symptoms:

• Intrauterine growth retardation
• Micro- and hydrocephalus
• Chorioretinitis, cataract (eye damage)
• Myocarditis
• Pneumonia
• Jaundice and liver enlargement
• Anemia
• Edema of the fetus (edema)
• Skin rash
• Fever

Prophylaxis

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

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

In general, pathology with timely diagnosis and treatment has quite favorable prognostic data, especially when pathology is detected at its early stages.

The symptomatic picture of intestinal infections with further development only gets worse, so you must immediately take preventive measures, which include breastfeeding the baby and strengthening his immunity, high-quality thermal processing of products.

Prevention of intestinal infections requires parents to closely monitor their child's water intake and thoroughly rinsing fruits and vegetables.

Acute intestinal inflammation in children is widespread, because the immune defense has not yet formed, and the digestive system itself is characterized by some features. The disease has a rather complex course in children, so it needs to be treated.

Intestinal infections, or abbreviated AEI among babies, occupy the "honorable" second place after ARVI, and often cause hospitalization of young children in the hospital, and in infancy can cause death with the addition of formidable complications (dehydration, infectious toxic shock, convulsions, coma).

Table of contents: What is meant by OCI? What pathogens are responsible for the development of OCI? Features of the digestion of babies, contributing to AEI The role of microflora in the genesis of AEI How infants become infected with intestinal infections Manifestations of intestinal infection in infants Features of lesions in different parts of the digestive tract What are special features of AEI in infants

What is meant by OCI?

Under the term OCI (acute intestinal infection), doctors mean a whole group of pathologies of infectious origin, which have different causes, but a single mechanism of infection ("diseases of dirty hands") and are manifested by similar clinical symptoms - diarrhea, vomiting, abdominal pain, malaise, fever.

These diseases in infancy are difficult, have every chance of a complicated course, which threatens hospitalization and intensive care.

Both in our country and throughout the world, the incidence of AEI is extremely high, and up to two years of age, it is these diseases and their complications that are one of the leading causes of death of babies, especially in the first year of life. Often, AEI have the form of epidemic outbreaks - that is, whole families or organized groups, departments of hospitals and even maternity hospitals get sick at once.

What pathogens are responsible for the development of OCI?

Based on the reason, all acute intestinal infections can be divided into several groups. So, there are:

note

Often, at an early age, the exact cause of AEI cannot be identified due to the early initiation of treatment and suppression of pathogenic flora at the expense of drugs at the time of the culture collection and its result. Sometimes a whole group of microbes is sown, and it is impossible to pinpoint the exact cause. Then the clinical diagnosis of OCINE is made, that is, it is OCI of unknown or unexplained etiology.

The difference in diagnosis practically does not affect clinical manifestations and methods of treatment, but it is important for epidemiological monitoring and measures to prevent the spread of infection (current and final disinfection in the outbreak).

Features of the digestion of babies, contributing to OCI

In childhood, especially up to three years of age, the digestive system has a special structure and functional activity, as well as specific immune responses, which is a contributing factor for the development of AEI. Infants are most sensitive to these diseases.

With AEI in children, various parts of the digestive tube can be affected, starting with the stomach (the esophagus and oral cavity are not involved in the process), ending with the rectum. Once in the oral cavity, food is processed with saliva, which contains lysozyme, which has a bactericidal effect. In infants, it is small and it is of weak activity, and therefore food is less disinfected.

The intestinal mucosa has a mass of villi, which are actively involved in digestion. In young children, they are very delicate and vulnerable, pathogenic objects easily damage them, which leads to edema and secretion of fluid into the intestinal lumen - which immediately forms diarrhea.

The walls of the intestine release a protective (secretory) immunoglobulin - IgA, up to three years of its activity is low, which also creates a predisposition to AEI.

Add to this a general decrease in immune defenses due to immaturity and early age.

note

If the child is artificial, another negative factor acts, the absence of breast milk immunoglobulins and protective antibodies, which will break the baby in the fight against pathogenic agents.

The role of microflora in the genesis of OCI

At birth, the digestive tract of infants is inhabited by microbes that form a specific intestinal microflora, which plays an important role in immunity, vitamin synthesis, digestion and even the metabolism of minerals, food breakdown. Microbial flora (creating a certain level of activity, pH and osmolarity of the medium) also, due to its activity, suppresses the growth and reproduction of pathogenic and opportunistic agents entering the intestine.

A stable balance of microbes helps the baby to defend against AEI, therefore the state of the microbial flora is extremely important at an early age, and the state of dysbiosis is a predisposing factor for the formation of AEI.

If we talk about all microbes, they can be divided into groups:

• Obligate (residing in the intestines), it also belongs to the useful flora. Its main representatives are bifido and lactoflora, Escherichia coli and some others. They account for up to 98% of the volume of all intestinal microbes. Its main functions are to suppress incoming pathogenic microbes and viruses, help digestion, and stimulate immunity.
• optional flora(it is also transient and opportunistic). This group of microbes, the presence of which in the intestine is permissible, but not necessary, in a small volume, they are quite acceptable and do not harm. Under special conditions, a group of opportunistic microbes can lead to the development of AEI (if immunity is reduced, intestinal dysbiosis is expressed, potent drugs were taken).
• pathogenic flora (atypical) getting into the intestinal lumen, it leads to intestinal infections, and therefore is dangerous for children.

For infants, it is the pathogenic flora that is most dangerous, and with a decrease in immunity, pronounced dysbiosis and some special conditions, it can become dangerous and even its opportunistic representatives give OCI.

How babies become infected with intestinal infections

The most common source of infection for infants is adults who have acute intestinal infections or who are carriers of pathogenic objects. The incubation period for OCI is usually short, with the exception of some pathogens, and lasts from several hours to several days (usually 1-2 days). For viral infections, infectiousness can last throughout the entire period of clinical symptoms and even up to two weeks after the disappearance of all symptoms. In addition, food and water can be sources of AEI pathogens for infants if they are infected with viruses or microbes of a dangerous group.

note

The causative agents of OCI enter the body through the mouth - from dirty pens, with food or water, and for some infections, airborne droplets are also relevant (as in ARVI). Household appliances, dishes and things that are contaminated with pathogenic viruses and microbes can also be sources of infection. Bathing water taken from open bodies of water that gets into the mouth can become dangerous, as well as the lack of personal hygiene by parents, especially if they themselves are sick or carriers of infection.

It is infants who are most susceptible to AEI, although people of any age can get sick with them. For children, the course is typically more severe, with a rapid onset of dehydration and negative consequences in the form of seizures, dehydration, or other complications. For infants, there are certain risk factors that form a more severe course of AEI:

• Formula feeding from birth
• Prematurity or immaturity babies
• Introduction of complementary foods that are unsuitable for age and improperly prepared, contaminated with pathogens
• Summer period when the activity of dangerous pathogens is higher (for microbes)
• Cold season (for viruses)
• Immunodeficiency states of congenital or acquired origin
• Damage to the nervous system of traumatic or hypoxic genesis.

It is important to understand that immunity to these infections is extremely unstable, and babies can, after having been ill with one OCI, subsequently become infected with other types of it, if precautions are not taken.

• Vaccination of children and adult women before planning pregnancy
• Respect for women's health
  • limiting contact with children, especially in educational institutions
  • restricting visits to crowded places
  • careful contact with pets, avoiding cleaning the litter box
  • food with thermally processed foods, excluding soft cheeses and semi-finished products
  • an adequate way to protect against infection during sexual intercourse
• Determination of the level of immunoglobulins for major intrauterine infections TORCH before planning pregnancy

What kind of examination can the doctor prescribe?

Infections of intestinal localization for infants are often the cause of death, therefore, timely detection of the pathology and its etiology is very important. The doctor examines the child and prescribes additional studies aimed at determining the causative agent of the pathology.

A scatology of feces is carried out, which makes it possible to identify a specific pathogen and detect abnormalities in the structure of the gastrointestinal tract. Also, bacterial culture, biochemistry and general studies of blood and feces, urine are carried out. If necessary, ultrasound diagnostics, etc.

Treatment and monitoring for intrauterine infection

I must say that not all intrauterine infections can be treated with treatment. Sometimes it is impossible to cure them. For such a therapy, first of all, it is necessary to establish the condition of the mother and child, and only then to prescribe the appropriate treatment. Treatment with antibiotics is indicated only in especially dangerous cases.

In some cases, vaccinations are given during pregnancy. For example, a herpes vaccine may be given. In addition, the duration of pregnancy also affects the methods of treatment.

And, it should be noted that the best that an expectant mother can do is to prevent the development of intrauterine infection, which will help to avoid further problems and pathologies. Therefore, it is best to observe preventive measures in relation to this. Preventive measures include, first of all, pregnancy planning.

At the planning stage, a woman can pass all the necessary tests, check her health and eliminate problems, if any. When planning to undergo an examination, both partners need to be examined, and if any diseases are detected in a man, he also needs to undergo the necessary treatment.

In addition, already during pregnancy, a woman needs to carefully monitor her hygiene, wash hands, vegetables and fruits, and also need hygiene in a relationship with a sexual partner.

Proper nutrition strengthens the body's defenses and has a beneficial effect on a woman's health, which means it is also a good prevention against all kinds of infectious diseases.

During pregnancy, a woman should especially carefully monitor her health, take the necessary tests and be examined in a timely manner. And even if the doctor talks about a possible infection of the fetus, do not panic ahead of time. Timely diagnosis and modern medicine in most cases have a positive effect on the health of the expectant mother and the health of the newborn. And even with intrauterine infections, absolutely healthy babies are born.

Therapy of intestinal infections in infants who are breastfed is much faster and easier than in artificial ones. After all, breast milk strengthens the immune defense and increases the body's resistance to pathogenic microorganisms.

The primary task is to cleanse the intestinal structures from pathogenic pathogens, which helps to stop the toxic effect and prevent dehydration. It is necessary to treat such small children under strict medical supervision, then the microclimate in the intestine will quickly return to normal.

It is important to exclude food for 12-18 hours, during which it is allowed to give the baby some water or weak tea.

The use of sorbent agents (Enterosgel, Smecta) is shown, which help to quickly remove all toxic substances from the structures of the gastrointestinal tract and contribute to the rapid restoration of water-electrolyte balance.

If the baby often vomits, then you need to rinse the stomach cavity. If the baby is still vomiting, then you need to provide drip-infusion nutrition for the child. If the infection has a severe bacterial form, then antibiotic treatment with a wide area of ​​influence is indicated.

As medical practice shows, in the human body there are always microorganisms that are the causative agents of all kinds of diseases. And if a man, having become infected with them, is responsible only for himself, then it is more difficult with a representative of the fair sex. In addition, if she is in an interesting position at the time of infection.

From what pathogen is the cause of the infection of the mother's body, such will be the baby's disease. According to doctors, the disease is caused by:

• Herpes, rubella, influenza viruses, cytomegaly;
• Bacteria - streptococci, colibacillus, treponema pale, chlamydia;
• Protozoa (Toxoplasma);
• Mushrooms.

The presence of the following factors in the expectant mother will increase the risk of infection of the newborn:

1. A woman's health is undermined by various chronic ailments;
2. The female body is influenced by many negative factors such as busting with smoking and alcohol and employment in hazardous industries;
3. Constant stress throughout pregnancy;
4. Mom suffers from chronic ailments of the genitourinary system.

T - toxoplasmosis;

O - others. By this we mean almost all ailments of an infectious nature;

R is rubella. In Latin rubella;

C - neonatal cytomegalovirus infection;

H - herpes.

From how long the infection occurred, the degree of influence of the infection on the further development of the baby will appear;

• Up to twelve weeks - infection at such an early stage often leads to the fact that spontaneous interruption occurs, or later the development of a small one will take place with large defects;
• Infection occurred between 12 and 28 weeks - usually at this time, infection will lead to developmental delay. The consequence of this will be that the newborn is born underweight;
• Infection after 28 weeks is dangerous in that it has a negative effect on the well-formed organs of the child. First of all, the brain, heart, liver and lungs are hit. That is, all the vital organs.

If infection is detected during pregnancy, this is not a reason to give up. The disease is perfectly treated with antibiotics. Here representatives of the penicillin group prevail. Indeed, despite their venerable "age" among antibiotics, they are still one of the most effective drugs in the treatment of viral infections. Moreover, they are practically safe for the health of the baby.

Simultaneously with them, antimicrobial drugs are actively used. Their use often saves the life of the child, and also reduces the negative consequences.

With a viral lesion, treatment is a rather difficult process, but if you start it in a timely manner, then the consequences can be prevented. But if they have already formed, then antiviral drugs are useless. In this case, operational methods often come to the rescue. In cases of cataracts or congenital heart disease, the child will have a chance to live the rest of his life on his own, with a minimum of outside help. It is not uncommon for these children to need hearing aids many years later.

As mentioned above, acute herpes with rashes on the labia of the mother is definitely an indication for a cesarean section. In other cases, nothing prevents natural childbirth.

Intestinal infection in infants is a common occurrence. Most of the causative agents of the disease enter the child's mouth through dirty hands and toys.

These microorganisms take part in the processing of food and form the baby's feces. Normally, the stool of a breastfed baby is more than 4 times a day. Feeding a child with artificial nutrition is less beneficial: stools are noted no more than 2 times, and problems with constipation often occur.

But not only beneficial microorganisms inhabit the children's intestines: pathogenic bacteria enter it along with the mother's dirty hands, unwashed pacifiers and toys. Intestinal infections in infants have a favorable prognosis only in the case of early diagnosis of pathology and on time of treatment started.

If the infection is started, the disease can cause dehydration and serious intoxication of the child's body. Signs of an intestinal infection in infants are repeated vomiting and diarrhea, which occur already in the first hours after the onset of the disease.

For an infant, this is dangerous due to severe dehydration, disruption of the urinary system, the development of pathological conditions on the part of the respiratory, cardiovascular and nervous systems. In extreme cases, in the absence of adequate treatment, an intestinal infection in an infant can lead to the death of the child.

How does the infection take place?

The route of infection is oral. Pathogens initially enter the child's mouth and then spread through the gastrointestinal tract.

You can get infected in several ways:

1. With direct contact with a sick person.
2. Through dirty objects in the child's mouth.
3. Through food. Disease-causing viruses and bacteria are found in spoiled or low-quality foods.
4. Poor quality water.

The first signs of infection

The first symptoms of an intestinal infection in infants, which should alert a young mother:

1. Sudden rise in temperature. It is impossible to miss this moment, since even in the absence of a thermometer, the fever in an infant is clearly visible due to a change in the color of the skin and an increase in their temperature to the touch.
2. The second symptom of intestinal infection in infants is repeated vomiting. In this case, the child can completely refuse food, since everything eaten immediately leaves the stomach in the opposite direction.
3. Change in color and consistency of feces. Normally, an infant's stool looks like a yellow, mushy mass. If the stool becomes greenish and very liquid, and even mixed with mucus, you need to sound the alarm.
4. Disruption of the intestines and the pain associated with this is expressed in the external discomfort of the baby. He cries pitifully, bends his knees to his stomach, shudders, as if asking for help.

How do you deal with an infection?

Treatment of intestinal infection in infants is aimed at destroying the pathogenic microflora. The complex course includes antibiotics, adsorbents, as well as drugs that eliminate dehydration and intoxication of the body.

Frequent pathogens of intrauterine infection

Statistics show that this list includes the following infections in descending order:

• Toxoplasmosis;
• Cytomegalovirus;
• Staphylococcal infection.

Cytomegalovirus in newborns

Specialists, in turn, divide staphylococcal infection into two types:

• Purulent-inflammatory processes with a local character;
• Generalized infection or sepsis.

The most dangerous for a child is Staphylococcus aureus. The fact that its pathogen is present in the child's body can be recognized by the pustules on the skin. This also includes purulent inflammation of the umbilical wound. The consequences of staphylococcal infection are quite severe, up to toxicological shock.

One of the decisive factors in this sense is the health of the mother during pregnancy and the successful outcome of childbirth. If parents, after being discharged from the hospital, notice unusual behavior of the child or uncharacteristic changes in appearance, you should immediately consult a doctor.

When is hospitalization indicated?

Doctors warn that if you have some symptoms, you need to urgently call an ambulance:

1. If small blood clots are found in the vomit of the crumbs;
2. If the baby cannot drink, he vomits constantly, after each sip of plain water;
3. If the baby has not asked to go to the toilet for the last 5-6 hours, and his skin is dry;
4. If hyperthermic reactions suddenly appear, which are difficult to stop;
5. If there are allergic rashes on the body or the child complains of severe headaches.

When such dangerous symptoms appear, the baby needs to be urgently taken to the hospital.

Risk groups for diseases dangerous to the fetus

Children's doctors have long compiled a list of those who are in the so-called risk group. In the same list, in addition to living persons, doctors also included subjective reasons. Here's a list:

• Mommies with children born earlier. Pupils of schools and pupils of preschool institutions;
• Kindergarten and school workers;
• Health workers who work directly with children;
• Pregnant women who have inflammatory diseases with a chronic course of the disease;
• Those women who have had multiple abortions for medical reasons;
• Women who have already had infected children;
• Those women who in the past had children or pregnancy with fetal malformation and fetal death in utero;
• The amniotic fluid departed long before childbirth.

A pregnant woman should consult a doctor as soon as she feels the following symptoms:

1. A sharp rise in temperature;
2. The lymph nodes are swollen and painful to the touch;
3. The skin is suddenly covered with a rash;
4. There was a cough, shortness of breath;
5. Snotty, lacrimation;
6. Joints are swollen and sore on movement.

It is not necessary that all these signs are dangerous for the little one. But they are mandatory for contacting doctors. It is better to play it safe than to be treated for a long and difficult time.

There are three main modes of transmission of intrauterine infection during pregnancy:

• Transplacental (hematogenous) - viruses (CMV, herpes, etc.), syphilis, toxoplasmosis, listeriosis

The pathogen enters from the mother's blood through the placenta. If this occurs in the 1st trimester, then malformations and deformities often occur. If the fetus becomes infected in the 3rd trimester, then the newborn will show signs of an acute infection. Direct entry of the pathogen into the baby's blood leads to generalized damage.

• Ascending - mycoplasma, chlamydia, herpes

The infection originates from the genital tract of the mother to the child. This usually occurs after the rupture of the membranes, at the time of childbirth, but sometimes it happens during pregnancy. The main cause of intrauterine infection is its ingress into the amniotic fluid, and as a result - damage to the skin, respiratory and digestive tract of the fetus.

The infection descends to the fetus through the fallopian tubes (with adnexitis, oophoritis).

Infection of a baby even before birth can be dangerous at any stage of pregnancy. But some infections pose a great threat to life and health in the first trimester (rubella virus, for example), and some diseases are terrible if they become infected a couple of days before giving birth (chickenpox).

Early infection is more likely to result in miscarriages and severe malformations. Late infection is usually associated with a rapidly developing infectious disease in the newborn. More specific risks and the degree of danger are determined by the attending physician based on the results of tests, ultrasound, gestational age and the characteristics of a specific infection.

• Women with older children attending school and preschool
• Kindergarten, nursery, school workers
• Medical workers
• Pregnant women with chronic inflammatory diseases
• Indication of multiple medical abortions
• Women with the birth of infected children in the past
• Past malformations and antenatal fetal death
• Untimely discharge of amniotic fluid

Preventive measures

It has long been known that any ailment is best prevented than treated later. TORCH infections are no exception. Preventive measures are divided into two types: preconception and pregnancy.

Measures before

First of all, this is the delivery of all tests for the presence of immunity to diseases included in the list of intrauterine ones. If the analyzes show that there is such an indicator as IqG in the titers, then this will indicate that the woman's body has the necessary antibodies. If this is not available, then this means only one thing - the woman's body is open to infection.

Therefore, if pregnancy is planned, then she must first be vaccinated against rubella. In order to avoid toxoplasmosis, you can temporarily remove all animals from the house before delivery and be examined with a partner for herpes and cytomegalovirus infection. If the IqG index is very high, then this indicates that there is an acute infection in the female body. And before you schedule the birth of a baby, you need to be completely treated.

But if in the analyzes of a pregnant woman there is a titer of IqG, then here it clearly indicates an infection of the female body. In theory, this means: the unborn baby is also in danger. And in order to exclude this, the expectant mother needs to pass some additional tests, according to which it is possible to determine the condition of the fetus and work out their actions further.

And keep track of your contacts.

Important facts about IUI

• Up to 10% of all pregnancies are associated with mother-to-fetus transmission
• 0.5% of babies born have some kind of symptoms of infection
• Infection of the mother does not necessarily lead to infection of the fetus.
• Many infections dangerous to the fetus are mild or asymptomatic in the mother.
• Fetal infection is more likely to occur with a first-onset infection in the mother.
• Timely treatment of a pregnant woman can reduce or eliminate the risks to the fetus.

How does the fetus get infected?

A newborn can become infected in several ways - this is through the circulatory system, connecting the mother with him or by passing through the birth canal.

How the wui gets to the fetus depends on what is its causative agent. If a pregnant woman becomes infected with a genital infection from a partner, the virus can enter the baby through the vagina and fallopian tubes. In addition, the fetus can become infected through the woman's circulatory system or through the amniotic fluid. This is possible when infected with diseases such as rubella, endometritis, placentitis.

These infections can be spread both from the sexual partner and through contact with a sick person, and even through the consumption of raw water or poorly processed food.

Danger of IUI during pregnancy.

If a woman has previously met with the causative agent of the infection, then she has developed immunity to a number of them. If it re-meets the pathogen IUI, then the immune system does not allow the disease to develop. But if a pregnant woman meets the causative agent of the disease for the first time, then not only the body of the mother and of the unborn baby may be affected.

The effect of the disease on the body and its degree depends on how long the woman is. When a pregnant woman becomes ill for up to twelve weeks, it can lead to miscarriage or fetal malformations.

If the fetus is infected between the twelfth and twenty-eighth weeks, then it can cause intrauterine growth retardation, as a result of which the newborn is low in weight.

At a later stage of infection of the child, the disease can affect his already developed organs and affect them. Pathologies can affect the baby's most vulnerable organ - the brain, which continues to develop in the mother's stomach until birth. Other mature organs such as the heart, lungs, liver, etc. can also be affected.

It follows from this that the expectant mother needs to carefully prepare for pregnancy, undergo all the necessary examinations and cure the existing hidden diseases. And in relation to some of them, preventive measures can be taken. For example, get vaccinated. Well, carefully monitor your health so that the baby is born strong.

Consequences of intrauterine infection for a child

Congenital infection can develop in 2 scenarios: acute and chronic. Acute infection is dangerous with severe sepsis, pneumonia and shock. Signs of ill health in such babies are visible almost from birth, they eat poorly, sleep a lot, and become less and less active. But often the disease received in the womb is sluggish or has no obvious symptoms. Such children are also at risk for long-term consequences: hearing and vision impairments, mental and motor developmental delays.

Developing in the mother's belly, the baby is relatively safe. In relative terms, since even in such sterile conditions there is a risk of developing an infectious disease. This large group of diseases is called intrauterine infections. During pregnancy, a woman should especially carefully monitor her health. A sick mother can infect her child during intrauterine development or during childbirth. We will discuss the signs and methods of diagnosing such diseases in the article.

The danger of intrauterine infections is that they unceremoniously interfere in the formation of a new life, which is why babies are born weak and sick - with mental and physical defects. Such infections can cause the greatest harm to the fetus in the first 3 months of its existence.

Intrauterine infection during pregnancy: what the statistics say

1. A timely diagnosed and treated infectious disease in a pregnant woman poses minimal danger to her child.
2. The causative agents of infection pass from mother to baby in 10 cases of pregnancy out of 100.
3. 0.5% of infants infected in utero are born with the corresponding signs of the disease.
4. An infection that has settled in the maternal body does not necessarily pass to the fetus, and the baby has a chance to be born healthy.
5. A number of infectious diseases that do not promise anything good to the baby can be present in the mother in a latent form and practically do not affect her well-being in any way.
6. If a pregnant woman falls ill with this or that infectious disease for the first time, it is highly likely that the child will also be infected from her.

Intrauterine infection - ways of infection of the embryo

There are four ways in which infectious agents can enter tiny growing organisms:

• hematogenous (transplacental) - from the mother, harmful microorganisms penetrate the fetus through the placenta. This route of infection is typical for viruses and toxoplasma;
• ascending - infection occurs when the causative agent of infection through the genital tract rises to the uterus and, having penetrated into its cavity, affects the embryo. So the baby may develop a chlamydial infection and enterococci;
• descending - the focus of infection is the fallopian tubes (with adnexitis or oophoritis). From there, the causative agents of the disease penetrate into the uterine cavity, where they infect the child;
• contact - the baby becomes infected during childbirth, when he moves along the birth canal of a sick mother. Pathogens enter the child's body after he has swallowed infected amniotic fluid.

Intrauterine infection at different stages of pregnancy: consequences for the child

The outcome of an infectious infection of the fetus depends on at what stage of intrauterine development it was attacked by dangerous microorganisms:

• gestation period 3 - 12 weeks: spontaneous termination of pregnancy or the appearance of various developmental anomalies in the fetus;
• gestation period 11 - 28 weeks: the fetus is noticeably behind in intrauterine development, the child is born with insufficient body weight and various malformations (for example, congenital heart disease);
• gestational age after 30 weeks: developmental anomalies affect the organs of the fetus, which by this time have already formed. The greatest danger of infection is for the central nervous system, heart, liver, lungs and organs of vision.

In addition, congenital infection is acute and chronic. The following consequences indicate an acute infection of a child at birth:

• shock state;
• pneumonia;
• sepsis (blood poisoning).

Some time after childbirth, an acute intrauterine infection in newborns can manifest itself with the following signs:

• exceeding the norm of daily sleep duration;
• poor appetite;
• insufficient physical activity, which decreases every day.

If the congenital infection is chronic, the clinical picture may be absent altogether. Distant signs of intrauterine infection are considered:

• complete or partial deafness;
• deviations in mental health;
• pathology of vision;
• lagging behind peers in motor development.

The penetration of infection to the fetus through the uterus leads to the following consequences:

• the birth of a dead baby;
• intrauterine embryo death;
• frozen pregnancy;
• spontaneous abortion.

Children who survived after such infection have the following pathological consequences:

• heat;
• rash and erosive skin lesions;
• non-immune dropsy of the fetus;
• anemia;
• an enlarged liver with jaundice;
• pneumonia;
• pathology of the heart muscle;
• pathology of the eye lens;
• microcephalus and hydrocephalus.

Intrauterine infection: who is at risk

Every expectant mother is at risk of being captured by the pathogen, because during pregnancy the defenses of her body are depleted to the limit. But the biggest danger lies in wait for women who:

• already have one or more children attending kindergarten, school;
• are related to the field of medicine and are in direct contact with people who may be potential carriers of infection;
• work in a kindergarten, school and other children's institutions;
• have had 2 or more medical abortions in the past;
• have inflammatory diseases in a sluggish form;
• faced with untimely outpouring of amniotic fluid;
• have had a pregnancy with abnormal development of the embryo or intrauterine fetal death in the past;
• have already given birth in the past to a baby with signs of infection.

Symptoms of intrauterine infection in a woman during pregnancy

Doctors identify several universal signs by which it can be assumed that the expectant mother has contracted an infectious disease:

• a sharp rise in temperature, fever;
• shortness of breath when walking or climbing stairs;
• cough;
• rash on the body;
• enlarged lymph nodes that are painful to touch;
• Sore joints that look swollen
• conjunctivitis, lacrimation;
• nasal congestion;
• painful sensations in the chest.

Such a set of indications may also indicate the development of allergies in a pregnant woman. In this case, there is no threat of infectious infection of the fetus. Be that as it may, the expectant mother should go to the hospital as soon as at least one of these symptoms appears.

The reasons for the development of intrauterine infection during pregnancy

The activity of ubiquitous pathogens is the main cause of morbidity among women who are preparing to become mothers. Many bacteria and viruses, entering the mother's body, are transmitted to the child, provoking the development of serious anomalies. Viruses that are responsible for the development of acute respiratory viral diseases do not pose a danger to the fetus. The threat to the condition of the child appears if only the pregnant woman has a high body temperature.

One way or another, but intrauterine infection of a baby comes exclusively from a sick mother. There are several main factors that can contribute to the development of infectious pathology in the fetus:

1. Acute and chronic diseases of the mother in the genitourinary system. Among them are such inflammatory pathologies as ectopia of the cervix, urethritis, cystitis, pyelonephritis.
2. The mother has an immunodeficiency state or HIV infection.
3. An organ and tissue transplant that a woman has undergone in the past.

Intrauterine infections: main characteristics and routes of infection

Cytomegalovirus (CMV)

The causative agent of the disease is a representative of herpes viruses. You can get an ailment through sexual and close household contact, through blood (for example, through a transfusion from an infected donor).

With the initial infection of a woman in position, the microorganism enters the placenta and infects the fetus. In some cases, no abnormal consequences are observed in the baby after infection. But at the same time, statistics say: 10 out of 100 babies whose mothers encountered an infection during pregnancy have pronounced signs of intrauterine infection.

The consequences of such an intrauterine infection during pregnancy are as follows:

• spontaneous abortion;
• the birth of a dead baby;
• hearing loss of neurosensory origin;
• being underweight at birth;
• hydro- and microcephaly;
• pneumonia;
• lag in the development of psychomotor skills;
• pathological enlargement of the liver and spleen;
• blindness of varying severity.

Cytomegalovirus under a microscope

If the infectious lesion has a general combined character, more than half of the babies die within 2 to 3 months after birth. In addition, the development of such consequences as mental retardation, hearing loss and blindness is likely. With a slight local lesion, the consequences are not so fatal.

Unfortunately, there are still no medications that could eliminate the symptoms of CMV in newborns. If a woman in a position has been diagnosed with cytomegalovirus infection, the pregnancy is left as the child has a chance to stay healthy. The expectant mother will be prescribed an appropriate course of treatment in order to mitigate the effect of the disease on her body as much as possible.

Intrauterine infection - herpes simplex virus (HSV)

A newborn baby is diagnosed with a congenital herpes infection if his mother is diagnosed with herpes simplex virus type 2, which in most cases is infected during unprotected sexual intercourse. Symptoms of the disease will appear in a child almost immediately, during the first month of life. Infection of a baby occurs mainly during childbirth, when it moves along the birth canal of an infected mother. In some cases, the virus enters the fetus through the placenta.

If the child's body is affected by herpes infection, the consequences are severe:

• pneumonia;
• violation of visual function;
• brain damage;
• skin rash;
• heat;
• poor blood clotting;
• jaundice;
• apathy, lack of appetite;
• stillbirth.

Severe infections result in oligophrenia, cerebral palsy and a vegetative state.

Herpes simplex virus under a microscope

Intrauterine infection - rubella

This disease is rightfully considered one of the most dangerous for the life of the embryo. The route of transmission of the rubella virus is airborne, and infection is possible even at a great distance. The disease, which poses a particularly great threat before the 16th week of pregnancy, "programs" various deformities in the development of the baby:

• underweight at birth;
• spontaneous abortion, intrauterine death;
• microcephaly;
• congenital anomalies in the development of the heart muscle;
• hearing loss;
• cataract;
• various skin diseases;
• pneumonia;
• unnatural enlargement of the liver and spleen;
• meningitis, encephalitis.

Intrauterine infection - parvovirus B19

The presence of this virus in the body provokes the development of a disease known as infectious erythema. In adults, the disease does not manifest itself in any way, since it proceeds latently. However, the consequences of the pathology for the fetus are more than serious: the child may die before birth, and there is also a threat of spontaneous abortion and intrauterine infection. On average, infected children die in 10 cases out of 100. At 13 - 28 weeks of gestation, the fetus is especially vulnerable to this infection.

When infected with parvovirus B19, the following consequences are noted:

• swelling;
• anemia;
• brain damage;
• hepatitis;
• inflammation of the myocardium;
• peritonitis.

Intrauterine infection - chickenpox

When the expectant mother is infected with chickenpox, the infection also affects the child in 25 cases out of 100, but the symptoms of the disease are not always present.

Congenital chickenpox is identified by the following features:

• brain damage;
• pneumonia;
• skin rash;
• delayed development of eyes and limbs;
• optic nerve atrophy.

Newborn babies infected in the womb are not treated for chickenpox, since the clinical picture of the disease does not progress. If a pregnant woman "caught" the infection 5 days before delivery and later, the child will be given an injection of immunoglobulin after birth, since there are no maternal antibodies in his body.

Intrauterine infection - hepatitis B

You can get a dangerous virus during intercourse with an infected person in the absence of barrier methods of contraception. The causative agent of the disease enters the baby through the placenta. The most dangerous period in terms of infection is from 4 to 9 months of pregnancy. The consequences of infection for a child are as follows:

• hepatitis B, which, with the appropriate approach, is treatable;
• oncological diseases of the liver;
• a sluggish form of hepatitis B;
• an acute form of hepatitis B, which provokes the development of liver failure in a child and he dies;
• delay in the development of psychomotor functions;
• hypoxia;
• miscarriage.

Intrauterine Infection - Human Immunodeficiency Virus (HIV)

HIV infection is a scourge for special immune lymphocytes. In most cases, infection occurs during intercourse with a sick partner. A child can become infected while in the womb, or during childbirth. Intensive complex treatment is shown to HIV-infected children, otherwise they will not live even two years - the infection quickly "eats up" the weak body. Infected babies die from infections that are not fatal to healthy babies.

To confirm HIV in an infant, a polymerase chain reaction diagnostic method is used. It is also very important to timely detect an infection in the body of a pregnant woman. If the baby is lucky enough to be born healthy, the mother will not breastfeed him so that the infection is not transmitted to him through milk.

Intrauterine infection - listeriosis

The disease develops as a result of the vital activity of the bacteria Listeria. The microorganism easily penetrates the fetus through the placenta. Infection of a pregnant woman occurs through unwashed vegetables and a number of food products (milk, eggs, meat). In a woman, the disease may be asymptomatic, although in some cases, fever, vomiting and diarrhea are noted. An infected baby has the following signs of listeriosis:

• rash and multiple accumulations of pustules on the skin;
• inflammation of the brain;
• refusal to eat;
• sepsis;
• spontaneous miscarriage;
• the birth of a dead baby.

If signs of listeriosis become apparent in the first week after birth, then babies die in 60 cases out of 100. After confirmation of listeriosis in a pregnant woman, she is prescribed a two-week course of Ampicillin treatment.

Intrauterine infection - syphilis

If a woman in a position is sick with syphilis, which she has not treated, the chance of infection in her child is almost 100%. Of the 10 infected babies, only 4 survive, and the survivors are diagnosed with congenital syphilis. The child will become infected even if the mother's disease is latent. The results of the activity of the infection in the child's body are as follows:

• tooth decay, damage to the organs of sight and hearing;
• damage to the upper and lower extremities;
• the formation of cracks and rashes on the skin;
• anemia;
• jaundice;
• mental retardation;
• premature birth;
• stillbirth.

Intrauterine infection - toxoplasmosis

The main carriers of toxoplasmosis are cats and dogs. The causative agent of the disease enters the body of the expectant mother when she takes care of her pet or, out of habit, tastes meat with an insufficient degree of heat treatment during the preparation of dinner. Infection during pregnancy poses a great danger to the intrauterine development of the baby - in 50 cases out of 100, the infection overcomes the placental barrier and affects the fetus. The consequences of infection in a child are as follows:

• damage to the organs of vision;
• hydrocephalus;
• microcephaly;
• an abnormally enlarged liver and spleen;
• inflammation of the brain;
• spontaneous abortion;
• delay in the development of psychomotor functions.

Cytomegalovirus, rubella, toxoplasmosis, herpes, tuberculosis, syphilis and some other diseases are combined into the group of so-called TORCH infections. When planning a pregnancy, expectant parents take tests that help identify these pathological conditions.

Tests for intrauterine infections during pregnancy

Within 9 months, the expectant mother will have to undergo more than one laboratory test so that the doctors are convinced that she is healthy. Women in position take a blood test for hepatitis B and C, syphilis. In relation to pregnant women, the OCP method is also practiced, thanks to which it is possible to identify active viruses in the blood, if any. In addition, expectant mothers regularly visit the laboratory to take a smear from the vagina for microflora.

Ultrasound is of great importance for the successful management of pregnancy. This method is absolutely safe for the fetus. And although this procedure is not directly related to the diagnosis of infectious diseases, with its help, doctors can detect abnormalities of intrauterine development caused by pathogenic microorganisms. There is every reason to talk about an intrauterine infection if the following symptoms became apparent on an ultrasound scan:

1. Formed developmental pathologies.
2. Polyhydramnios or low water.
3. Swelling of the placenta.
4. Enlarged abdomen and abnormally enlarged kidney units.
5. Enlarged internal organs: heart, liver, spleen.
6. Focuses of calcium deposition in the intestines, liver and brain.
7. Enlarged ventricles of the brain.

In the diagnostic program of examination of expectant mothers belonging to the risk groups, which we talked about above, a special place is occupied by the seroimmunological method for the determination of immunoglobulins. As necessary, physicians resort to amniocentnesis and cordocentesis. The first method of research is to study the amniotic fluid, the second involves the study of umbilical cord blood. These diagnostic methods are very informative in detecting infection. If the presence of an intrauterine infection is suspected in an infant, then the biological fluids of the baby - for example, saliva or blood - serve as the material for the study.

Danger of TORCH infections during pregnancy. Video

beremennuyu.ru

Intrauterine infection during pregnancy, risk of IUI

When carrying a child, a woman tries to protect him from adverse external influences. The health of a developing baby is the most important thing during this period, all protective mechanisms are aimed at preserving it. But there are situations when the body cannot cope, and the fetus is affected in utero - most often it is an infection. Why it develops, how it manifests itself and what risks it carries for the child - these are the main questions of concern to expectant mothers.

Causes

In order for an infection to appear, including intrauterine, the presence of several points is necessary: ​​the pathogen, the route of transmission and the susceptible organism. Microbes are believed to be the immediate cause of the disease. The list of possible pathogens is very wide and includes various representatives - bacteria, viruses, fungi and protozoa. It should be noted that intrauterine infection is mainly due to microbial associations, that is, it has a mixed character, but monoinfections are not uncommon. Among the common pathogens, the following are worth noting:

1. Bacteria: staphylo-, strepto- and enterococci, Escherichia coli, Klebsiella, Proteus.
2. Viruses: herpes, rubella, hepatitis B, HIV.
3. Intracellular agents: chlamydia, mycoplasma, ureaplasma.
4. Fungi: candida.
5. The simplest: Toxoplasma.

Separately, a group of infections was identified, which, despite all the differences in morphology and biological properties, cause similar symptoms and are associated with persistent developmental defects in the fetus. They are known under the abbreviation TORCH: toxoplasma, rubella, cytomegalovirus, herpes, and others. It must also be said that in recent years there have been certain changes in the structure of intrauterine infections, which is associated with the improvement of diagnostic methods and the identification of new pathogens (for example, listeria).

The infection can penetrate to the child in several ways: through the blood (hematogenous or transplacental), amniotic fluid (amnial), the mother's genital tract (ascending), from the wall of the uterus (transmurally), through the fallopian tubes (descending) and with direct contact. Accordingly, there are certain risk factors for infection that a woman and a doctor should be aware of:

• Inflammatory pathology of the gynecological sphere (colpitis, cervicitis, bacterial vaginosis, adnexitis, endometritis).
• Invasive interventions during pregnancy and childbirth (amniocentesis or cordocentesis, chorionic biopsy, cesarean section).
• Abortions and complications in the postpartum period (postponed earlier).
• Insufficiency of the cervix.
• Polyhydramnios.
• Placental insufficiency.
• Common infectious diseases.
• Focuses of chronic inflammation.
• Early onset of sexual activity and promiscuity in sexual relations.

In addition, many infections are characterized by a latent course, undergoing reactivation in case of metabolic and hormonal processes in the female body: hypovitaminosis, anemia, heavy physical exertion, psychoemotional stress, endocrine disorders, exacerbation of chronic diseases. Those who have identified such factors are at high risk of intrauterine infection of the fetus. He is also shown regular monitoring of the condition and preventive measures aimed at minimizing the likelihood of the development of pathology and its consequences.

Intrauterine infection develops when infected with microbes, which is facilitated by many factors on the part of the maternal body.

Mechanisms

The degree of pathological impact is determined by the characteristics of the morphological development of the fetus at a particular stage of pregnancy, its response to the infectious process (the maturity of the immune system), the duration of microbial aggression. The severity and nature of the lesion is not always strictly proportional to the virulence of the pathogen (the degree of its pathogenicity). Often, latent infection caused by chlamydial, viral or fungal agents leads to intrauterine death or the birth of a seriously abnormal baby. This is due to the biological tropism of microbes, i.e., the tendency to multiply in embryonic tissues.

Infectious agents have different effects on the fetus. They can provoke an inflammatory process in various organs with the further development of a morphofunctional defect or have a direct teratogenic effect with the appearance of structural anomalies and malformations. Of no small importance are fetal intoxication with products of microbial metabolism, metabolic disorders and hemocirculation with hypoxia. As a result, fetal development suffers and the differentiation of internal organs is impaired.

The clinical manifestations and severity of the infection are determined by many factors: the type and characteristics of the pathogen, the mechanism of its transmission, the strength of the immune system and the stage of the pathological process in the pregnant woman, the gestational age at which the infection occurred. In general, this can be represented as follows (table):

The symptoms of intrauterine infection are noticeable immediately after birth or in the first 3 days. But it should be remembered that some diseases may have a longer incubation (latent) period or, conversely, appear earlier (for example, in premature babies). Most often, the pathology is manifested by the syndrome of infection of the newborn, manifested by the following symptoms:

• Weakening of reflexes.
• Muscle hypotension.
• Refusal to feed.
• Frequent regurgitation.
• Pale skin with periods of cyanosis.
• Change in the rhythm and frequency of breathing.
• Muffled heart tones.

Specific manifestations of pathology include a wide range of disorders. Based on the tissue tropism of the pathogen, intrauterine infection during pregnancy can manifest itself:

1. Vesiculopustulosis: a rash on the skin in the form of blisters and pustules.
2. Conjunctivitis, otitis media and rhinitis.
3. Pneumonia: shortness of breath, cyanosis of the skin, wheezing in the lungs.
4. Enterocolitis: diarrhea, bloating, sluggish sucking, regurgitation.
5. Meningitis and encephalitis: weak reflexes, vomiting, hydrocephalus.

Along with a local pathological process, the disease can be widespread in the form of sepsis. However, its diagnosis in newborns is difficult, which is associated with the low immune reactivity of the child's body. At first, the clinic is rather scarce, since there are only symptoms of general intoxication, including those already listed above. In addition, the baby is underweight, the umbilical wound does not heal well, jaundice appears, the liver and spleen enlarge (hepatosplenomegaly).

In children infected in the prenatal period, violations of many vital systems are revealed, including the nervous, cardiovascular, respiratory, humoral, and immune systems. Key adaptive mechanisms are violated, which is manifested by hypoxic syndrome, malnutrition, cerebral and metabolic disorders.

The clinical picture of intrauterine infections is very diverse - it includes specific and general signs.

Cytomegalovirus

Most babies infected with cytomegalovirus do not have any visible abnormalities at birth. But in the future, signs of neurological disorders are revealed: deafness, slowing down of neuropsychic development (mild mental retardation). Unfortunately, these disorders are irreversible. They can progress to the development of cerebral palsy or epilepsy. In addition, a congenital infection can manifest itself:

• Hepatitis.
• Pneumonia.
• Hemolytic anemia.
• Thrombocytopenia.

These disorders disappear within a certain period, even without treatment. Chorioretinopathy may occur, which is rarely accompanied by decreased vision. Severe and life-threatening conditions are very rare.

Herpetic infection

The greatest danger to the fetus is a primary genital infection in the mother or an exacerbation of a chronic disease. Then the child becomes infected by contact, passing through the affected genital tract during childbirth. Intrauterine infection is less common, it occurs before the natural end of pregnancy, when the fetal bladder bursts, or at other times - from the first to the third trimester.

Infection of the fetus in the first months of pregnancy is accompanied by heart defects, hydrocephalus, abnormalities of the digestive system, intrauterine growth retardation, and spontaneous abortions. In the second and third trimesters, pathology leads to the appearance of the following deviations:

• Anemia.
• Jaundice.
• Hypotrophy.
• Meningoencephalitis.
• Hepatosplenomegaly.

And herpes infection in newborns is diagnosed by vesicular (vesicular) lesions of the skin and mucous membranes, chorioretinitis and encephalitis. There are also common forms when several systems and organs are involved in the pathological process.

Rubella

A child can become infected from the mother at any stage of pregnancy, and clinical manifestations will also depend on the time of infection. The disease is accompanied by damage to the placenta and fetus, intrauterine death of the latter, or does not give any consequences at all. For children born with an infection, rather specific anomalies are characteristic:

• Cataract.
• Deafness.
• Heart defects.

But in addition to these signs, there may be other structural abnormalities, for example, microcephaly, cleft palate, skeletal disorders, genitourinary system, hepatitis, pneumonia. But in many children born infected, no pathology is detected, and in the first five years of life, problems begin - hearing deteriorates, psychomotor development slows down, autism, diabetes mellitus appears.

Rubella has a clear teratogenic effect on the fetus, leading to various abnormalities, or provokes its death (spontaneous abortion).

Toxoplasmosis

Infection with toxoplasmosis in early pregnancy can be accompanied by severe consequences for the fetus. An intrauterine infection provokes the death of a child or the occurrence of multiple abnormalities, including hydrocephalus, brain cysts, edema syndrome, and destruction of internal organs. Congenital disease is often common, manifesting itself with the following symptoms:

• Anemia.
• Hepatosplenomegaly.
• Jaundice.
• Lymphadenopathy (swollen lymph nodes).
• Fever.
• Chorioretinitis.

With infection at a later date, the clinical manifestations are rather scarce and are mainly characterized by decreased vision or unexpressed disorders in the nervous system, which often remain undetected.

Additional diagnostics

Of great importance is the prenatal diagnosis of an infectious lesion of the fetus. To determine the pathology, laboratory and instrumental methods are used to identify the pathogen and identify deviations in the development of the child at various stages of pregnancy. If intrauterine infection is suspected, perform:

1. Biochemical blood test (antibodies or microbial antigens).
2. Analysis of smears from the genital tract and amniotic fluid (microscopy, bacteriology and virology).
3. Genetic identification (PCR).
4. Ultrasound (fetometry, placentography, Doppler ultrasonography).
5. Cardiotocography.

After birth, newborns are examined (skin washings, blood tests) and the placenta (histological examination). Comprehensive diagnostics allows you to identify pathology at the preclinical stage and plan further treatment. The nature of the activities carried out will be determined by the type of infection, its spread and clinical picture. An important role is also played by prenatal prevention and the correct management of pregnancy.

flovit.ru

Intrauterine infections - symptoms, treatment, forms, stages, diagnosis

Intrauterine infection (IUI) is understood as infectious and inflammatory diseases of the fetus and young children that occur during the antenatal (prenatal) and (or) intrapartum (birth) periods with vertical infection from the mother.

It is necessary to distinguish between the concepts of "intrauterine infection" and "intrauterine infection". Infection implies the penetration of the pathogen into the child's body without the development of the clinical picture, while intrauterine infection is a full-fledged implementation of intrauterine infection in the form of a clinical manifestation of an infectious disease.

According to the results of some studies, infection is detected in approximately 50% of term infants and 70% of premature infants. According to more "optimistic" data, every tenth fetus (child) is exposed to pathogenic agents during pregnancy and childbirth.

In 80% of cases, IUI complicates the child's health with various pathological conditions and developmental defects of varying severity. According to the autopsy results, it is determined that in every third case, perinatal infection was the main cause of the death of the newborn, accompanied or complicated the course of the underlying disease.

Long-term studies show that children in the first years of life who have undergone an intrauterine infection have weaker immune capabilities and are more susceptible to infectious and somatic diseases.

In the early 70s of the XX century, the World Health Organization proposed the name "TORCH syndrome". This abbreviation reflects the names of the most common intrauterine infections: T - toxoplasmosis (Toxoplasmosis), O - others (mycoplasma, syphilis, hepatitis, streptococci, candida, etc.) (Other), R - rubella (Rubella), C - cytomegalovirus (Cytomegalovirus), H - herpes (Herpes). If the etiological factor is not known for certain, they speak of TORCH syndrome.

Causes and risk factors

The main source of infection in IUI, as already noted, is the mother, from whom the pathogen enters the fetus during the ante- and (or) intrapartum period (vertical transmission mechanism).

The causative agents of intrauterine infection can be bacteria, fungi, protozoa, viruses. According to statistics, the first place in the structure of intrauterine infections is occupied by bacterial diseases (28%), followed by chlamydial and associated infections (21%).

Infectious agents that are the most common causes of intrauterine infection:

• rubella, herpes simplex, chickenpox, hepatitis B and C, influenza viruses, adenoviruses, enteroviruses, cytomegalovirus;
• pathogenic bacteria (Escherichia, Klebsiella, Proteus and other coliform bacteria, group B streptococci, Haemophylus influenzae, alpha-hemolytic streptococci, non-spore-forming anaerobes);
• intracellular pathogens (toxoplasma, mycoplasma, chlamydia);
• mushrooms of the genus Candida.

Risk factors for intrauterine infection:

• chronic diseases of the urogenital sphere in the mother (erosive damage to the cervix, endocervicitis, colpitis, vulvovaginitis, ovarian cyst, urethritis, cystitis, pyelo- and glomerulonephritis, etc.);
• infectious diseases suffered by the mother during pregnancy;
• long dry period.

Factors indirectly indicating a possible intrauterine infection:

• burdened obstetric history (spontaneous abortion, infertility, stillbirth, the birth of children with multiple malformations);
• polyhydramnios, the presence of inclusions and impurities in the amniotic fluid;
• fever, not accompanied by signs of inflammation in any organ system, developed in the mother during pregnancy or during childbirth;
• the birth of a premature baby before the due date of birth;
• intrauterine growth retardation of the child;
• Apgar score 0–4 points at the 1st minute of the child's life with the preservation of unsatisfactory indicators or deterioration of the assessment by the 5th minute of life;
• fever of a newborn of unknown etiology.

Forms of the disease

Depending on the duration of pregnancy, at which the infection occurred, there are:

• blastopathies - are realized during the first 14 days of pregnancy;
• embryopathies - appear in the period from 15 days of pregnancy to 8 weeks;
• fetopathies - develop after 9 weeks of pregnancy (early fetopathies - from the 76th to the 180th day of pregnancy, late fetopathies - from the 181st day of pregnancy to the moment of delivery).

An intrauterine infection that develops in the first 2 weeks of pregnancy most often leads to the death of the embryo (missed pregnancy) or the formation of severe systemic malformations similar to genetic developmental anomalies. Spontaneous abortion usually occurs 2-3 weeks after infection.

Since all organs and systems are laid in the embryonic period, the development of IUI at these periods will lead to the death of the embryo or, as in the previous case, to the formation of malformations of varying severity.

Fetopathies have a number of characteristics:

• congenital defects are realized only in those organs, the formation of which was not completed at the time of the birth of the child;
• infectious processes are often generalized (widespread);
• infection is often accompanied by the development of thrombohemorrhagic syndrome;
• morphological and functional maturation of organs lags behind.

The World Health Organization (ICD-10) has proposed an extensive classification of intrauterine infections, the main forms of which are:

Symptoms

Often, intrauterine infections do not have characteristic symptoms, therefore, nonspecific signs of an infectious and inflammatory process in a newborn allow suspecting their presence (their similarity was noted in IUI provoked by various pathogens):

• decreased or lack of appetite;
• significant weight loss (decrease in body weight by more than 10% of the original birth weight);
• repeated weight loss, poor body weight recovery (slow gain, insignificant gains);
• inflammation of the skin and subcutaneous fat (sclera);
• lethargy, drowsiness, lethargy;
• grayish-pale coloration of the skin, anemic mucous membranes, possible icteric staining of the skin and mucous membranes, icterus of the sclera;
• edematous syndrome of varying severity and localization;
• respiratory disorders (shortness of breath, short-term episodes of respiratory arrest, involvement of auxiliary muscles in the act of breathing);
• dyspeptic disorders (regurgitation, including profuse, fountain, unstable stool, an increase in the size of the liver and spleen);
• symptoms of involvement of the cardiovascular system (tachycardia, decreased blood pressure, swelling or pastiness, cyanotic staining of the skin and mucous membranes, marbling of the skin, cold extremities);
• neurological symptoms (hyper- or hypotension, dystonia, decreased reflexes (including deterioration of the sucking reflex);
• changes in the blood formula (leukocytosis, accelerated ESR, anemia, decreased platelet count).

Signs of intrauterine infection often manifest in the first 3 days of a newborn's life.

Diagnostics

When diagnosing IUI, data from anamnesis, laboratory and instrumental research methods are taken into account:

• a general blood test (leukocytosis with a neutrophilic shift to the left, accelerated ESR);
• biochemical blood test (for markers of the acute phase reaction - C-reactive protein, haptoglobin, ceruloplasmin, plasminogen, alpha-1-antitrypsin, antithrombin III, C3-complement fraction, etc.);
• classical microbiological techniques (virological, bacteriological);
• polymerase chain reaction (PCR);
• direct immunofluorescence method using monoclonal antibodies;
• enzyme-linked immunosorbent assay (ELISA) with the quantitative determination of specific antibodies of the IgM, IgG classes;
• Ultrasound of the abdominal organs, heart, brain.

Treatment

Treatment of intrauterine infection is complex, consists of etiotropic and symptomatic components:

Pregnancy outcomes with IUI:

• intrauterine fetal death;
• stillbirth;
• the birth of a live viable or live non-viable (with malformations incompatible with life) a child with signs of intrauterine infection.

Complications of intrauterine infection:

• malformations of internal organs;
• secondary immunodeficiency;
• the child's lag behind peers in physical and mental development.

Forecast

With timely diagnosis and complex treatment of intrauterine infection that arose at a later date, the prognosis is generally favorable (the prognosis improves as the gestational age at which infection occurs), although it is purely individual.

The likelihood of a favorable outcome of the disease depends on many characteristics: the virulence of the pathogen, its type, method of infection, the presence of concomitant pathology and aggravating factors on the part of the mother, the functional state of the pregnant woman's body, etc.

When IUI occurs in the early stages, the prognosis is usually poor.

Prophylaxis

Prevention of IUI development is as follows:

• prevention of infectious diseases of the mother (remediation of foci of chronic inflammation, timely vaccination, screening of pregnant women for the presence of TORCH infections);
• antibacterial or antiviral therapy for pregnant women with the development of acute or exacerbation of chronic infectious inflammation;
• examination of newborns from mothers from high-risk groups;
• early vaccination of newborns.

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Intrauterine Infections in Newborns

intrauterine infection

Currently, a paradoxical situation has arisen in the Russian Federation, when the emerging trend towards an increase in the birth rate and a decrease in perinatal mortality is combined with a deterioration in the quality of newborn health, an increase in the proportion of congenital malformations and infectious pathology among the causes of infant mortality. The high infection rate of the adult population with viruses, protozoa and bacteria determines the significant prevalence of intrauterine infections in newborns. The mother is always the source of infection for the fetus. The pathogen can enter the fetus antenatally and intrapartum; the result of this penetration can be two clinical situations, called "intrauterine infection" and "intrauterine infection". These concepts are not identical.

Intrauterine infection should be understood as the alleged fact of intrauterine penetration of microorganisms into the fetus, in which no signs of an infectious disease of the fetus are detected.

Intrauterine infection should be understood as the established fact of intrauterine penetration of microorganisms into the fetus, in which pathophysiological changes characteristic of an infectious disease occurred in the body of the fetus and / or newborn, and were detected prenatally or shortly after birth.

Most cases of suspected intrauterine infection are not accompanied by the development of an infectious disease. The frequency of clinical manifestation of intrauterine infection in a newborn depends on the properties of the microorganism, the pathways and timing of its transmission from the pregnant woman to the fetus and averages about 10% of all cases of intrauterine infection (ranging from 5% to 50%).

The group of increased risk for intrauterine infection consists of: pregnant women with obstetric pathology (threat of termination of pregnancy, spontaneous miscarriages, premature birth, undeveloped pregnancy, antenatal death and fetal malformations); women who have had acute infections during pregnancy, who have foci of chronic infection, especially in the urogenital area, as well as those who have had infectious complications in the early postpartum period.

Risk factors for intranatal infection are a prolonged anhydrous period, the presence of meconium in the amniotic fluid, fever during labor in the mother, the birth of a child in asphyxiation, which required the use of mechanical ventilation.

The clinical picture of intrauterine infection in a newborn depends on a number of factors. Of great importance is the fact of the mother's primary illness during pregnancy, when the primary immune response is significantly reduced. In this case, as a rule, a severe, often generalized form of the disease develops; the pathogen penetrates the fetus transplacentally. If a pregnant woman is immune to infection, then intrauterine infection or a mild form of the disease is possible.

The clinic of intrauterine infection in a newborn is significantly affected by the period of penetration of the infectious agent to the fetus. In the case of viral infection of the fetus in the embryonic period of development, antenatal death or multiple malformations are observed. At 3-5 months of intrauterine life, infectious fetopathies develop, characterized by a decrease in fetal body weight, tissue malformations, immaturity of the central nervous system, lungs, kidneys, dystrophic disorders in the cells of parenchymal organs. When a fetal infection occurs in the II-III trimesters of pregnancy, both signs of an infectious lesion of individual organs (hepatitis, myocarditis, meningitis, meningoencephalitis, chorioretinitis, etc.) and symptoms of generalized infection can be detected.

The clinical manifestations of intrauterine infection also depend on the route of penetration of the infectious agent to the fetus. Distinguish:

1) hematogenous (transplacental) route of penetration; as a rule, gives the development of a severe, generalized form of the disease and is characterized by severe jaundice, hepatitis, multiple organ lesions;

2) the ascending route of infection - more often with urogenital infection in the mother (for example, chlamydia); the pathogen enters the uterine cavity, affects the membranes of the fetus, enters the amniotic fluid; the newborn develops conjunctivitis, dermatitis, lesions of the gastrointestinal tract, pneumonia, while generalization of the process is possible;

3) the descending route of infection - the infectious agent penetrates through the fallopian tubes, and then - as in the ascending route of infection;

4) the contact route - during birth, through the natural birth canal, for example, with genital herpes, candidiasis colpitis; the disease in a newborn develops in the form of lesions of the skin and / or mucous membranes, although in the future it can also generalize.

The most typical symptoms of intrauterine infection detected in the early neonatal period are: intrauterine growth retardation, hepatosplenomegaly, jaundice, rash, respiratory distress, cardiovascular failure, and severe neurological disorders. Considering that the combination of the above symptoms occurs in intrauterine infections of various etiologies, the term "TORCH syndrome" is used to designate the clinical manifestations of intrauterine infection in the English-language literature. In this abbreviation, “T” stands for toxoplasmosis (toxoplasmosis), “R” stands for rubella (rubella), “C” stands for cytomegalia, “H” stands for herpes infection (herpes infectio), and “O” stands for other infections (other). The “other infections” that manifest themselves in the neonatal period with the TORCH syndrome currently include syphilis, listeriosis, viral hepatitis, chickenpox, etc.

In recent years, there has been a tendency towards an increase in the frequency of mixed viral-viral and viral-bacterial infections.

Laboratory diagnostics

All newborns with typical manifestations of intrauterine infection, as well as children from the high-risk group, if their condition worsens in the early neonatal period, should undergo a targeted laboratory examination for TORCH infection in order to establish or objectively confirm the etiology of the disease.

The diagnosis of intrauterine infection is always clinical and laboratory. The absence of clinical manifestations of an infectious disease in the perinatal period in most cases makes laboratory research for TORCH infection impractical. An exception may be a routine examination of clinically healthy newborns from mothers with tuberculosis, syphilis and genital herpes (in case of its exacerbation shortly before delivery).

According to the ability to detect the causative agent of infection, laboratory diagnostic methods can be divided into two groups: direct, allowing to detect viruses or microorganisms in biological fluids or tissues of the child (fetus), and indirect, allowing to register the specific immune response of the child (fetus) to viruses or microorganisms.

Direct methods include:

• Microscopy (electronic or direct, for example in a dark field)
• Detection of viral or bacterial antigens (including one-step enzyme immunoassay and immunochromatographic methods)
• Polymerase chain reaction (PCR)
• Cultural method.

Direct laboratory diagnostic methods can detect the presence of the pathogen in biological fluids or tissue biopsies of an infected child. However, their sensitivity and specificity significantly depends on the type of pathogen detected, the quality of laboratory equipment and reagents. Therefore, the results of the examination of the child, carried out in different clinical and research laboratories, may be different.

Despite the fact that in recent years the PCR method has been rapidly developing, as a highly sensitive and specific, the "gold standard" for the diagnosis of all bacterial and a number of viral infections (including rubella and herpes) is the culture method. The most reliable method for diagnosing syphilis until now is the detection of treponemal antigen by the reaction of immune fluorescence and the reaction of immobilization of pale treponema.

Indirect (indirect) methods include the so-called serological methods, of which the most informative is the enzyme-linked immunosorbent assay for the determination of specific IgG, IgM, IgA (ELISA). Indicators of sensitivity and specificity of serological methods for detecting infections in newborn children are significantly worse than in older children and adults, which is associated with the peculiarities of the immune response and the presence of maternal antibodies in their blood. However, from a technical point of view, these methods are quite simple, which makes it possible to use them for primary screening for intrauterine infection.

When using serological diagnostic methods, remember:

1) the examination must be carried out before the use of donated blood products in the treatment of the child;

2) the results of the examination of the child must always be compared with the results of the examination of the mother;

3) the presence of specific immunoglobulins of the IgG class in a titer equal to or less than the titer of the corresponding maternal antibodies indicates not an intrauterine infection, but a transplacental transfer of maternal antibodies;

4) the presence of specific immunoglobulins of the IgM class in any titer indicates the primary immune response of the fetus or newborn to the corresponding bacterial / viral antigen and may be an indirect sign of infection;

5) the absence of specific immunoglobulins of the IgM class in the blood serum of newborns in a number of diseases (including neonatal herpes) does not exclude the possibility of intrauterine (intranatal) infection.

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Intrauterine infections

Intrauterine Infections of Newborns(IUI) are infectious diseases in which pathogens from an infected mother spread to the fetus during pregnancy or childbirth.

In newborns, IUIs are manifested in the form of severe lesions of the central nervous system, heart, and organs of vision.

The time of infection of a pregnant woman, as well as the type and virulence of the pathogen, the massiveness of infection, the path of penetration of the pathogen, the nature of the course of pregnancy are important in the development of the disease.

Infection of the mother occurs from the family of feline domestic animals and birds (cattle, pigs, horses, sheep, rabbits, chickens, turkeys) infected with Toxoplasma, and wild animals (hares, squirrels). The transmission mechanism is fecal-oral through unwashed hands after contact with soil contaminated with animal feces, consumption of unpasteurized milk, raw or poorly roasted meat; hematogenous - with transfusion of infected blood products. A person infected with toxoplasmosis for others not dangerous.

Infection from mother to fetus is transmitted through the placenta only once in a lifetime, if she first became infected during this pregnancy. During subsequent pregnancy or in the case of a previous illness before pregnancy, the fetus is not infected. This is due to the fact that a high immunological activity towards this pathogen has already been formed in the mother's body.

Fetal involvement in the first trimester of pregnancy results in miscarriages, stillbirths and severe organ damage. When infected in the third trimester of pregnancy, the fetus is less likely to become infected, the disease manifests itself in a milder form. Toxoplasmosis can be asymptomatic for a long time and can be found in children at an older age, even at 4-14 years of age.

Distinguish between acute, subacute and chronic phases of the disease. The clinical symptoms of an infectious disease are diverse and not always specific. For acute phase(stage of generalization) is characterized by a general serious condition, fever, jaundice, enlarged liver and spleen, maculopapular rash. Possible dyspeptic disorders, interstitial pneumonia, myocarditis, intrauterine growth retardation. For the defeat of the nervous system, lethargy, drowsiness, nystagmus, strabismus are characteristic. The fetus becomes infected shortly before the birth of the child, and a severe infection that began in utero continues after birth.

V subacute phase(stage of active encephalitis) a child is born with symptoms of central nervous system damage - vomiting, convulsions, tremors, paralysis and paresis, progressive micro-, hydrocephalus are detected; there are changes in the eyes - opacity of the vitreous body, chorioretinitis, iridocyclitis, nystagmus, strabismus.

V chronic phase irreversible changes in the central nervous system and eyes occur - micro-, hydrocephalus, calcifications in the brain, delayed mental, speech and physical development, epilepsy, hearing loss, optic nerve atrophy, microphthalmia, chorioretinitis. Fetal infection occurs early, the child is born with manifestations of chronic toxoplasmosis.

Treatment. V treatment with pyrimitamine preparations (chloridine, daraprim, tindurin) in combination with sulfonamides ( bactrim, sulfadimezin). Combination drugs are used fancidar or metakelphin. Are effective spiramycin (rovamycin), Sumamed, Rulid. With an active inflammatory process, corticosteroids are indicated. Multivitamins are required.

To prevent toxoplasmosis, it is important to carry out sanitary and educational work among women of childbearing age, to identify infected among pregnant women (screening test at the beginning and at the end of pregnancy), to prevent contact of pregnant women with cats and other animals;

wash hands thoroughly after contact with raw meat. Identified infected women in the first half of pregnancy are treated spiramycin or terminate the pregnancy.

Congenital cytomegalovirus infection. The causative agent of the disease belongs to DNA viruses from the herpes family. The disease is characterized by damage to the salivary glands, central nervous system and other organs with the formation of giant cells with large intranuclear inclusions in their tissues.

The source of infection is only a person (sick or virus carrier). From an infected organism, the virus is excreted in urine, saliva, secretions, blood, less often in feces. Excretion of the virus in the urine can last for several years. The transmission mechanism is mainly contact, less often airborne, enteral and sexual.

The source of infection in newborn babies is mothers who are carriers of the cytomegaly virus. Viruses penetrate to the fetus through the placenta, ascending or during childbirth, to the newborn - with infected milk, through an infected blood transfusion. Infection during childbirth occurs when aspiration or ingestion of infected amniotic fluid, secretions of the mother's birth canal.

Signs of the disease in pregnant women may be absent O asymptomatic form). If a latent infection is activated in a pregnant woman, then a less intense infection of the placenta is observed. Due to the presence of specific IgG antibodies in the mother, less pronounced damage to the fetus is also noted.

The defeat of the fetus in the early stages of pregnancy leads to miscarriages, stillbirths. A child is born with malformations of the central nervous system, cardiovascular system, kidneys, lungs, thymus, adrenal glands, spleen, intestines. The organ damage is of a fibrocystic nature - liver cirrhosis, biliary atresia, cystosis of the kidneys and lungs, mucoviscidosis. Viremia and virus excretion into the external environment is not observed, since it is in a latent state.

If infection occurs shortly before birth, during labor, the baby is born with generalized form disease or it develops soon after birth. It is characterized by clinical symptoms from the first hours or days of life, the involvement of many organs and systems in the process: low birth weight, progressive jaundice, enlarged liver and spleen, hemorrhages - petechiae, sometimes resembling “blueberry pie” on the skin, melena, hemolytic anemia, meningoencephalitis, and small cerebral calcifications around the ventricles. Chorioretinitis, cataract, optic neuritis are revealed. With lung damage in children, persistent cough, shortness of breath and other signs of interstitial pneumonia are observed.

Localized form develops against the background of isolated damage to the salivary glands or lungs, liver, central nervous system.

Diagnostics. Laboratory diagnostics is based on the results of cytological, virological and serological studies. The virus is isolated in urine sediments, saliva, cerebrospinal fluid. Serological methods - RSK, PH, RPHA - confirm the diagnosis. ELISA, PCR and D NK hybridization are used.

Treatment. During treatment, you should make sure that there are no pathogens in the mother's milk. Apply a specific anti-cytomegalovirus 10% solution of immunoglobulin - cytotect, sandoglobulin(IgG). Use pentaglobin - IgM, KIP, antiviral drugs (cytosine arabinoside, adenine arabinoside, ioddeoxyuridine, ganciclovir, foscarnet). Syndromic and symptomatic therapy is carried out.

It is important to follow the rules of personal hygiene when caring for newborns with jaundice and toxic-septic diseases. All pregnant women are screened for cytomegaly.