Newborn shortness of breath
Introduction
Introduction The incidence of pneumonia in prenatal infection is mostly within 3 to 7 days after birth. Symptoms are often atypical. The smaller the gestational age, the more abnormal the symptoms are. The normal temperature is about half of the body temperature, and the rest is unstable. The temperature of severely sick or premature infants is often not high. Symptoms are mostly non-characteristics such as refusal to eat, drowsiness or irritability, poor complexion, weight loss, and no cough. Soon, there will be shortness of breath, nose flapping, sputum, soft tissue depression during inhalation, and heart rate increase. Premature babies are prone to apnea, and lung signs have increased or decreased breath sounds, with dry or wet voices, but may be completely negative. The various pneumonias that occur after birth are late onset, and the symptoms are typical. There are nasal congestion, cough, shortness of breath, and full-term fever in term, but the body temperature is normal. Premature infants may have low body temperature. The lungs can hear wet sounds of varying thickness. When the empyema or pus, the pneumothorax is reduced, the percussion is voiced or the reverberation is enhanced, and the pneumonia caused by various pathogens has some characteristics.
Cause
Cause
Neonatal pneumonia can be divided into prenatal infection (including intrauterine and intrapartum) and postnatal infection. The infection is mostly from pregnant women, transmitted to the fetus through the placenta, or due to premature rupture of amniotic membrane in pregnant women, long-term labor, microbial infection in the vagina. Caused.
Examine
an examination
Related inspection
Lung ventilation imaging sputum routine examination
1. History and signs: Pregnant women have had infectious diseases before birth or have had intrauterine distress in their fetuses. Newborns after birth should be alert to the possibility of prenatal infectious pneumonia. The diagnosis of post-natal pneumonia depends on the symptoms and signs of the child. Although the diagnosis is easier, it is necessary to pay attention to the development of the disease and complications.
2. Chest X-ray: Viral pneumonia is mainly caused by interstitial changes. Bacterial pneumonia is mainly bronchial pneumonia, sometimes like hyaline membrane disease. Chlamydia pneumonia has interstitial pneumonia with focal infiltration. Emphysema is more pronounced in neonates with pneumonia, sometimes causing mediastinal spasms. The incidence of partial atelectasis is also higher than at other ages.
3. Etiology: The pathogen diagnosis of pneumonia is not very easy. For bacterial pneumonia, intratracheal aspirate or nasopharyngeal swabs can be used for culture and blood culture. For viral pneumonia and chlamydial pneumonia, rapid diagnosis such as ELISA or PCR can be used.
Diagnosis
Differential diagnosis
Pneumonia with prenatal infection: the incidence is more than 3 to 7 days after birth. Symptoms are often atypical. The smaller the gestational age, the more abnormal the symptoms are. The normal temperature is about half of the body temperature, and the rest is unstable. The temperature of severely sick or premature infants is often not high. Symptoms are mostly non-characteristics such as refusal to eat, drowsiness or irritability, poor complexion, weight loss, and no cough. Soon, there will be shortness of breath, nasal agitation, convulsions, soft tissue depression when inhaling, and increased heart rate. Premature babies are prone to apnea, and lung signs have increased or decreased breathing sounds, with dry or wet sounds, but may also be completely negative.
Neonatal wet lungs: Most of the children are full-term infants, and most of them have accelerated breathing (>60 beats/min) within 6 hours after birth. It is mildly mild and the symptoms last only for 12 to 24 hours. Severe cases are less common, can be delayed to 2 to 5 days, manifested as low crying, bruising, mild sputum, nasal fan, three concave signs, rapid breathing (can exceed 100 times per minute). There are not many positive signs in the lungs. Auscultation may have reduced breath sounds and coarse wet rales, and PaO2 slightly decreases. Vomiting can be seen in individual cases. Both PaCO2 rise and acidosis are uncommon. The child is generally in good condition, can cry, can also suck milk.
Pulmonary hyaline membrane disease: Due to the lack of pulmonary surfactant, dyspnea occurs within 12 hours after birth, gradually worsening, and the disease progresses slightly slower than prenatal pneumonia. However, these two diseases are often difficult to distinguish from clinical, X-ray and pathologically. Therefore, for hyaline membrane disease, prenatal infectious pneumonia (especially group B streptococcal pneumonia) can also be tested, and a larger dose of penicillin is used.
Hypoxic-ischemic encephalopathy: In term infants, the disease is caused by asphyxia, and in preterm infants, there is no history of hypoxia. At the onset of the onset, respiratory irregularities, increased or decreased muscle tone, and sometimes convulsions occur, but prenatal pneumonia begins slightly later and has fewer neurological symptoms.
Congenital heart disease: It usually needs to be identified with a complex congenital heart or a cyanotic heart that appears shortly after birth. The heart will appear to increase breathing or cyanosis within a few days after birth. The heart can sometimes hear murmurs, and the lungs have no snoring. Chest X-ray films can be identified.
Diaphragm: The abdominal viscera enters the chest through the pupil, oppresses the heart and lungs, causes lung dysplasia, and presents with shortness of breath. Chest X-ray films can help identify.
Pneumonia caused by cytomegalovirus: slow onset, symptoms of fever, dry cough, shortness of breath, chest X-ray film is typical interstitial pneumonia, these are similar to chlamydia pneumonia, but hepatosplenomegaly in children with giant cell inclusion disease Obviously, sometimes accompanied by jaundice.
The pathogen diagnosis of pneumonia is not very easy. For bacterial pneumonia, intratracheal aspirate or nasopharyngeal swab can be cultured and blood cultured. For viral pneumonia and chlamydial pneumonia, rapid diagnosis such as ELISA or PCR can be used.
