ДОДАТОК А

Дата добавления: 2015-10-15; просмотров: 367

Intrauterine pneumonia is most frequently observed in preterm infants. In the majority of cases intrauterine pneu­monia is diagnosed during the first two days of life, the first symptoms becoming manifest a few hours after birth.

The diagnosis of intrauterine pneumonia is based on bacteriologic, virologic, roentgenologic investigations, the analysis of the amniotic fluid at the moment of birth, and histologic studies of the placenta. In cases of fatal outcomes morphologic examinations are carried out.

The infant's history usually reveals factors predisposing to early infection of the fetus: maternal infections, uterine hemorrhages during pregnancy, premature rupture of the amniotic sack, complicated pregnancy and. delivery.

Intrauterine hypoxia, massive aspiration, inflammatory changes in the lungs develop in the fetus.

At birth the infants are in a poor condition with asphyxia and apnea. The reflexes of the newborn including those of sucking and swallowing are often absent.

The skin is of grey-yellowish colour, often cyanotic. Physiological erythema of the newborn is either absent or only slightly expressed. Dryness of the skin, petechial erup­tion, maceration, pyoderma and hemorrhages are usually noted. Edema of the limbs and lower part of the abdomen is also a typical feature.

The body temperature in premature infants with intrau­terine pneumonia is 32-35° C, in babies born at term it may increase up to 40° C.

1-3 hours following birth the clinical symptoms of res­piratory distress become more severe: the respiration becomes shallow, the respiratory rate is 21 to 120 per minute.

Auscultation reveals weakened respiratory activity, and diffuse moist râles are usually observed on the l-2nd day of life.

Respiratory distress in infants with intrauterine pneu­monia is associated with the disturbances of the acid-alkaline balance in the blood.

Functional disturbances of the cardio-vascular system are observed in all infants with intrauterine pneumonia. Hematologic status of such infants is characterized either by leucocytosis or leucopenia.

Roentgenologic diagnosis of intrauterine pneumonia is extremely difficult. The roentgenologic examination of the newborn's chest is carried out at 10-72 hours of life. It usually shows infiltrative changes in the bronchial branches and multiple microfocal shadows in the lungs.

The following case reports illustrate the clinical course and the outcome of intrauterine pneumonia.

Case 1. A female infant was born to a young mother after a 27 week gestation. The mother had suffered acute infections and her pregnancy had been complicated by neph­ropathy and imminent abortion. Labor began spontaneously with premature rupture of the amniotic sack; delivery was complicated by the breech presentation. The infant was born in the state of арnеа. The birth weight was 1,000 gr.

During the first hours following birth the infant's condition deteriorated: respiratory rate became 64 per minute; shortened percussion sound, weak respiration, repeated episodes of asphyxia and cyanosis were noted. Extensive con­fluent consolidation in the bronchial trunks were evident on the roentgenogram.

The anamnesis findings, the clinical picture, and the findings of the roentgenologic examination suggested the diagnosis of intrauterine bilateral microfocal pneumonia. The treatment consisting of antibiotics, cardiacs, vicasole, oxygen, plasma proved ineffective, and the infant died on the 10-th day of life.

The findings of the postmortem examination confirmed the diagnosis of intrauterine macrofocal pneumonia with aspiration, atelectasis and hyperplasia of the lung tissue. Multiple lesions of the other inner organs were found.

Case 2. A male infant was born to a 20-year-old primipara following pregnancy complicated by toxicosis, anemia and hypotension. Three weeks prior to delivery she had suffered an attack of quinsy.

The infant's condition after birth was poor, asphyxia, and elevated body temperature being noted. On percussion fine moist rales and shortened percussion sounds were noted. The X-ray examination of the infant's chest showed areas of consolidation in the right upper lobe and in the right middle lobe. With the development of the disease the con­solidation gradually increased. On the 62-nd day after birth purulent emphysema was diagnosed.

In spite of intensive therapy including thoracocentesis and repeated drainage the infant died at the age of 84 days.

The diagnosis of intrauterine interstitial microfocal pneu­monia, pneumothoraces, pericarditis, and dystrophy of the inner organs was confirmed by autopsy findings.