Developing in the mother's belly, the child 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 fetal 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 with the formation of a new life, which is why babies are born weak and sick - with defects in mental and physical development. Such infections can cause the greatest harm to the fetus in the first 3 months of its existence.

Intrauterine infection during pregnancy: what statistics say

1. A timely diagnosed and treated infectious disease in a pregnant woman poses minimal danger to her child.
2. Infectious agents pass from mother to baby in 10 out of 100 pregnancies.
3. 0.5% of infants infected in the womb are born with corresponding signs of the disease.
4. An infection that has settled in the mother’s body does not necessarily pass to the fetus, and the child has a chance to be born healthy.
5. A number of infectious diseases that do not promise anything good for the baby may be present in the mother in a latent form and have virtually no effect on her well-being.
6. If a pregnant woman gets sick with one or another infectious disease for the first time, there is a high probability that her child will also become infected.

Intrauterine infection - ways of infecting the embryo

There are four ways that infectious agents can enter a tiny growing organism:

• hematogenous (transplacental) – from the mother, harmful microorganisms penetrate to the fetus through the placenta. This route of infection is characteristic of viruses and toxoplasma;
• ascending - infection occurs when the infectious agent rises through the genital tract to the uterus and, having penetrated its cavity, infects the embryo. So the baby may develop chlamydial infection and enterococci;
• descending – the focus of infection is the fallopian tubes (with adnexitis or oophoritis). From there, the pathogens penetrate the uterine cavity, where they infect the child;
• contact - infection of the baby occurs during childbirth, when it moves through 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 infectious infection of the fetus depends on at what stage of intrauterine development it was attacked by dangerous microorganisms:

• pregnancy 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 delayed in intrauterine development, the child is born with insufficient body weight and various malformations (for example, congenital heart disease);
• pregnancy period after 30 weeks: developmental anomalies affect the fetal organs, which by this time have already formed. The infection poses the greatest danger to the central nervous system, heart, liver, lungs and organs of vision.

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

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

Some time after birth, acute intrauterine infection in newborns may manifest itself with the following signs:

• excess daily sleep duration;
• poor appetite;
• insufficient physical activity, which decreases every day.

If the congenital infection is chronic, there may be no clinical picture at all. Distant signs of intrauterine infection include:

• complete or partial deafness;
• mental health disorders;
• vision pathologies;
• lagging behind peers in motor development.

Penetration of infection to the fetus through the uterus leads to the following consequences:

• stillbirth of a baby;
• intrauterine embryonic death;
• frozen pregnancy;
• spontaneous abortion.

The following pathological consequences are recorded in children who survived such infection:

• high temperature;
• rash and erosive skin lesions;
• non-immune hydrops fetalis;
• anemia;
• enlarged liver due to jaundice;
• pneumonia;
• pathologies of the heart muscle;
• pathology of the eye lens;
• microcephaly and hydrocephalus.

Intrauterine infection: who is at risk

Every expectant mother runs the risk of being captured by an infectious agent, because during pregnancy her body’s defenses are depleted to the limit. But the greatest danger awaits women who:

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

Symptoms of intrauterine infection in a woman during pregnancy

Doctors identify several universal signs that suggest that the expectant mother has contracted an infectious disease:

• sudden increase in temperature, fever;
• shortness of breath when walking or climbing stairs;
• cough;
• rash on the body;
• enlarged lymph nodes that react painfully to touch;
• painful joints that appear swollen;
• conjunctivitis, lacrimation;
• nasal congestion;
• painful sensations in the chest.

This 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.

Causes of intrauterine infection during pregnancy

The activity of ubiquitous pathogenic microorganisms 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 responsible for the development of acute respiratory viral diseases do not pose a danger to the fetus. A threat to the child’s condition appears only if a pregnant woman develops a high body temperature.

One way or another, intrauterine infection of the baby occurs exclusively from the 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 inflammatory pathologies such as cervical ectopia, urethritis, cystitis, and pyelonephritis.
2. The mother has an immunodeficiency state or HIV infection.
3. Organ and tissue transplantation that the 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 the disease through sexual and close household contact, through blood (for example, through a transfusion from an infected donor).

During the primary infection of a pregnant woman, the microorganism penetrates the placenta and infects the fetus. In some cases, the baby does not experience any abnormal consequences 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;
• stillbirth;
• hearing loss of sensorineural origin;
• low birth weight;
• 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 is of a general combined nature, more than half of the babies die within 2 to 3 months after birth. In addition, consequences such as mental retardation, hearing loss and blindness are likely to develop. With mild local damage, the consequences are not so fatal.

Unfortunately, there are no medications yet that can eliminate the symptoms of CMV in newborns. If a pregnant woman is diagnosed with cytomegalovirus infection, the pregnancy is abandoned because the child has a chance to remain healthy. The expectant mother will be prescribed an appropriate course of treatment to minimize the effect of the disease on her body.

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 contracted through unprotected sexual contact. Signs of the disease will appear in the child almost immediately, during the first month of life. Infection of the baby occurs mainly during the birth process, when it moves through the birth canal of the infected mother. In some cases, the virus reaches the fetus through the placenta.

When a child’s body is affected by a herpes infection, the consequences are severe:

• pneumonia;
• visual impairment;
• brain damage;
• skin rash;
• high temperature;
• poor blood clotting;
• jaundice;
• apathy, lack of appetite;
• stillbirth.

Severe cases of infection result in mental retardation, cerebral palsy and a vegetative state.

Herpes simplex virus under a microscope

Intrauterine infection - rubella

This disease is rightfully considered one of the most life-threatening embryos. The route of transmission of the rubella virus is airborne, and infection is possible even over a long distance. The disease, which poses a particularly great threat before the 16th week of pregnancy, “programs” various deformities in the development of the baby:

• low birth weight;
• spontaneous abortion, intrauterine death;
• microcephaly;
• congenital anomalies of 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 erythema infectiosum. In adults, the disease does not manifest itself in any way because it is latent. 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 pregnancy, the fetus is especially defenseless against this infection.

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

• swelling;
• anemia;
• brain damage;
• hepatitis;
• myocardial inflammation;
• peritonitis.

Intrauterine infection - chickenpox

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

Congenital chickenpox is identified by the following characteristics:

• 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” an infection 5 days before giving birth or later, the baby 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 sexual intercourse with an infected person in the absence of barrier methods of contraception. The causative agent of the disease penetrates 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:

• hepatitis B, which can be treated with the appropriate approach;
• liver cancer;
• indolent form of hepatitis B;
• acute form of hepatitis B, which provokes the development of liver failure in the 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 sexual intercourse with a sick partner. A child can become infected while in the womb or during birth. Intensive complex treatment is recommended for HIV-infected children, otherwise they will not live even two years - the infection quickly “eats” the weak body. Infected children die from infections that do not pose a mortal danger to healthy children.

To confirm HIV in an infant, the polymerase chain reaction diagnostic method is used. It is also very important to promptly detect the 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 activity of the Listeria bacterium. 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 women, the disease may be asymptomatic, although in some cases fever, vomiting and diarrhea are noted. In an infected baby, the signs of listeriosis are as follows:

• rash and multiple accumulations of pustules on the skin;
• inflammation of the brain;
• refusal of food;
• sepsis;
• spontaneous miscarriage;
• stillbirth of a baby.

If signs of listeriosis become obvious 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 treatment with Ampicillin.

Intrauterine infection - syphilis

If a pregnant woman has syphilis, which she has not treated, the probability of infecting her child is almost 100%. Out of 10 infected babies, only 4 survive, and those who survive are diagnosed with congenital syphilis. The child will become infected even if the mother’s disease is latent. The results of the infection in the child’s body are as follows:

• tooth decay, damage to the organs of vision and hearing;
• damage to the upper and lower extremities;
• 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 a pet or, out of habit, tastes meat with an insufficient degree of heat treatment while preparing 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 a child becoming infected are as follows:

• damage to the organs of vision;
• hydrocephalus;
• microcephaly;
• 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 a group of so-called TORCH infections. When planning a pregnancy, future parents undergo tests that help identify these pathological conditions.

Tests for intrauterine infections during pregnancy

Over the course of 9 months, the expectant mother will have to undergo more than one laboratory test so that doctors can make sure that she is healthy. Pregnant women take a blood test for hepatitis B and C, and syphilis. The PRC method is also used for pregnant women, thanks to which it is possible to detect active viruses in the blood, if any. In addition, expectant mothers regularly visit the laboratory to take a vaginal smear for microflora.

Ultrasound examination is of no small importance for successful pregnancy management. 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 become obvious on an ultrasound:

1. Formed developmental pathologies.
2. Polyhydramnios or oligohydramnios.
3. Swelling of the placenta.
4. Enlarged abdomen and unnaturally enlarged structural units of the kidneys.
5. Enlarged internal organs: heart, liver, spleen.
6. Foci of calcium deposition in the intestines, liver and brain.
7. Enlarged ventricles of the brain.

In the diagnostic program for examining expectant mothers belonging to the risk groups we discussed above, a special place is occupied by the seroimmunological method for determining immunoglobulins. As necessary, doctors resort to amniocentesis and cordocentnesis. The first method of research is to study amniotic fluid, the second involves studying umbilical cord blood. These diagnostic methods are very informative in detecting infection. If the presence of an intrauterine infection is suspected in a baby, then the material for research is the baby’s biological fluids - for example, saliva or blood.

The danger of TORCH infections during pregnancy. Video

Intrauterine infectious diseases pose a great danger to the health and life of the child, as they lead to delayed fetal development, various defects and diseases.

Intrauterine infection in a newborn is an infectious disease that occurs as a result of infection in the womb or during childbirth. The consequences can be very different - from the formation of congenital defects to the death of the child.

The clinical manifestations of such infections depend on a large number of different factors. For the most part, they depend on acute illnesses of the mother during the prenatal and birth periods. Symptoms are completely different and the clinical picture does not always help to identify the presence of the disease. Therefore, proper monitoring of a woman during pregnancy helps either eliminate the risk completely or eliminate all consequences.

In newborns they occur as a result of infection of the fetus with a pathogen during pregnancy or during childbirth. Most often, a child becomes infected with an infection from the mother. Cases of infection are much less likely to occur with specific types of diagnostics of the mother (invasive prenatal diagnosis), administration 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 condition of the mother's birth canal. Provided the integrity and healthy functionality of the placenta, the child is inaccessible to the simplest viruses and most harmful bacteria. However, with fetoplacental insufficiency or various injuries, there is a high probability of infection of the child.

The severity of the disease depends on the time of infection and the type of pathogen. Infection during the first ten weeks of intrauterine development guarantees a high probability of spontaneous miscarriage.

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. The disease in the second and third trimesters causes damage to individual organs or extensive infection.

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

Symptoms

It is possible to detect intrauterine infection during childbirth. Signs of infection may include:

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

In the future, other manifestations of the disease can be diagnosed:

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

Manifestations of intrauterine infection may include a grayish color of the newborn's skin, depression of the central nervous system, and excessive regurgitation. In the future, during a protracted period of development, infections can cause the occurrence of osteomyelitis, various types of encephalitis and meningitis.

Congenital toxoplasmosis

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

The chronic form leads to strabismus, microcephaly, optic nerve atrophy and iridocyclitis. Cases of monosymptomatic and latent forms of the disease occur much less frequently. Late complications entail blindness, epilepsy, mental retardation.

Congenital rubella

The disease of rubella in a pregnant woman at different periods of pregnancy with varying degrees guarantees the possibility of infection of the child. When infected during the first eight weeks, the disease in the fetus is 80% and the consequences have a high degree of risk - up to spontaneous miscarriage. The disease in the second trimester will reduce the risk to 20%, and in the third – to 8%.

A baby with rubella is often born low birth weight or premature. The typical clinical picture includes congenital heart disease, damage to the auditory nerve and eyes. Deafness may develop.

Atypical manifestations and consequences may develop:

• hepatitis
• hydrocephalus;
• microcephaly;
• cleft palate;
• skeletal abnormalities;
• defects of various systems;
• mental or physical developmental delay.

Cytomegaly

Infection with pathogens of cytomegalovirus infection often leads to damage and abnormalities in the development of various internal organs, disruption of the functioning of the immune system, and various complications.

Most often, congenital pathologies are present, which 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.

Herpetic infection

This disease occurs in three forms - broad, mucocutaneous and neurological. The broad form of the disease is characterized by toxicosis, jaundice, hepatomegaly, pneumonia, and distress syndrome. Other forms occur with rashes and encephalitis. Sepsis may develop.

Hepatitis can cause defects of varying severity - dwarfism, retinopathy, microcephaly. Later complications include developmental delay, blindness, and deafness.

Diagnostics

For modern medicine, one of the most pressing tasks is in the initial stages. To do this, a wide range of different tests are carried out to identify pathologies - smears and cultures of flora from the pregnant woman’s vagina, PCR diagnostics, specialized laboratory tests for a complex of intrauterine diseases in newborns.

A method often used is to identify specialized markers using widely used ultrasound. This method allows you to determine low and polyhydramnios, turbidity of amniotic fluid, developmental disorders and damage to the placenta, various pathologies of the fetus and disorders in the development of various organ systems of the child.

During the postpartum period, a complex of various laboratory tests is carried out to confirm or refute the presence of intrauterine infections. Tests for microorganisms, viruses and bacteria are widespread. The molecular biological research method based on DNA, serological and histological analyzes are used.

In the first days of life, if an infection is suspected, the 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.

Treatment

Treatment of intrauterine infections is a complex of multidirectional therapies that together help cope with the disease. The main types of treatment are aimed at ridding the body of pathogens, restoring the full range of functioning of the immune system, and restoring the body after an illness.

To strengthen the immune system, immunomodulators and immunoglobulins are prescribed. Most antibiotics intended for newborns and pregnant women help fight viruses and bacteria. Restoring the body consists of getting rid of residual symptoms of intrauterine infections.

Prevention

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

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

During a child's intrauterine life, the infections he receives leave a significant contribution to the statistics of newborn mortality, illness or further disability. Today, cases have become more frequent when a healthy woman (without chronic diseases or bad habits) gives birth to a not entirely healthy baby.

How can this phenomenon be explained? The course of pregnancy in women is characterized by a decrease in immunity and the activation of certain hidden (latent) infections that did not manifest themselves before pregnancy (especially dangerous in the 1st trimester).

Important information about intrauterine infection (IUI)

Every woman who is preparing to become a mother should be aware of the potential dangers that intrauterine infections pose to the fetus:

• Timely treatment for a pregnant woman can reduce or eliminate risks to the fetus.
• About 10 percent of all pregnancies involve mother-to-child transmission.
• Infection of the fetus often occurs when the mother becomes infected for the first time.
• Infection of the mother with an infection may not always result in infection of the fetus.
• Most infections that are dangerous to the fetus do not show symptoms when they occur in the mother.
• 0.5% of newborns have various symptoms of infection.

How does fetal infection occur?

There are three main ways of intrauterine infection during pregnancy:

• Descending - the infection reaches the fetus through the fallopian tubes in the presence of oophoritis or adnexitis in the mother.

• Ascending – intrauterine infections in children reach the fetus through the mother’s reproductive tract. Often this process occurs during childbirth (when the amniotic sac ruptures), but can also happen during pregnancy. When microorganisms enter the amniotic fluid, intrauterine infection can have serious consequences for the baby - improper development of the respiratory and digestive organs, skin lesions. Such infections include herpes, chlamydia and mycoplasma.

• Hematogenous (transplacental)– syphilis, listeriosis, toxoplasmosis, viruses (herpes, CMV, etc.). Penetration of the pathogen occurs through the placenta from maternal blood. Infection of the fetus in the 1st trimester very often affects the formation of developmental defects or deformities. Infection in the 3rd trimester of a newborn is accompanied by obvious signs of acute infection. Direct penetration of the pathogen into the child’s blood leads to the spread of infection.

Common pathogens of intrauterine transplacental infection

Many viruses and bacteria that are familiar to modern medicine can penetrate the fetus and cause harm to it. Most infections can be very contagious or pose a great danger to the baby's health. Some types of viruses cannot infect a child (almost all that cause ARVI); their danger arises only when the temperature rises strongly.

The result of intrauterine infection on a child

Infection of the fetus can occur in chronic and acute forms. The danger of acute infection can cause pneumonia, sepsis and shock. The consequences of intrauterine infection in newborns appear almost from birth: the child eats poorly, sleeps a lot of time, and the baby’s activity decreases. There are often cases when infection in the womb is not active and there are no obvious symptoms. Such babies are at risk due to certain consequences: delayed motor and mental development, visual and hearing impairments.

Clinic of Intrauterine Infections

During infection through the mother's genitals (intrauterine penetration), miscarriages, antenatal fetal death, miscarriage and stillbirth very often occur. Symptoms of intrauterine infections that appear in surviving babies:

• Fever
• Intrauterine growth retardation
• Micro- and hydrocephalus
• Swelling in the fetus (dropsy)
• Damage to the heart muscle (myocarditis)
• Low hemoglobin levels in the blood (anemia)
• Chorioretinitis, eye damage ()
• Inflammation of the lungs (pneumonia)
• Liver enlargement and

Who is at risk?

There are certain groups of women who have a significantly increased risk of developing intrauterine infections. These include:

• Women who have already had infected newborns
• Employees of preschool institutions and schools
• Medical workers
• Mothers with older children who go to nurseries, kindergartens and schools
• Pregnant women with chronic inflammatory diseases
• Having had multiple pregnancy terminations in the past
• Developmental disorders and antenatal fetal death
• Untimely rupture of the bladder with amniotic fluid

During what period of pregnancy is infection dangerous?

Intrauterine infections in pregnant women are dangerous at any stage. Certain infections pose a great threat to health and life in the 1st trimester (rubella), but there are other diseases that, if infected a few days before giving birth, will be very dangerous ().

Infection in the early stages often leads to negative consequences (severe disturbances in fetal development, miscarriage). Infection in the third trimester indicates the rapid progression of an infectious disease in a newborn. The degree of danger and the establishment of risks to the fetus are determined by the attending physician based on the results of tests for infection, which are often prescribed for pregnant women, ultrasound, gestational age and symptoms of infection.

Signs of infection

There are certain symptoms that may indicate the presence of infection in pregnant women:

• Swelling and pain in the joints
• Enlargement and pain of lymph nodes
• Chest pain, cough and shortness of breath
• , runny nose and watery eyes

Similar symptoms may indicate other diseases that do not pose a danger to the baby, but still, at the first signs of illness, you should immediately consult a doctor.

Common pathogens of intrauterine infection

The table below shows the most common carriers of intrauterine infections, which the analysis will help detect.

Viruses

	Maternal infection	Consequences for the child
HIV	Injection and sexual contact	Congenital HIV
Rubella	Airborne	Fetal rubella syndrome
Hepatitis B, C	Sexually	Chronic carrier of hepatitis
Herpes simplex 2	Most often through sexual intercourse	Congenital herpes
Measles	Airborne	Miscarriage, congenital measles
Parvovirus B19	Airborne	Hydrops and anemia in the fetus
Chickenpox	Contact-household and airborne droplets	Inhibition in fetal development during early infection, congenital chickenpox during infection before birth
Cytomegalovirus	Through body fluids: blood, saliva, urine, semen	Congenital CMV (without or overt symptoms)

Bacteria

Protozoa

Cytomegalovirus (CMV)

CMV belongs to the group of herpes viruses and is transmitted through sexual intercourse, blood transfusions and other interventions, and through close household contacts. About half of women throughout Europe have been infected with this virus at least once in their lives. Penetration of CMV to the placenta most often occurs when the mother is first infected.

But the presence of CMV during pregnancy can cause undesirable consequences for the fetus. The highest risk of contracting an infection is observed in pregnant women in the third trimester, but infection in the early stages causes severe consequences.

Statistics say that approximately 30-40 percent of pregnant women are at risk, but only 10 percent of newborns are born with obvious signs of intrauterine infection, while in the rest it is hidden.

The consequences of CMV for the newborn include:

• Delayed mental development and motor skills;
• Stillbirth, miscarriages;
• Blindness due to optic nerve atrophy;
• Low birth weight;
• Pneumonia;
• Poor hearing or deafness (sensorineural hearing loss);
• Damage and enlargement of the liver and spleen;
• Insufficient brain development;
• Accumulation of fluid in the cavities of the brain.

If the infection in pregnant women is not treated, and the consequences are combined, a third of newborns die in the first few months of life. Others develop negative consequences: blindness, deafness or mental retardation. Mild infection has virtually no consequences for the baby.

At the moment, there is no drug that would completely eliminate the manifestations of CMV in newborns. Only ganciclovir drugs can alleviate pneumonia and blindness. However, the presence of CMV is not an indication for termination of pregnancy, since with correct treatment negative consequences for the fetus can be avoided.

Herpes simplex virus (HSV)

Infection with HSV, especially the sexual form, causes congenital infection of the child and manifests itself during the first month of life. Most often, children become infected from mothers who have developed herpes for the first time. A child becomes infected with herpes when passing through the birth canal, but in some cases infection also occurs through the placenta.

The consequences of congenital herpes for an infant include:

• Brain disorders (convulsions, apnea, increased intracranial pressure);
• Miscarriages and stillbirths;
• Eye diseases, in particular chorioretinitis;
• Poor appetite and constant lethargy;
• Pneumonia;
• Severe increase in temperature;
• Impaired blood clotting process;
• Herpetic rash on the skin;
• Jaundice.

Often, the most negative manifestations of congenital herpes appear in the first week of a child’s life. It is at this time that the disease affects many organs and the baby may simply die from shock. If the virus affects the brain, the risk of developing encephalitis, meningitis or atrophy of the substance in the cerebral cortex increases. It is the herpes virus that often causes mental retardation.

Despite the high danger of the disease, very often in newborns the disease manifests itself only in small lesions of the eyes or skin.

Pregnant women who have been diagnosed with herpes are prescribed a course of antiviral drugs (Acyclovir) in the third trimester, and if the disease is accompanied by a rash on the genitals, a caesarean section may be recommended to prevent infection during childbirth.

Rubella

The rubella virus during pregnancy is considered one of the most dangerous, as it can cause physical deformities in newborns. The greatest danger is infection in the first trimester of pregnancy. The manifestations of rubella directly depend on the period of penetration of the virus to the fetus.

Amniocentesis and cordocentesis

Cordocentesis is a puncture of the mother's abdomen to collect cord blood. This is a very accurate method of diagnosing infection because blood from the umbilical cord may contain DNA from the infection or immune cells against it.

Amniocentesis is the examination of amniotic fluid.

Seroimmunological method

This analysis is necessary primarily for women who are at risk. The presence of IgM indicates acute infection or activation of a latent infection. Such data may be an indication for cordocentesis.

Modern medicine carries out mandatory seroimmunological analysis for the causative agents of syphilis, rubella, hepatitis and HIV. Often, a pregnant woman is recommended to be additionally tested for TORCH infections. In addition, if preparations are being made for pregnancy, it will be much easier to decipher the data obtained if there are results of similar tests before conception.

Immunoglobulins are determined as follows:

• Acute infection is diagnosed in the presence of IgM and absence of IgG;
• Formed immunity against infection shows the presence of IgG and the absence of IgM;
• The absence of both IgM and IgG indicates immature immunity;
• The presence of IgG and IgM indicates the presence of infection and the process of immunity formation. In this case, the fetus is not in danger.

Carrying out this study on a newborn is not informative, since maternal antibodies are still present in his blood.

Analysis of saliva, urine, blood and cerebrospinal fluid in a newborn

These tests can detect intrauterine infection even with hidden symptoms.

Treatment methods

Timely diagnosis and treatment of intrauterine infections will significantly reduce the risk of malformations in the fetus.

Therapy for IUI includes:

Taking medications

If a pregnant woman has been diagnosed with a bacterial infection, antibacterial drugs are often prescribed (most often penicillins, as the most effective and safe). Newborns are also given similar medications to prevent complications.

Viral diseases are much less treatable in both infants and pregnant women. Acyclovir drugs are often prescribed, and if the treatment works quickly, the risk of developing defects in the fetus is significantly reduced. The consequences of viral infections (brain disorders, heart defects) cannot be treated with antiviral drugs.

Method of delivery

If a woman has rashes on the genitals (for example, with an acute form of herpes), doctors recommend a cesarean section so that the baby does not become infected while passing through the birth canal. But most infectious diseases still do not prevent natural childbirth.

Newborn monitoring

If infected with rubella or CMV, even if there are no symptoms, children should be seen regularly and have their hearing levels checked until around age six.

Treatment of consequences

Some consequences of intrauterine infections (for example, heart defects) are eliminated surgically. In this case, the chance of raising a healthy child increases. However, very often, years after surgery, children have to wear a hearing aid due to the spread of hearing loss.

Preventive agents

To prevent the development of intrauterine infections, you should follow some recommendations from doctors:

• Timely vaccinate children and women at the stage of planning conception;
• Conduct analysis for TORCH infections at the planning stage;
• Protect the health of the expectant mother, namely limit her contact with preschool children, visit crowded places less often, minimize contact with pets and their feces, eat only high-quality foods that have been heat-treated and use protection during sexual intercourse.

Actions to take when coming into contact with an infected person

If during pregnancy a woman was forced to have long-term contact with a sick person, she must consult a doctor.

Intrauterine infection in a newborn is a special group of diseases that the baby becomes infected with before birth. Cases of infection directly during labor are also recorded. Infections of this nature can lead to fetal death, miscarriage or abnormal development.

Cases have been recorded where pathologies led to early childbirth, defects, and severe damage to the central nervous system. That is why it is advisable to carry out diagnostics in a timely manner. It involves carrying out research at the microscopic level. Additionally, the functioning, immunity, enzymes, interaction of molecules and the correctness of biological processes are analyzed.

Treatment of infections of this nature is carried out with the help of immunoglobulins and modulators. The woman is prescribed regular use of antiviral drugs, the action of which is aimed at destroying bacteria.

Intrauterine infection in newborns is observed in the presence of pathologies in certain processes. The situation is observed against the background of fetal infection. To date, it has not been possible to fully determine the route of infection. Today, approximately 10% of all children are born with this disease. This problem is especially acute in pediatrics, since this causes a large number of deaths and the development of diseases immediately after birth. Parents are advised to pay attention to infection prevention. In this case, it will be possible to reduce the risk of developing dangerous diseases.

Diagnosis of infection is prescribed during pregnancy

Causes of diseases

The process of infection in these diseases begins while the fetus is in the womb. The risk of infection also remains during labor. In this case, the mother is the carrier of the infection. The disease can be transmitted vertically or upward. It all depends on the location of the viruses and bacteria.

Only in rare cases has a pregnant woman been infected during a diagnosis that involved a biopsy or other specific procedures. The risk increases when drugs are administered to the baby through blood or plasma.

Viral agents can be transmitted antenatally. In this case, the fetus may be infected with rubella, herpes, hepatitis, and HIV. Due to intracellular pathogens, toxoplasmosis or mycoplasmosis is diagnosed.

An important role is played by the condition of the birth canal and the very process of the birth of the baby. At this stage, there remains a risk of microbes entering the baby’s body in various ways. Among bacteria, the possibility of infection with streptococci, Proteus, Klebsiella and others is increased. The placenta is initially used as an effective barrier. However, even minor damage to it can lead to the development of insufficiency. Through small holes, harmful bacteria can get inside without any special obstacles. Among them, the syphilis virus is especially dangerous.

The mother's medical history and the presence of previously unfavorable pregnancies are also taken into account. The risk of developing intrauterine infections also increases if the baby is born prematurely. Additionally, the period during which the woman was infected (before and after pregnancy) is analyzed.

During childbirth, the doctor analyzes the basic properties of amniotic fluid

The child is directly affected by the period of infection, as well as the virus that caused the development of the pathology. For example, if the pathogen penetrates during the first ten weeks of pregnancy, it will end in spontaneous miscarriage. If the infection occurs in the twelfth week, then most likely the child will be born dead or will have serious defects in the development of internal organs and systems. Infection of the fetus from the second trimester is fraught with improper development of individual internal organs or the presence of a pronounced generalized infection after birth.

It should be noted that the symptoms are radically different between mother and child. Even if no negative manifestations were detected in a woman, serious lesions may subsequently be detected in the fetus.

The possibility of stillbirth cannot be completely ruled out. Viruses and bacteria tend to penetrate deep into tissue and disrupt the functioning of the central nervous system, heart and other important organs.

Symptoms of infections

The consequences of infection in a baby are visible even during labor. The doctor pays attention to the condition of the amniotic fluid - it becomes cloudy and contains a lot of meconium. The patient may feel unwell. If a child has an intrauterine infection, then the risk of having a baby with asphyxia, a large liver and other general developmental defects increases. As a rule, rubella, pyoderma and various profuse skin rashes are additionally diagnosed. Some babies experience fever, convulsions, and various respiratory and cardiac disorders.

Antenatal intrauterine infection can lead to pneumonia, myocarditis, anemia and other diseases that appear within a few days after the baby is born. Next, the child is examined using special medical equipment. With its help, you can identify diseases of the organs of vision, defects in the heart, the presence of cysts and improper functioning of the brain.

With IUI, a child may develop pathologies

The neonatologist pays attention to the baby in the postpartum period. In the presence of diseases, he often regurgitates, there is muscle weakness, and an incorrect reaction of the central nervous system. The skin is examined regularly. It is not allowed to be a pronounced gray color. Intrauterine infections have different incubation periods. Each disease is analyzed separately depending on the nature and specification of the manifestation.

Each individual TORCH infection has different diagnostic and treatment methods. It is recommended that you consult a specialist in the field for detailed advice on this matter.

Main types of infections

Intrauterine infection is a broad concept. Its division is carried out depending on the source of the disease:

In medical practice, it is customary to combine the most common diseases with a special abbreviation - TORCH.

This syndrome includes toxoplasmosis, rubella, herpes and other lesions.

This includes testing for the presence of HIV, hepatitis, smallpox, mycoplasmosis, and syphilis.

Toxoplasmosis: features of infection

The disease is diagnosed if the fetus in the womb has been infected with Toxoplasma Gondii cells. Pathology can lead to abnormal development, the presence of defects of the brain, heart and other internal organs.

Diagnosis is made immediately after the baby is born. The infection manifests itself in the form of severe fever, jaundice, swelling, stool disorders, and periodic convulsions. Additionally, the baby may have symptoms of meningitis and encephalitis. If the disease becomes chronic, the situation is aggravated by strabismus or complete atrophy of the optic nerve. Unfortunately, the infection can be fatal before delivery.

At a late stage of the disease, the baby develops epilepsy and complete blindness.

Features of rubella during intrauterine infection

Infection occurs when the disease is transmitted during gestation. In the first eight weeks the probability reaches eighty percent. In the second trimester it drops to twenty, and in the third to eight percent.

If the child has the disease, he will be born prematurely and will not gain weight well. Additionally, a rash and obvious manifestations of jaundice can be seen on the skin.

Congenital rubella is dangerous due to the following symptoms:

• partial or complete damage to the eye muscle;
• insufficient tone of the auditory nerve.

If the infection strikes the baby in the second part of pregnancy, he may be born with retinopathy or complete deafness.

Anomalies against the background of rubella are extensive. Defects can manifest themselves in the structure of the palate, hepatitis, abnormal structure of the skeleton or genitourinary system. The infection is dangerous because the child may subsequently lag behind in physical and mental development.

Diagnosis should be carried out during pregnancy and after the birth of the baby

Cytomegaly: features of infection and course of infection

This type of infection is dangerous because it leads to severe damage to the internal systems of the sick child. The complication can also lead to immunodeficiency or the appearance of purulent skin lesions. Defects can be either congenital or appear during a certain period of development. During the postpartum period, jaundice, hemorrhoids, pneumonia, anemia and other diseases may appear.

Subsequently, the organs of vision, liver, deafness and other diseases remain at risk.

Intrauterine herpes infection

Herpes infection can manifest itself in several forms:

• the generalized form is characterized by toxicosis, the presence of respiratory diseases, jaundice, diseases of the upper respiratory tract and lungs, hemorrhoids;
• neurological;
• damage to the mucous membrane and skin.

If the bacterial infection becomes multiple, the child is diagnosed with sepsis.

Herpes is a dangerous infection that can lead to a number of complications. Among the most dangerous are complete deafness, blindness, abnormal development or delay in it.

Features of diagnostics

Today, the diagnosis of intrauterine infections is quite acute. It is necessary to find out as early as possible about the presence of harmful bacteria, viruses and fungi. To do this, a smear is taken in the gynecologist’s office, cultured to check for the presence of bacteria and the state of the microflora. In some cases, PCR or complex TORCH analysis is additionally prescribed. Invasive prenatal diagnosis should only be performed on women who are at increased risk.

The gynecologist will be able to examine certain markers during an ultrasound examination. Attention should be paid to diagnosis if low or polyhydramnios and other pathologies of pregnancy development were previously diagnosed. If there are deviations, the doctor will additionally prescribe a study of the functioning of the heart and blood flow.

Additional research must be carried out even after the baby is born. For this purpose, microbiological tests are performed. DNA research should be done. For this purpose, serological research methods are used. An important role is played by the result of histology of the placenta, which can also be done after childbirth.

If the baby is suspected of having any intrauterine infection, then during the first day of life he should be constantly under the supervision of a neurologist, cardiologist and other specialists in the field of childhood diseases. At their discretion, tests are prescribed to identify pathologies in the development of hearing, vision and other internal organs.

For prevention purposes, a woman should be regularly examined by a gynecologist.

Basic principles of treating infections

At the first stage of eliminating pathologies, it is necessary to take medications to boost immunity against the development of viral, bacterial and other diseases.

To improve immunity, it is necessary to use special modulators and immunoglobulins. Acyclovir is most often used against viruses. Effective therapy against bacteria involves the use of broad-spectrum antibiotics.

Therapy must be carried out one at a time to get rid of each individual symptom. Otherwise, the risk of pathologies in the central nervous system increases. As a result, the child may experience problems with the heart and lungs.

Prevention of infections

If a patient is diagnosed with a generalized form of infection, then the probability of transmitting it to the child is eighty percent. With local manifestations, the risk of damage to only individual internal organs increases. Unfortunately, almost every infection can lead to problems with the central nervous system in the future.

Basic methods of prevention involve conducting a complete examination of the patient before pregnancy. During pregnancy, you should protect yourself from contact with sick people. If a woman has not previously had rubella and has not been vaccinated against it, then the injection must be given three months before the planned pregnancy. Additionally, it should be noted that some cases of infection require termination of pregnancy at any stage.

Not much time has passed since death from infectious diseases in the first year of life was depressingly common, and in 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 widely used in the forties of our century, revolutionized the treatment of infectious diseases in infants; There has also been a significant increase in information about how to combat infectious diseases in general.

Infant mortality, that is, the death rate for children under one year of age, is now a tenth of what it used to be, and infectious diseases, which used to be the leading cause of child mortality, now rank lower on the list.

Universal immunization, compulsory by law in the UK, has prevented terrible epidemics. With the advent of a vaccine in 1950, polio, once a terrible disease that crippled and killed thousands of children every year, became a disease of the past. Measles, which just a few years ago was practically recognizable at first sight, has become so rare that today's medical students are unable to make the diagnosis. Postpartum care, sterilization of artificial milk, 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 pose a particular risk. Some babies' bodies cannot produce 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 baby's body, which form harmless colonies of bacteria on the baby's skin, in the mouth, in the throat and in the intestines. A healthy person is able to coexist with this horde of completely ordinary bacteria, unless they begin to multiply too quickly and get into those parts of the body where they are not supposed to be. We all have natural flora. It is, of course, necessary to distinguish these bacteria from the less common and much more dangerous ones, which we classify as pathogenic, since they can cause disease, and we try to protect the child from them by strengthening his immunity.

Cystic fibrosis (cystic fibrosis) is an inherited disease whose cause is unknown; occurs in approximately one case out of two thousand. This is a general disorder in the body's glands that produce abnormal cells, resulting in excessive sweating, intestinal obstruction and respiratory complications. The pancreas, located next to the liver, is affected in 80% of cases, which makes normal digestion and absorption of fats impossible and leads to insufficient nutrition of the body.
Ma, why does the child not gain weight? Often fatal; 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 reserve of antibodies in a newborn baby is greater than that of the mother. The child receives relatively more antibodies that fight viral infections, and less of those that fight certain types of bacterial infections. When a particular bacterium firmly holds its position, it is usually discovered that the child has not received enough antibodies against it. If anything, nature's accounting seems to have made a mistake. Of course, if the mother herself does not have a certain type of antibody, she cannot pass it on to her child. For example, a child of a mother who has had measles or has been vaccinated against this disease is born with a supply of antibodies that will protect him in 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 supply of antibodies gradually declines, and by the end of the fourth to sixth month, only a very small amount remains to fight infection for the next four to five months. At about three months of age, the baby begins to produce the same antibodies it received from its mother, and by the age of three to four years, antibody production 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 show no symptoms even though antibodies are produced. Immunization is required against those dangerous bacteria from which the child is not protected because he received little or no antibodies from the mother. A good example is whooping cough, or spasmodic cough. Vaccination against whooping cough, diphtheria and tetanus, which a child is given at one of his first visits to the pediatrician, stimulates the production of antibodies against these microorganisms. If a child is not immunized, he will be vulnerable to infectious diseases and will not be equipped 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 amount of maternal antibodies has dropped to a certain level.

When can a child become infected?

Firstly, this 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 membranes. In these cases, the infection crosses the placenta from the mother's blood supply into the baby's bloodstream.

A classic example of this type of transmission of infection from mother to child is, of course, syphilis. Although this disease has become quite rare, there has been a slight increase in cases of infection. Another disease transmitted by mother to child during the prenatal period is typhoid fever. But most contagious bacterial diseases are well controlled.

Infectious disease exposure in utero came into the spotlight at the end of World War II when it was discovered that the rubella virus could damage the fetus in the first few weeks of pregnancy. A significant number of children whose mothers become infected with rubella in the first three months of pregnancy may become infected with the disease. 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, and possibly when the baby passes through the affected cervix during childbirth. As with rubella, an infected baby can produce the virus for many months after birth and become a source of infection for others. A child in the womb is also vulnerable to microorganisms, one of which is the causative agent of toxoplasmosis.

After the baby is born, infection from the amniotic fluid and membranes can be directly transmitted to the baby. This can happen if the membranes have burst and labor has not begun. This is why it is so important that the maternity hospital knows that your membranes have ruptured and can advise you when to come to the maternity hospital. Many departments have different opinions regarding how long to wait for labor to begin after membrane rupture. Usually, contractions and labor begin a few hours after your water breaks. But it still happens that nothing happens.

It is generally accepted that if contractions have not begun six hours after the sudden rupture of the membranes, it is worth inducing labor with an intravenous infusion of oxytocin. The reason for this is that the more time passes from the moment the membranes rupture, the more opportunity microorganisms have to penetrate the uterus. A smear is usually taken and antibiotics are sometimes prescribed, but only if labor has not started within twelve hours of the membranes rupturing.

It is worth emphasizing once again that every maternity hospital, every clinic and every gynecologist and obstetrician has its own scheme of action. Nevertheless, today in every maternity hospital obstetricians make notes about the delivery in order to record the sequence of actions in certain circumstances. These records should continue to be maintained because they allow the decision-making process to be based on the highest standards recorded in them.

Infection during childbirth used to be very common, but precautions taken by modern obstetricians have greatly reduced the risk of infection. Most babies are born in maternity wards under sterile conditions and then transported to the nursery, where the watchword 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 discharge from the maternity 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. Colds, sore throats, diarrhea and so on caused by the virus are common, and a child who has just arrived from the hospital is not protected from these ailments, but for reasons that are not entirely clear, these diseases cause much milder symptoms in the first few months of life.

Newborn babies are susceptible to urinary tract infections, respiratory diseases, cutaneous meningitis or skin infections. In other words, they are susceptible to the same types of infectious diseases as adults. The difference is the speed at which the disease spreads in the newborn. As a result, a disease that is easily curable in older children and adults is usually more of a concern when the patient is an infant. The doctor is more likely to admit an infant with a urinary tract infection, severe diarrhea, or high fever without any specific symptoms. Many infections, even very dangerous ones, can cause nonspecific symptoms in a newborn.

Sometimes an infection can be found in the bloodstream; this disease is known as sepsis; happens extremely rarely. Another possible target for infection is the umbilical cord stump, which is cut off from the bloodstream and not sufficiently protected to withstand the onslaught of bacteria. This inflammation, which is of great concern in underdeveloped countries, is called omphalitis. Proper care of the umbilical cord is mandatory in maternity hospitals, and sanitary conditions have significantly reduced the incidence of this inflammation.

Intestinal obstruction

There are many different causes of intestinal obstruction, even in young children. A foreign body, local inflammation, or tumor can block the intestinal passage. With early detection, most causes of intestinal obstruction can be detected and completely eliminated.

Although intestinal obstruction is rare, it is important to know the symptoms. This is spasmodic pain in the abdominal area, causing the infant to cry excessively, vomiting, flatulence (bloating due to the accumulation of gases) and gradual dehydration, manifested in the usual signs of a decrease in the amount of fluid in the body, such as a dry tongue, wrinkled skin, sunken eyeballs and so on. Whatever the cause of the obstruction, surgical treatment is required.

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

Other causes include intestinal volvulus and nodule formation, sometimes in the form of a hernia. In young children, one section of the intestine may nest into the adjacent one (intussusception - see below). It should be emphasized that these diseases are rare, all can be treated surgically and usually do not cause problems in the future.

Intussusception

This is a rare intestinal disease that occurs primarily in infants and young children. Requires medical supervision and surgical intervention. The child screams in severe pain, and his stool resembles lumps of currant jelly. This undeniable appearance of the stool is given by mucus mixed with blood. A section of intestine suddenly invades the adjacent one. Imagine holding a heavy flexible hose or nozzle with both hands, and then bringing your hands together to force the hose to fold. This illustrates with sufficient accuracy what happens during intussusception: a small section of intestine is inserted inside, and with subsequent spasms, an increasing length of intestine gets inside. Blood vessels also enter the interior, blood supply
is disrupted, swelling and necrosis of the intestinal area that has undergone intussusception occurs.

Obviously the pain is very severe. It can be periodic, with intervals of calm, and is usually a serious reason for parents to contact a doctor. Jelly-like stools will confirm the diagnosis if necessary. Treatment consists either of administering an enema, which can straighten the intestines, or, if this method does not produce results, in surgery, which will be the only way out. During the operation, a small section of the intestine is either straightened or removed. The prognosis 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 occurs in newborns often enough 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 attention of the mother, but doctors and nurses in the maternity hospital closely monitor this manifestation.

However, jaundice can be caused by medical conditions that are more serious. The actual physiological cause of jaundice is a yellow pigment called bilirubin, which is usually present in small quantities 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 continuously undergoes the 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 blood circulation. These old cells break down and the hemoglobin undergoes a chemical change - the product of this chemical breakdown is bilirubin, which causes jaundice. Bilirubin is then transported by the bloodstream to the liver for further processing, and here, with the exception of a small amount, enters the bile. Bile flows through the bile duct into the duodenum, into the intestinal contents and is excreted from the body.

The remaining bilirubin in the body returns from the liver to the bloodstream. The amount of bilirubin normally present in the body is small, but it can be measured. A chemical analysis, or blood test, can distinguish bilirubin going to the liver from bilirubin that has already been processed and returned to the blood, and it is the amount of bilirubin that reaches a critical level in jaundice.

Hepatitis is a disease that most people associate with jaundice in an adult. In this case, the liver becomes inflamed and cannot fully perform its job of processing bilirubin formed during the normal breakdown of old cells. Therefore, bilirubin accumulates in the blood and the patient experiences yellowing. Another cause is gallstones blocking the gallbladder or ducts; and some types of anemia, in which red blood cells are destroyed so quickly that the liver can't handle all the bilirubin.

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

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

Another cause of jaundice in newborns, often very serious, is incompatibility of the blood types of mother and child (Rh factor incompatibility).

Finally, as a result of very high levels of bilirubin, or in other words, excessive jaundice, a disease called kernicterus occurs. Not all babies with high bilirubin levels develop kernicterus, but there is a strong correlation between the two. If the level of jaundice becomes very high, degenerative changes can occur, severe damage to parts of the brain, resulting in cerebral palsy and deafness. Needless to say, this is extremely rare and jaundice is not allowed to reach critical levels. Obviously, the primary task of the physician is not only to discover the underlying cause of jaundice, but also to keep the jaundice within safe limits.

Pulmonary collapse

Sometimes air enters the pleural cavity and remains between the lungs, chest and diaphragm; this disease is called pneumothorax. In a newborn, pneumothorax can cause breathing difficulties caused by airway obstruction.

The air present in the pleural cavity can also press on the lungs and thereby reduce the volume of the lungs during inspiration. This may result in rapid breathing and blue coloring. A doctor may diagnose pneumothorax after listening to the chest and taking an X-ray if the child 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 space.

Moniliasis (thrush)

This common fungal infection is very common in the vagina of women, and especially during pregnancy. It can also occur in a child, often in the mouth; a child can catch a 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 is very often talked about. First of all, it is a common practice to screen all newborns for phenylketonuria; secondly, this disease is a typical example of 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 (absorption) of one of the components of proteins (proteins), which are called amino acids - phenylalanine. Think of amino acids as the building blocks needed to build all proteins, and the process of digestion as the breakdown of proteins into these small components. Each amino acid is essential for a specific step in the normal process of growth and development.

With phenylketonuria, the body is unable to convert phenylalanine into tyrosine due to a deficiency or disruption of the production of a certain enzyme. This can be detected by a routine test of a blood sample taken from the baby'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, this can affect the child’s overall physical development and well-being. Children whose disease has become severe eat poorly, vomit, and do not gain weight.

This disease is easily treatable, which consists of switching to a special diet containing exactly as much of this amino acid as the body requires and no more. For example, vegetables and fruits contain little phenylalanine, and artificial milk has been developed that contains all the essential amino acids and a reduced amount of phenylalanine. But still, since treatment is necessary and observation is fraught with difficulties, it was considered necessary to organize treatment centers locally. Today, treatment for phenylketonuria can be completely completed for most children by school time.

Pyloric stenosis (narrowing of the pylorus)

This means that the muscle valve that ensures the outflow of food mixed with gastric juices from the stomach to the beginning of the small intestine (duodenum) thickens and partially or completely blocks the lumen. Since in this case there is no other way for milk and other food to leave the stomach except through the mouth, the child begins to vomit. Vomiting during or immediately after a feeding is the first symptom a parent will see, but for some babies, spitting up small amounts of milk during a feeding is common.

Usually the vomiting is rapid - like a fountain. This differs from regular regurgitation, in which milk flows out in a weak stream. If this vomiting continues, signs of dehydration and starvation develop. Very often, vomiting begins a few weeks after the child leaves the hospital, and is much more common in first-born children and boys. The diagnosis is made upon examination and confirmed by x-ray examination. The treatment is quite simple, consisting of a small surgical operation, well tolerated by infants, during which, under general anesthesia, a small incision is made in the stomach muscle in order to ensure patency of the gastrointestinal tract. Usually the child wakes up after a few hours.

Finally, there is no significant hereditary influence; Therefore, if one child in a family has the disease, subsequent children are only slightly more likely to have it than any other child.

Spinal column defects

Think of the spinal column as columnar rings of bone, held together by ropes, or ligaments, and adjacent to each other in such a way that together they can tilt forward, backward, or sideways. The spinal cord passes through a tube or canal formed by rings stacked 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, consisting of nerve endings that connect the control centers of the brain to the web of nerves that envelop the entire body. Signals in the form of encoded pulses travel through this cable in both directions.

At all levels, from the cervical region to the lumbar region, nerves branch from the spinal cord through spaces between rings of bone called vertebrae. The spinal cord, like the brain, floats in a fluid called cerebrospinal fluid and is located under membranes called the meninges. Thus, the fluid and membrane together form a safety cushion that protects the fragile brain and spinal cord.

Sometimes (the actual reason is unknown) there is a cleft in the bone 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 a hole in the spinal column, the length of which can vary from one to five or even six vertebrae.

Spina bifida can be very small and is only discovered when, upon examination, the doctor notices a small 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 see membranes protruding from the cleft, and even see cerebrospinal fluid through the transparent membrane. This is called a meningocele. Some of these cases can be corrected with surgery, while others, unfortunately, can cause problems of varying severity, from mild disability to complete disruption of the functions of the intestines and urinary system.

Thirty years ago, the diagnosis could only be made after the birth of the child, but now this disease is detected with a reasonable degree of accuracy in two ways. First, through a blood test, which is usually done after the sixteenth week at the same time as the Down syndrome blood test, which measures the amount of a substance called alpha-fetaprotein. It is this substance that increases to high levels in spina bifida and sometimes in some cases of hydrocephalus. This analysis is not entirely accurate, but if it does not detect the disease, today most women in our country undergo a mandatory ultrasound examination during the pregnancy period of sixteen to nineteen weeks, during which such defects can be detected and, together with the parents, a decision on further action can be made.

In severe cases, when there is, for example, spina bifida and at the same time hydrocephalus and the prognosis for the child is very unfavorable, it is possible
but it is worth going for an abortion. If not, a prenatal diagnosis may be helpful either by ensuring that the birth takes place in an intensive care unit, where all the facilities necessary for surgery are available, or by ensuring that a variety of specialists are present during the birth so that so that the situation can be assessed as early as possible.

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

Esophageal tracheal fistula

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 various forms, but always requires surgical treatment.

If you press at the base of your throat just below your Adam's apple, you can feel your windpipe. It starts from the pharynx, or glottis, and ends in the chest a few inches below the clavicular cavity. At its lower part, the trachea divides into two large branches called bronchi, through which the air you inhale 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 disorder, these two tubes communicate, or if the esophagus ends, as sometimes happens, in a blind cul-de-sac, then nothing swallowed - food, liquid or saliva - can enter the stomach.

A child with this disease is in serious danger, and to make matters worse, stomach acid is released through the esophagus into the trachea and lungs, causing a violent reaction with pneumonia. Children with this condition are unable to eat and are prone to lung infections; they regurgitate food back, choke and choke; a serious condition quickly develops. This disease undoubtedly requires surgical treatment in the first few days of life. The results are usually very satisfactory.

Undescended testicles

The testicles of a male child are formed early in fetal development, but they are initially located high in the abdominal cavity and remain there until late in pregnancy. Most boys' testicles descend into the scrotum by the time of birth, but sometimes one or both testicles remain outside the scrotum, and when the doctor examines the newborn, the testicles cannot be felt in the scrotum.

We don't know why this happens. This may be due to underdeveloped testicles and is more common in premature babies. It should be noted that testicles that remain in the abdomen will almost certainly not be able to produce sperm after puberty, even if surgery lowers them to their normal location, the scrotum. Therefore, treatment consists of a relatively simple operation that requires hospitalization for several days, and the prognosis is favorable. The length of the operation will depend on a number of factors. Unless one testicle is descended, it must be operated on no later than puberty, but usually between the ages of five and twelve years. If both testicles are not descended, usually one is operated on in infancy and the other at the age of five or six years.

Defects of the urinary system

Congenital defects of the urinary system are quite common, and since obstruction at any site can have serious consequences for the entire system, and because urine is the body's primary means of eliminating waste, the importance of this topic is obvious.

What do we mean by urinary system? There are two kidneys, ureters, a bladder and a 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, which are 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, and in men it runs along the entire length of the penis.

It is not difficult to imagine that a urinary tract obstruction 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 the urethra. The accumulated urine would stretch the bladder, the bladder would contract to get rid of the urine, thickening its muscle wall, the ureters would have to work harder to push urine into the already full bladder, the urine would begin to flow back up from the bladder and then into the bladder. kidneys Under the increasing pressure of the returned urine, the kidneys would begin to stretch, and this chain of degenerative changes could end in renal failure. A similar picture would arise if the blockage were present in any other area.

How can urinary obstruction be diagnosed?

Sometimes this can be detected by palpation: in the side of the newborn’s abdomen you can feel a kidney that is much larger than it should be. But in some cases, problems arise only after an infection enters the urinary system: difficulties with urination, a thin dripping stream and the complete impossibility of potty training - these are the signals that require attention. Excessive urination, high fever, abdominal pain, nausea, vomiting, and cloudy or bloody urine are all symptoms of a possible urinary tract infection.

There are many tests available to determine if and where the obstruction is located. Today, the fetal urinary tract can easily be seen during ultrasound examination of the mother's abdominal cavity, and abnormalities are often detected. Most of the abnormalities in question can be corrected surgically in the first few years of life.

Source Sanders P. All about pregnancy: day by day. - M.: Eksmo Publishing House, 2005.