CHAIR OF PEDIATRY WITH CHAIR OF PEDIATRY WITH MEDICAL GENETICSMEDICAL GENETICS

SUBJECT OF LECTURE:SUBJECT OF LECTURE:

““Pneumonias of newborns. Hemorrhagic Pneumonias of newborns. Hemorrhagic disease of newborns”.disease of newborns”.

Definition

Pneumonia is an acute infectious disease of Pneumonia is an acute infectious disease of the pulmonary parenchyma, that is the pulmonary parenchyma, that is diagnosed in case of presence of breathing diagnosed in case of presence of breathing violation syndrome, physical data and violation syndrome, physical data and infiltrative changes at roentgenogram.infiltrative changes at roentgenogram.

Variant of pneumonia Depending on period of infection:Depending on period of infection:

Intrauterine transplacentalIntrauterine transplacental ( (causative agent entered causative agent entered from mother through placentafrom mother through placenta) ) and and antenatalantenatal ( (causative causative agent penetrates fetus through amniotic fluidagent penetrates fetus through amniotic fluid););

IntranatalIntranatal ( (child is infected during delivery through child is infected during delivery through infectedinfected maternal passages); maternal passages);

PostnatalPostnatal ( (infection happens after birthinfection happens after birth))::hospitalhospital;;““streetstreet”, “”, “homehome”, acquired”, acquired pneumonias (out of hospital) pneumonias (out of hospital);;children havechildren have ventilation ventilation associated pneumonias at the firstassociated pneumonias at the first

72 72 hours of being onhours of being on artificial pulmonary ventilation artificial pulmonary ventilation..

Pneumonias etiologyIntrauterine pneumonias: streptococcus of Intrauterine pneumonias: streptococcus of В, В, G and G and

D groups, D groups, ККl. pneumoniael. pneumoniae, , St. aureusSt. aureus, , Listeria Listeria monocytogenes, E.coli. monocytogenes, E.coli.

Out of hospital pneumoniasOut of hospital pneumonias: : Staphilococcus aureusStaphilococcus aureus, , Streptococcus epidermidisStreptococcus epidermidis,, Str. Str. РРneumoniaeneumoniae, , Chlamidia pneumoniae, Mycoplasma Chlamidia pneumoniae, Mycoplasma pneumoniaepneumoniae, ,

Hospital pneumoniasHospital pneumonias: : Pseudomonas aeruginosaPseudomonas aeruginosa, К, Кl. l. pneumoniaepneumoniae, , E. coli, Proteus spp., St. aureus, E. coli, Proteus spp., St. aureus, anaerobic floraanaerobic flora – – Acinetobacter, Serratia. Acinetobacter, Serratia.

VVentilation entilation associated pneumoniasassociated pneumonias: : pneumococcuspneumococcus, , HemHem. . InfluenzaeInfluenzae....

Risk factors of pneumonia development

at newborns Somatic and/or obstetric pathology during pregnancy Somatic and/or obstetric pathology during pregnancy

(it causes chronic antenatal hypoxia of fetus and (it causes chronic antenatal hypoxia of fetus and suppression immunologic reactivity).suppression immunologic reactivity).

MotherMother’’s chronic infection pathology s chronic infection pathology ((especially ofespecially of urogenital systemurogenital system).).

Acute infectious diseases during pregnancyAcute infectious diseases during pregnancy.. CComplicationomplications of intranatal periods of intranatal period ( (choreoamnionitischoreoamnionitis, ,

premature membranes rupturepremature membranes rupture, , long waterless period, long waterless period, plural manual researches).plural manual researches).

Pneumopathies.Pneumopathies. Congenital violations of lungs development.Congenital violations of lungs development. SSusceptibility usceptibility to regurgitates.to regurgitates. Prematurity, intrauterine growth retardation.Prematurity, intrauterine growth retardation.

Pathogenesis

Passes of lungs contamination by the pathogenic flora:Passes of lungs contamination by the pathogenic flora:Bronchogenic-droplet pass is typical for postnatal pneumonia and pass Bronchogenic-droplet pass is typical for postnatal pneumonia and pass

through infected amniotic fluid is typical for intranatal pneumonia;through infected amniotic fluid is typical for intranatal pneumonia;microaspiration of oral pharynx content;microaspiration of oral pharynx content; Hematogenic Hematogenic – – causative agent entering fromcausative agent entering from extrapulmonary extrapulmonary infection infection

sourcesource; ; Lymphogenic Lymphogenic – – infection spread from theinfection spread from the nearby nearby organs.organs.

Pathogenic phases:Pathogenic phases: Entering of the causative agent to the pulmonary tissueEntering of the causative agent to the pulmonary tissue, hydropic, hydropic – –

inflammatory obstruction of respiratory tract, function violations of inflammatory obstruction of respiratory tract, function violations of ciliated epithelium with spread of the agent through tracheobronchial ciliated epithelium with spread of the agent through tracheobronchial tree to alveoles and between alveoles through Kon’s pores; tree to alveoles and between alveoles through Kon’s pores;

Primary alteration of pulmonary tissue with development of Primary alteration of pulmonary tissue with development of morphologic substrate of pneumoniamorphologic substrate of pneumonia ( (of the focusof the focus, , segmentsegment, , lobe orlobe or intersticium intersticium ););

Activation of processes ofActivation of processes of lipid peroxidation lipid peroxidation with damaging not only with damaging not only causative agent but also structures of own organismcausative agent but also structures of own organism, , function violations function violations ofof surfactant, destabilization surfactant, destabilization of cell membranesof cell membranes – –increase in size of the increase in size of the injured pulmonary tissue;injured pulmonary tissue;

Pathogenesis

Pathogenic phases (continue):Pathogenic phases (continue): Violation ofViolation of perfusion perfusion through alveolethrough alveole – – capillary membrane capillary membrane ––

respiratory hypoxiarespiratory hypoxia, , development of complexdevelopment of complex dyspnea, tachycardia, dyspnea, tachycardia, increase ofincrease of stroke volume ( stroke volume (SVSV), cardiac output), cardiac output (CO); (CO);

As a result of hypoxia the increase of pressure in the system ofAs a result of hypoxia the increase of pressure in the system of pulmonary artery pulmonary artery causescauses overload overload of right heartof right heart, , dystrophic changes in dystrophic changes in myocardium – myocardium – circulatory hypoxia;circulatory hypoxia;

Respiratory and circulatory hypoxia causeRespiratory and circulatory hypoxia cause centralization centralization of blood of blood circulation and violation of perfusion of peripheric tissuescirculation and violation of perfusion of peripheric tissues, , that causesthat causes accumulation accumulation ofof suboxide suboxidess, , acidosis and acidosis and hystotoxic hypoxiahystotoxic hypoxia developmentdevelopment;;

In condition of acidosis In condition of acidosis О2-О2-connecting function of erythrocytes is connecting function of erythrocytes is violated - violated - hemic hypoxiahemic hypoxia. Toxicosis appears: exogenous – as a result of . Toxicosis appears: exogenous – as a result of action of microbal toxins, and endogenous – as a result of metabolism action of microbal toxins, and endogenous – as a result of metabolism violations. Violations of other organs and systems, all types of exchange violations. Violations of other organs and systems, all types of exchange and immunologic homeostasis appear.and immunologic homeostasis appear.

Brain is mostly sensitive to hypoxemia and hypoxiaBrain is mostly sensitive to hypoxemia and hypoxia, , thatthat’’s why function s why function violations of CNS areviolations of CNS are irreplaceable concomitant irreplaceable concomitants of newborns.s of newborns.

Classification By the periods of origin: intrauterine (antenatal and transplacental), intranatal, By the periods of origin: intrauterine (antenatal and transplacental), intranatal,

postnatal (by the location of origin: out-of-hospital, hospital).postnatal (by the location of origin: out-of-hospital, hospital).By the etiologyBy the etiology: : viralviral, , bacterialbacterial, fungous, , fungous, mixed.mixed.By the morphologic substrateBy the morphologic substrate: : focalfocal, , segmentalsegmental, , loballobal (croupous) (croupous), interstitial. , interstitial. By the localization: one-side, two-side, injured lobe and segment. By the localization: one-side, two-side, injured lobe and segment. By the course: acute (till 6 weeks), prolonged.By the course: acute (till 6 weeks), prolonged.By the severity: moderate, severe, over severe.By the severity: moderate, severe, over severe.By the degree of respiratory insufficiency:By the degree of respiratory insufficiency: І, ІІ, ІІІ І, ІІ, ІІІ degreesdegrees..By the periodBy the period: : startingstarting, , heightheight, resolution, , resolution, recovery.recovery.By the presence of complications:By the presence of complications: ToxicToxic ( (cardiocardio- - vascular syndromevascular syndrome, , syndrome of neurotoxicosissyndrome of neurotoxicosis, , DICDIC--

syndromesyndrome, , gastricgastric- - intestinal syndromeintestinal syndrome, , acute epinephros insufficiency).acute epinephros insufficiency). PPurulent: urulent: pulmonarypulmonary (abscess, (abscess, destructiondestruction), ), pulmonarypulmonary- - pleuralpleural ( (pleuritispleuritis, ,

pneumothoraxpneumothorax), extrapulmonary (), extrapulmonary (meningitismeningitis, , osteomielitisosteomielitis, , pyelonephritispyelonephritis, , otitis).otitis).

Examples of diagnosisExamples of diagnosis: : Antenatal interstitial pneumoniaAntenatal interstitial pneumonia, , severe formsevere form, , acute courseacute course, , starting periodstarting period, ,

uncomplicateduncomplicated, , RI of the third degree RI of the third degree Intranatal small- focal bronchopneumonia, medium difficult, acute course, period Intranatal small- focal bronchopneumonia, medium difficult, acute course, period

of height, uncomplicated, RI of the second degree of height, uncomplicated, RI of the second degree

Clinical and diagnostic criteria of pneumonia

Pulmonary (respiratory) complaintsPulmonary (respiratory) complaints Intoxication symptomsIntoxication symptoms Signs of respiratory insufficiency Signs of respiratory insufficiency Local physical dataLocal physical data Roentgenologic changes Roentgenologic changes Laboratory dataLaboratory data

Clinical and diagnostic criteria of antenatal pneumonia

Symptoms of respiratory insufficiency (dyspnea, Symptoms of respiratory insufficiency (dyspnea, tachypnea, dilated nostrils, additional muscles’ part in tachypnea, dilated nostrils, additional muscles’ part in the act of breathing, cyanosis, expiratory sounds) are the act of breathing, cyanosis, expiratory sounds) are shown up in the first minutes of life.shown up in the first minutes of life.

Often it connects with difficult hypoxia and it is one of Often it connects with difficult hypoxia and it is one of the component of generalized intrauterine infection.the component of generalized intrauterine infection.

Intoxication symptomsIntoxication symptoms (depression, (depression, temperaturetemperature instability, instability, appetite decreasesappetite decreases, tolerance , tolerance to to enteral enteral feeding feeding decreasesdecreases, , haemodynamics violationshaemodynamics violations, , jaundicejaundice, , haemorrhagic symptomhaemorrhagic symptom, , tachycardiatachycardia, deafness, deafness of heart of heart sounds) prevail in clinic.sounds) prevail in clinic.

Physical data is informativePhysical data is informative: dullness on percussion, : dullness on percussion, smallsmall- vesicle - vesicle and and crackling rales crackling rales duringduring inspiration. inspiration.

Clinical and diagnostic criteria of intranatal pneumonia

Light interval is typical (2-3 days of life);Light interval is typical (2-3 days of life); Often it connects withOften it connects with purulen purulent conjunctivitis t conjunctivitis

and local purulent skin injures;and local purulent skin injures; Physical data is informativePhysical data is informative: dullness on : dullness on

percussion, percussion, smallsmall- vesicle - vesicle and and crackling rales crackling rales duringduring inspiration. inspiration.

Clinical and diagnostic criteria of postnatal pneumonia

Out-of-hospital:Out-of-hospital:

The beginning is acuteThe beginning is acute, , it starts with catarrhal processes it starts with catarrhal processes inin epipharynx epipharynx, temperature increase with , temperature increase with consequential RI. Processes of toxicosis prevail at the consequential RI. Processes of toxicosis prevail at the beginning of disease (flaccidity, refusal of food, beginning of disease (flaccidity, refusal of food, decrease of muscle tonus). Physical data of lungs are decrease of muscle tonus). Physical data of lungs are small informative: tympanic resonance at periapical small informative: tympanic resonance at periapical areas, rales are rare.areas, rales are rare.

Hospital:Hospital:

Difference between hospital and out-of-hospital Difference between hospital and out-of-hospital pneumonias is: spectrum of causative agents, pneumonias is: spectrum of causative agents, resistance of agents to antibacterial therapy, difficulty resistance of agents to antibacterial therapy, difficulty and frequency of complications, high lethality.and frequency of complications, high lethality.

Features of pneumonia course at premature children:

Dominating of symptoms of RI and toxicosis in clinics.Dominating of symptoms of RI and toxicosis in clinics. Fever is not constant, it also can be hypothermia.Fever is not constant, it also can be hypothermia. The frequency of complications is highThe frequency of complications is high: : pulmonary pulmonary

(pneumothorax, atelectasis , pleuritis) and extrapulmonary (pneumothorax, atelectasis , pleuritis) and extrapulmonary ((otitisotitis, enteroparesis, enteroparesis, haemorrhagic symptom, metabolic , haemorrhagic symptom, metabolic violations- mixed acidosis, hypoglycemia, hypo-calcium, -violations- mixed acidosis, hypoglycemia, hypo-calcium, -sodium, - potassiumemia, hyperbilirubinemia).sodium, - potassiumemia, hyperbilirubinemia).

Aspiration pneumonia is more frequent at premature children in Aspiration pneumonia is more frequent at premature children in comparison with mature ones. comparison with mature ones.

The following order is characteristicThe following order is characteristic: : RDSRDS – – pneumoniapneumonia- - sepsissepsis, , as opposed to as opposed to mature children that in case of sepsis donmature children that in case of sepsis don’’t have t have lungs aslungs as site of entry site of entry of infection. of infection.

The frequency of connecting with other diseases is high.The frequency of connecting with other diseases is high. The frequency of remote consequences is highThe frequency of remote consequences is high, , it causesit causes

recidivationrecidivation of bronchopulmonary diseases. of bronchopulmonary diseases.

Plan of examination of the newborn

with suspicion on pneumonia Roentgenography of chest in 2 projections (interspersed Roentgenography of chest in 2 projections (interspersed

peribronchial focal infiltration or focal shadows at the peribronchial focal infiltration or focal shadows at the background of increased bronchovascular pattern and background of increased bronchovascular pattern and hyperpneumotization). hyperpneumotization).

Clinical blood analysis with calculating of thrombocytesClinical blood analysis with calculating of thrombocytes ((leucopenia or leucocytosis are typicalleucopenia or leucocytosis are typical, , increase of total amount increase of total amount ofof stab neutrophil stab neutrophilss, leukogram , leukogram shift to the leftshift to the left, , total total neutrophillosisneutrophillosis, , increase of leucocytic indexincrease of leucocytic index, , thrombocytopenia).thrombocytopenia).

Determination of gas content of blood and indices of acid-base Determination of gas content of blood and indices of acid-base balance.balance.

Virologic and bacteriological research.Virologic and bacteriological research. Blood examination on its sterility.Blood examination on its sterility. UUrine rine clinical analysis.clinical analysis. CCerebrospinal erebrospinal puncture by indications.puncture by indications...

Treatment of pneumonias at newborns

Main directions of therapy:Main directions of therapy: Keeping the therapyKeeping the therapy- protective,- protective, hygiene and hygiene and

sanitasanitary regimenry regimen.. Infusion therapy.Infusion therapy. Treatment of respiratory insufficiency.Treatment of respiratory insufficiency. Etiotropic therapyEtiotropic therapy. . Pathogenic therapyPathogenic therapy (anticoagulant (anticoagulant and and

antienzymeantienzyme therapy therapy).). Increase of childIncrease of child’’s resistances resistance ( (immuneimmune--

substitutive and vitamins therapysubstitutive and vitamins therapy).). PPhysical therapyhysical therapy and exercise therapy. and exercise therapy.

Treatment of pneumonias at newbornsVolume and type of feeding is determined by age, maturity Volume and type of feeding is determined by age, maturity

and condition of the newborn.and condition of the newborn.IIndicationndication for enteral feeding: for enteral feeding:

--absence of vomiting and regurgitations;absence of vomiting and regurgitations;--absence of bloatingabsence of bloating;;--absence of decompensation of circulation and RI II- III absence of decompensation of circulation and RI II- III

degrees.degrees.Purpose of Purpose of infusion therapy isinfusion therapy is:: absorption of toxins and its absorption of toxins and its

excretion from the organism, correction of acid-base excretion from the organism, correction of acid-base balance violations and water-electrolytes exchange balance violations and water-electrolytes exchange violations, improve of rheological properties of blood. violations, improve of rheological properties of blood. The fluid volume is counted individually and it The fluid volume is counted individually and it depends on daily needs in fluid, condition of heart- depends on daily needs in fluid, condition of heart- vascular system, signs of dehydration, presence or vascular system, signs of dehydration, presence or absence of pathologic loss. absence of pathologic loss.

Treatment of pneumonias at newbornsSolutions that are used for infusions: Solutions that are used for infusions: 10% 10% solution of solution of

glucose, glucose, 5% 5% solution of albumin, fresh frozen plasma. solution of albumin, fresh frozen plasma. The fluid is injected through infusator droply.The fluid is injected through infusator droply.

Features of infusion therapy:Features of infusion therapy: Using of osmose diuretics and volemic preparations is Using of osmose diuretics and volemic preparations is

forbidden (forbidden (10% 10% solution of albumin, reopolyglycin)solution of albumin, reopolyglycin)..5% 5% albumin can be used not often than 1 time a day. albumin can be used not often than 1 time a day. Infusion therapy is carrying under obligatory controlInfusion therapy is carrying under obligatory control by the by the

hour hour diuresis and waterdiuresis and water--saline balance. saline balance. Using the lazix by 1mg/kg 2 times a day is obligate. Using the lazix by 1mg/kg 2 times a day is obligate. PPlasmapheresis lasmapheresis and hemosorption can be used for and hemosorption can be used for

detoxication. detoxication.

Treatment of pneumonias at newbornsMethods of oxygen therapy in case of pneumoniaMethods of oxygen therapy in case of pneumonia

Through mask or funnelThrough mask or funnel – – speed of oxygen giving is speed of oxygen giving is 2-3 2-3 l/min., it l/min., it allows to make oxygen concentration around allows to make oxygen concentration around 25-34%.25-34%.

Through oxygen tent – speed of oxygen giving is Through oxygen tent – speed of oxygen giving is 3-4 3-4 l/min., it allows l/min., it allows to make oxygen concentration around to make oxygen concentration around 25-425-400%.%.

Through the nasal cannulasThrough the nasal cannulas (“moustache” (“moustache”) – speed of oxygen giving ) – speed of oxygen giving is is 0,2-0,5 0,2-0,5 l/min., it allows to make oxygen concentration around l/min., it allows to make oxygen concentration around 440-500-50%.%.

Oxygen therapy that is carrying directly in the baby’s place – speed Oxygen therapy that is carrying directly in the baby’s place – speed of oxygen giving is of oxygen giving is 3-4 3-4 l/min., it allows to make oxygen l/min., it allows to make oxygen concentration around 30%.concentration around 30%.

An indispensable condition of oxygen therapy is warmingAn indispensable condition of oxygen therapy is warming--up andup and humidificationhumidification of oxygen. of oxygen.

Treatment of pneumonias at newborns Indications for spontaneous breathing under permanent positive Indications for spontaneous breathing under permanent positive

pressure (SBUPPP) : augmenting of RI symptoms on the pressure (SBUPPP) : augmenting of RI symptoms on the background of usage of oxygen therapy by free oxygen flow, background of usage of oxygen therapy by free oxygen flow, rating by the Silverman’s or Down’s scale is >rating by the Silverman’s or Down’s scale is > 4 4 points, frequent points, frequent and long attack of apnea, bradycardia.and long attack of apnea, bradycardia.

Indications for artificial lung ventilation (ALV): clinical Indications for artificial lung ventilation (ALV): clinical symptoms of severe RI (rating by the Silverman’s or Down’s scale symptoms of severe RI (rating by the Silverman’s or Down’s scale is is > 7 > 7 pointspoints), ), on the background of SBUPPP on the background of SBUPPP Ра О2 Ра О2 is is <50<50 mm. mm. mercury column,mercury column, Ра СО2 Ра СО2 is is >60 >60 mm. mercury column, mm. mercury column, рНрН is is <7.2; <7.2; shock, prolonged apnea with bradycardia and cyanosis; persistent shock, prolonged apnea with bradycardia and cyanosis; persistent central cyanosis on the background of SBUPPP arterial central cyanosis on the background of SBUPPP arterial hypotension; violations of the peripheral haemodynamics. hypotension; violations of the peripheral haemodynamics.

Inhalation therapyInhalation therapy ( (lazolvanlazolvan, , euphylineuphylin, , hydrocortizonhydrocortizon, , vit Cvit C, 2% , 2% solution of chlorides or hydrocarbonate of sodium), ultrasonic solution of chlorides or hydrocarbonate of sodium), ultrasonic inhalator is used. inhalator is used.

Treatment of pneumonias at newborns

Treatment of intrauterine pneumoniaTreatment of intrauterine pneumonia::1. 1. PPenicillinenicillinss::NaturalNatural – benzylpenicillin – benzylpenicillin byby 25 000 25 000 UAUA//kgkg//dayday 2 2 times parenteraly;times parenteraly;SemisyntheticSemisynthetic::- ampicillin, - ampicillin, oxacillin by oxacillin by 25 25 mg/kg/day 2 times parenteraly;mg/kg/day 2 times parenteraly;- - amoxicillin by amoxicillin by 30 30 mg/kg/day 2 times parenteraly;mg/kg/day 2 times parenteraly;- “protected” - “protected” penicillins penicillins ((amoxyclavamoxyclav, , ampysulbinampysulbin) - 30 ) - 30 mgmg//kgkg//day day 2 2

times parenteraly.times parenteraly.2. 2. CCephalosporinephalosporins of the s of the І І generation (cephalexin, cephazolin) or generation (cephalexin, cephazolin) or ІІ ІІ

generation generation ((cephuroximcephuroxim) ) byby 20-50 20-50 mg/kg/day 2 times parenteraly.mg/kg/day 2 times parenteraly.3. 3. AAminoglycosides minoglycosides of the of the ІІ ІІ generation generation (gentamycin) (gentamycin) or the III or the III

generation (amicacyn) by generation (amicacyn) by 5-7,5 5-7,5 mg/kg/day 2 times parenteraly.mg/kg/day 2 times parenteraly.

Treatment of pneumonias at newbornsTreatment of out-of-hospital pneumoniaTreatment of out-of-hospital pneumonia::

1. 1. AmoxyclavAmoxyclav - 30 - 30 mg/kg/day 2 times parenteraly;mg/kg/day 2 times parenteraly;2. 2. Cephuroxim - Cephuroxim - 50 50 mg/kg/day 3 times parenteraly.mg/kg/day 3 times parenteraly.3. 3. AAminoglycosides minoglycosides of the of the ІІ ІІ generation generation (gentamycin) (gentamycin) or the III generation (amicacyn) by or the III generation (amicacyn) by 5-7,5 5-7,5 mg/kg/day 2 mg/kg/day 2 times parenteraly.times parenteraly.

PPenicillinenicillins and cs and cephalosporinephalosporins are effective at s are effective at treatment of outtreatment of out--ofof--hospital pneumonia that are hospital pneumonia that are caused by Strcaused by Str. р. рneumoniaeneumoniae, , HH..influenzaeinfluenzae,, at at pneumonia that are caused by Chlamidia pneumonia that are caused by Chlamidia pneumoniaepneumoniae, , Mycoplasma pneumoniae Mycoplasma pneumoniae macrolidemacrolides s should be used should be used ((erythromycin, azitromycinerythromycin, azitromycin – 10 – 10 mg/kg/day by the scheme)mg/kg/day by the scheme)..

Treatment of pneumonias at newbornsTreatment of hospital pneumoniaTreatment of hospital pneumonia::

1. Semisynthetic 1. Semisynthetic penicillinspenicillins: : carbopenicillinscarbopenicillins ( (carbenicillincarbenicillin) ) byby 100 100 mgmg//kgkg//dayday, , ureidopenicillinsureidopenicillins ( (azlocillinazlocillin, , mezlocillinmezlocillin) ) byby 50 50 mgmg//kgkg//dayday, “, “protectedprotected” ” penicillins penicillins ((amoxiclavamoxiclav) ) by by 30 30 mgmg//kgkg//dayday..

2. 2. CCephalosporinephalosporins of the IIs of the IIІ І generationgeneration ( (cephtriaxoncephtriaxon, , cephoperazoncephoperazon, , cephotaximcephotaxim) ) or the IV generation (cephepim) by or the IV generation (cephepim) by 50 50 mg/kg/day.mg/kg/day.

3. 3. AAminoglycosides minoglycosides of the of the ІІ ІІ generation generation (gentamycin, (gentamycin, tobramycintobramycin, , sizomycin bysizomycin by 4-8 4-8 mg/kg/day or the III generation (amycacin by mg/kg/day or the III generation (amycacin by 7,5 7,5 mg/kg/day, nethilmycin bymg/kg/day, nethilmycin by 2,5 2,5 mg/kg/day).mg/kg/day).

4. 4. FFluoroquinolones luoroquinolones of the II (ciprofloxacin), the III (levofloxacin) of the II (ciprofloxacin), the III (levofloxacin) or the IV generation (gatifloxacin) by or the IV generation (gatifloxacin) by 15 15 mg/kg/day in 2 doses.mg/kg/day in 2 doses.

5. 5. Carbopenems (imipenem, meropenem) byCarbopenems (imipenem, meropenem) by 60 60 mg/kg/day.mg/kg/day.TheThe 4 4th and theth and the 5 5th groups of antibiotics are prescribed according to th groups of antibiotics are prescribed according to

live indications.live indications.

Haemorrhagic disease of newborns. Definition

Haemorrhagic disease of newbornsHaemorrhagic disease of newborns ( (HmDNHmDN) ) is a disease of is a disease of newborns that is connected with the low rate of vit Knewborns that is connected with the low rate of vit K- - associated factors ofassociated factors of blood coagulation. blood coagulation.

At the first days of life healthy mature newborns have the At the first days of life healthy mature newborns have the low rate of vit Klow rate of vit K- - associated factors ofassociated factors of blood blood coagulationcoagulation, that is caused not by vit K deficiency, but it , that is caused not by vit K deficiency, but it is caused by transient insufficiency of liver function. is caused by transient insufficiency of liver function.

2-5% 2-5% of children have more low level of vit Kof children have more low level of vit K- - associated associated factors offactors of blood coagulation blood coagulation in comparison with healthy in comparison with healthy mature children, and exactly they have HmDN.mature children, and exactly they have HmDN.

Variants of HmDN Early HmDNEarly HmDN. . It develops at the first day of life. It occurs It develops at the first day of life. It occurs

rarely. Clinically it is characterized by skin and mucous layers rarely. Clinically it is characterized by skin and mucous layers hemorrhages, intracranial hemorrhages, hemorrhage from the hemorrhages, intracranial hemorrhages, hemorrhage from the umbilical wound, melena (intestinal hemorrhage). Risk umbilical wound, melena (intestinal hemorrhage). Risk factors: applying medical therapy (anticoagulants, factors: applying medical therapy (anticoagulants, anticonvulsant preparations, antibiotics, sulfanilamides, anticonvulsant preparations, antibiotics, sulfanilamides, acetylsalicylic acid) at the late periods of pregnancy. acetylsalicylic acid) at the late periods of pregnancy.

Classical HmDNClassical HmDN. . It develops at theIt develops at the 2 2ndnd- 6- 6th day of lifeth day of life.. Clinically it is characterized by melena, skin and mucous Clinically it is characterized by melena, skin and mucous layers hemorrhages, hemorrhage from the umbilical wound. layers hemorrhages, hemorrhage from the umbilical wound. Risk factors: gestosis of pregnancy, deficiency of vegetables Risk factors: gestosis of pregnancy, deficiency of vegetables in the feeding of pregnant woman, liver diseases, bile-in the feeding of pregnant woman, liver diseases, bile-excreting pass diseases, intestinal disbacteriosis, prematurity, excreting pass diseases, intestinal disbacteriosis, prematurity, intrauterine growth retardation.intrauterine growth retardation.

Late HmDNLate HmDN. . It develops after theIt develops after the 1 1st week of life duringst week of life during 3-8 3-8 weeksweeks.. Clinically it is characterized by intracranial Clinically it is characterized by intracranial hemorrhages, skin hemorrhagic syndrome, melena. Risk hemorrhages, skin hemorrhagic syndrome, melena. Risk factors: artificial feeding, absence of prophylaxys prescription factors: artificial feeding, absence of prophylaxys prescription of vit K.of vit K.

Diagnostics and treatment of HmDN

Diagnostics Diagnostics is based on anamnesis and typical clinical datais based on anamnesis and typical clinical data. . Among Among laboratory methods test of Apt is used. Also prolongation of laboratory methods test of Apt is used. Also prolongation of prothrombin time and shortening of prothrombin index are prothrombin time and shortening of prothrombin index are typical. typical.

TreatmentTreatment:: Treatment- protected regimenTreatment- protected regimen;; AAdequate dequate feeding; feeding; Prophylactical intramuscularly injection of vit KProphylactical intramuscularly injection of vit K (1% (1% solution of solution of

vicasol byvicasol by 0,3-0,5 0,3-0,5 mlml 1-2 1-2 mgmg) ) after birthafter birth;; Local therapy in case of melena isLocal therapy in case of melena is 0,5% 0,5% of sodium chlorides per of sodium chlorides per

os by 1 tea spoon 3 times a day, solution of thrombin in os by 1 tea spoon 3 times a day, solution of thrombin in epsilonaminocapron acid per os by 1 tea spoon 3 times a day.epsilonaminocapron acid per os by 1 tea spoon 3 times a day.

In case of difficult course using ofIn case of difficult course using of fresh frozen plasma fresh frozen plasma by by 15 15 ml/kg and concentrate of factors of prothrombin complex PPSB ml/kg and concentrate of factors of prothrombin complex PPSB by by 15-30 15-30 UA/kg is possible.UA/kg is possible.