Newborn bronchiolitis: a viral infection of the lower respiratory tract
Brionchiolitis in the newborn is a disease that should not be underestimated that affects infants in the first months of life, especially during the winter. In case of brionchiolitis, your doctor will prescribe the most suitable treatment for the newborn in order to recover quickly. With a small child. it is good to pay attention to every choice and always follow the most suitable hygiene rules. Find out how to take care of your baby, watch our video!
Pathogens of newborn bronchiolitis
The pathogens of this infection are primarily RSV, respiratory syncytial virus, but also metapneumovirus, coronavirus, rhinovirus, adenovirus and influenza and parainfluenza viruses or it can be caused by a type of germ, chlamydiae, which they can give rise to a more severe form of bronchiolitis, especially in infants from 1 to 3 months. Less frequently, bronchiolitis in newborns is a consequence of infection with Rhinovirus, Retrovirus, Measles Virus, Mycoplasma pneumoniae. Usually it is a viral infection. Influenza, parinfluenza and adenoviruses are more rarely responsible. Respiratory syncytial virus infects people of all ages. In cultures infected with this pathogen, cells fuse.In cytology, this fusion of two or more cells with the formation of a single multinucleated cell is called syncytium, hence the name of the virus itself. This virus is more dangerous in children under the age of two, as being the smaller respiratory tract, it can cause dyspnea (difficulty in breathing) even severe. Infants of one or two months old are particularly at risk, who despite having absorbed antibodies from the mother during pregnancy through the placenta, can easily become infected in contact with infected people. Due to the infection in the inflamed respiratory system, a lot of mucus is produced, the airways are blocked and the newborn experiences serious difficulty in breathing. The virus narrows the bronchioles, consequently little air enters the lungs and breathing difficulties arise. Obviously, there are greater risks if the baby is less than twelve weeks old, if he was born prematurely, if he has previous pathologies, congenital heart disease, bronchopulmonary dysplasia and immune deficiency.
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Symptoms of bronchiolitis
Bronchiolitis usually begins with an inflammation of the nose and a modest fever. In addition to rhinitis, the child may have a persistent cough, wheezing and difficulty in breathing. Usually, the infection resolves with timely and adequate treatment. But in some cases, hospitalization is necessary. In fact, especially if the baby is less than 6 months old, his blood oxygen level can drop. The oximeter (also called pulse oximeter or oximeter) monitors the degree of oxygen saturation; allows not only to measure the oxygen saturation of hemoglobin in arterial blood ("SpO2"), but also to measure the patient's heart rate. The sweat caused by labored breathing and poor nutrition, due to the difficulties deriving from the physical conditions of newborn, can lead to dehydration. There is also the possibility of a long pause in breathing (apnea). Chest retractions due to exhalation can also be detected. In these cases, they must be monitored constantly. patient will be able to take advantage of humidified and heated oxygen, to improve blood oxygenation, and an infusion with glucosaline solutions to obtain better hydration. In cases in which hospitalization is reached, doctors can constantly monitor the evolution of the infection in children, they can resolve complications by administering oxygen and parenteral feeding The course is about 12 days with a benign prognosis, except for complications.
The diagnosis of bronchiolitis in the newborn
A visit to the pediatrician and observation of symptoms is usually enough to reach a diagnosis of bronchiolitis. The diagnosis is based on the medical history and direct examination. The pediatrician collects data and news regarding the child's health in order to be able to use them for a more complete diagnosis. Then he moves on to the physical examination, listening to the newborn with the stethoscope. Sometimes the specialist requires specific analyzes or x-rays, if he deems it appropriate. For example, it may be necessary to analyze the aspirate of the nose and pharynx to identify the virus involved and measure arterial saturation. The identification of the respiratory syncytial virus can be done with a molecular diagnostic test or by swabbing. Chest x-ray is rarely necessary to rule out thickening of atelactasia, which causes respiratory failure or bronchial thickening.
Prevention and therapy
The hygiene rules to reduce the possibility of contagion and complications are as follows: avoid contacting the child with people suffering from respiratory tract infections, cleanse and disinfect your hands well before taking care of him, breastfeed him to increase his intake of liquids, wash his nasal cavities, lair of various microorganisms, with physiological solutions, do not smoke in the house. If the child has no respiratory deficit, eats, has a sufficient level of oxygen in the blood, it can be treated at home with the therapies and advice of the pediatrician. His nasal secretions are aspirated with frequent washing; the inhalation of bronchodilator drugs makes breathing easier, the aerosol with hypertonic solution thins the excessive mucus of the phlegm. The concentration of salts in the hypertonic solution is higher than that of our cells; it allows these to release water, favoring the expulsion of mucus. The use of cortisone does not reveal any real improvements in children with this type of infection. Antibiotics should only be used if they are children with a deficient immune system or if it is presumed that there is also a bacterial infection in place. Antibiotics are not suitable therapy for viral infections. Therefore, only in cases of bacterial infections, they will be prescribed by the specialist.
Bronchiolitis: An attack on the bronchi and bronchioles
This lower respiratory tract infection damages the bronchioles, thin branches of the respiratory system close to the pulmonary alveoli. In addition to excessive mucus secretion, it often causes an increase in the thickness of the bronchi. Due to the infection in the inflamed respiratory system, a lot of mucus is produced, the airways are blocked and the newborn experiences serious difficulty in breathing. In fact, bronchiolitis causes inflammation, edema and flaking of the epithelial cells of the alveoli. Respiratory syncytial virus (RSV) causes small epidemics, especially in winter. Direct contact with infected secretions causes the infection, the phase of which lasts from 6 to 10 days. The infection occurs through the breathing of small infected drops of someone who coughs or sneezes or by touching contaminated objects and then putting their hands on their mouth, nose and eyes, without having first cleaned them well with disinfectant soaps. The risk increases in pediatric age due to immaturity of the lungs and immune system.
In children over two years of age and in adults the symptoms are mild and the disease heals rapidly, taking seven days, even if the breathing difficulties when they are considerable are slower to pass.
Complications in the course of bronchiolitis
After 2 days with symptoms such as cold, low fever, dyspnea can worsen, breathlessness and tachypnea (rapid breathing) occurs. Tachycardia, cyanosis, dehydration, blockage of urine, dry cough, wheezing and noises in breathing, loss of appetite, irritability and insomnia may occur. If there is only a drop in oxygen (O2) it is defined as of I.R. hypoxemic, if carbon dioxide (CO2) increases at the same time as hypoxemic-hypercapnic IR (type II or total). In newborns, asthma and gastroesophageal reflux can cause symptoms that resemble those of bronchiolitis. Also against pertussis and cystic fibrosis it is necessary to carry out differential diagnoses or rather a differential diagnosis, by which we mean not the point of arrival, but the path operated by the exclusion of other diseases through symptoms and laboratory and instrumental investigations. If bronchiolitis is quite serious, thanks to antivirals it is possible they can achieve good results if the therapy is started in the initial phase It is advisable to call the doctor if the baby is not breathing well, has not eaten, has not urinated for at least twelve hours, has a high fever and fits of irritability.
By following all the prescriptions of the specialist and all his advice, the newborn can recover without complications and consequences: breastfeeding the newborn little and often and making him drink a lot hinders dehydration and facilitates the thinning of the mucus; it is important to keep the rooms humidified, not subject it to passive smoke, keep it seated or semi-seated as much as possible to make it breathe better; do not hesitate to go to the emergency room if the baby's condition worsens, that is, if the baby shows a lethargic state, cyanotic color, long apneas, has a high fever or feels sudden cold. Very often in older children and adults the disease is considered a simple flu and this underestimation of the pathology can lead to complications, especially in the elderly, heart patients, chronic bronchitis patients, immunosuppressed subjects. gathering and the presence of children who already attend school and could infect the newborn. RSV is a very resistant virus even to disinfectants, it resists skin and objects for up to seven hours. Therefore, it is necessary to observe maximum hygiene of the newborn, his toys and the environment in which he lives.
