Pyelonephritis in infants
Content:
- Symptoms of pyelonephritis in infants
- Causes of pyelonephritis in infants
- Diagnosis of pyelonephritis in infants
- Treatment of pyelonephritis in infants
Pyelonephritis in infants is an inflammation of the kidneys in a breastfed baby, which is provoked by pathogenic microorganisms.
Girls are more susceptible to infection than boys; they have pyelonephritis diagnosed 6 times more often. In infants, pyelonephritis is diagnosed mainly at 4-5 months, when they begin to be transferred to artificial feeding. In newborns, the disease is detected in 1-3% of cases, and most often these children are premature.
Symptoms of pyelonephritis in infants
The course of the disease in young children has some differences and depends on the age of the child.
So, in infants, the following symptoms will be noted:
-
An increase in body temperature to high values, the fever will last from two days or more;
- Complete rejection of breastfeeding;
- Increased regurgitation;
- The urine has an unpleasant odor;
- Vomiting;
- Bowel disorders with a predominance of loose stools;
- During urination, the newborn may show anxiety, which is expressed in crying;
- The child may show increased sleepiness
- Urination occurs in small portions;
- The younger the child's age, the faster he will lose weight, especially against the background of a high temperature.
During the neonatal period, pathogenic bacteria that provoke pyelonephritis circulate in the child's blood, therefore the symptoms of the disease are not specific for this inflammation:
- Body temperature can drop to critically low values, or reach high levels, causing a feverish state;
- Yellowing of the skin is often observed;
- The child refuses to suckle at the breast;
- There are multiple regurgitation and vomiting;
- Male newborn infants have hyponatremia and hyperkalemia, although these conditions may develop in girls;
- The child is delayed in development.
Causes of pyelonephritis in infants
In most cases, during the neonatal period, the cause of the development of the disease is the ingress of bacteria into the child's blood. Circulating through the bloodstream, they reach the kidneys in a hematogenous way and cause inflammation of their tissues and systems. Therefore, almost any microbe can lead to the development of a disease in a newborn.
As for infants, they are more characterized by an ascending path of infection, when pathogenic microorganisms enter the kidneys from the bladder. In most cases, pyelonephritis in infants is provoked by Escherichia coli (see also: Causes and symptoms of Escherichia coli), although the introduction into the kidney tissue of Clesibella, bacteria of the enterococcus group, less often - staphylococci, streptococci, viruses, fungi can occur. It is possible that the kidneys are damaged by microbial associations.
The following factors contribute to the development of the disease:
- Purulent omphalitis of newborns;
- Pneumonia;
- Angina;
- Intestinal dysbiosis;
- Pustular lesions of the skin;
- Intestinal infections;
- Vulvitis, vulvovaginitis, cystitis, balanoposthitis;
- Improper and insufficient child care, non-observance of the rules for washing babies;
- Abnormalities in the development of the urinary system that impede the normal passage of urine;
- Congenital malformations of the kidneys;
- Vesicoureteral reflux;
- Hypotrophy;
- Prematurity;
- Rickets;
- Excess vitamin D;
- Postponed infectious diseases that contribute to a drop in the body's immune forces.
Diagnosis of pyelonephritis in infants
As a rule, the first to diagnose pyelonephritis in infants is a pediatrician, who sends the child with his parents for a mandatory consultation with a pediatric nephrologist or a pediatric urologist. To confirm the diagnosis, you will need to perform:
- AS;
- TANK;
- OAM;
- Sowing urine for flora with a mandatory antibioticogram;
- Biochemical analysis of urine;
- Zimnitsky's test is performed in the interpretation of Reiselman, when urine is collected not every 3 hours, but in the rhythm in which the child urinates;
- Possible detection of the disease by PCR and ELISA;
- Evaluation of spontaneous urination and control of urine output are important.
Also, the child is sent for ultrasound of the kidneys and bladder. Cystourethrography is not performed after the first episode of the disease in a child, it is carried out with repeated pyelonephritis, or if hydronephrosis, sclerosis of the renal vessels, and obstruction are detected during ultrasound.
Treatment of pyelonephritis in infants
Treatment of pyelonephritis in infants is based on the following principles:
- Compliance with bed rest during the entire febrile period;
- Refusal to introduce complementary foods, without restriction in natural protein foods;
- Timely hygiene measures in compliance with the rules for washing babies;
- Conducting symptomatic therapy using antipyretic, detoxifying and infusion drugs;
- Antibiotic therapy.
The main condition for getting rid of the child from the disease is antibiotic therapy, which is carried out in three stages. At the first stage, which lasts from 10 days to 2 weeks, the child, at the choice of the doctor, is treated with protected penicillins: Amoxiclav, or Ampicillin in combination with Sulbactam. Also used are third-generation cephalosporins: Cefotaxime, Ceftazidime, Cefixime, Ceftriaxone, Ceftibuten. When the disease is severe, aminoglycosides (Netromycin, Gentamicin, Amikacin), 4th generation cephalosporins (Cefepime) or carbapenems (Imipenem, Meropenem) are administered.
The second stage of treatment is reduced to uroseptic therapy, which is performed for 2-3 weeks. It is performed with the help of 5-nitrofuran derivatives (Furagin, Furamag), and with the help of non-fluorinated quinolones (Negram, Nevigramon, after a year - Palin), combined sulfonamides (at the age of 2 months, Co-trixomazole is allowed).
The third stage of treatment is prophylactic anti-relapse therapy. To do this, for a long time (perhaps up to a year), the child is given nitrofuran preparations - Furagin, Furamag and a course of herbal medicine is carried out, preferably monophytotherapy, taking into account individual intolerance.
As phytopreparations for the prevention of pyelonephritis in infants, you can use Canephron N, offering the child 15 drops up to 3 times a day.
For the treatment of dysbiosis, probiotics are used (Linex, Acipol). For a month, the child is given vitamin A, B6, E, which is a prerequisite for antioxidant therapy. Subsequently, it is carried out in courses.
A child after an episode of acute pyelonephritis is subject to dispensary observation for five years, and in case of relapses - constantly.
The author of the article: Sokolova Praskovya Fedorovna | Pediatrician
Education: Diploma in the specialty "General Medicine" received at the Volgograd State Medical University. A specialist certificate was immediately received in 2014.
