General principles of patient management
The main feature of managing newborns with intrauterine infections lies in the limited nature of the aetiotropic approach. For a significant number of pathogens, specific treatment capable of selectively destroying the pathogen is simply absent.
Due to the difficulties of accurate diagnosis and the lack of aetiotropic drugs, syndromic therapy becomes an absolute priority. The primary task of the physician is to relieve specific clinical manifestations and organ damage caused by the infectious process. Therapeutic measures are aimed at combating conditions such as:
- Pneumonia;
- Myocarditis;
- Hepatitis;
- Nephritis;
- Central nervous system (CNS) lesions.
Special attention should be paid to the management of cases with an asymptomatic course. If a newborn infant shows exclusively laboratory markers of IUI, while any clinical symptoms are completely absent, the prescription of specific drug therapy is not indicated. The infant only requires further monitoring.
Immunotherapy and immunomodulation
To support the newborn's defense mechanisms, therapy with immunoglobulin (Ig) preparations is widely used. Depending on their composition and clinical focus, they are all divided into three main groups:
- Standard (polyvalent) preparations. Their composition is dominated by immunoglobulin G (IgG). They are used exclusively as intravenous solutions. This group includes such drugs as Intraglobin, Octagam, and Sandoglobulin.
- Enriched preparations. Unlike standard ones, they include not only IgG, but also IgM and IgA. This significantly broadens their spectrum of action. A typical representative of this group is Pentaglobin.
- Specific (hyperimmune) preparations. Their action is directed against one specific pathogen. In neonatal practice, anti-cytomegalovirus immunoglobulin (Cytotect), hepatitis B immunoglobulin (NeoHepatect), and anti-staphylococcal immunoglobulins are used.
In addition, interferon preparations may be used as immunomodulators, but it should be taken into account that they do not possess specific activity against particular microorganisms.
Aetiotropic therapy: antiviral and antibacterial agents
If the causative agent of the infection is reliably established and there are clear clinical indications, the patient is prescribed targeted (aetiotropic) drugs.
Antiviral therapy For the treatment of viral infections, drugs with direct antiviral action are used. The main agents in the neonatologist's arsenal are Acyclovir and Ganciclovir.
Antibacterial therapy The choice of antibiotic depends on the type of suspected or identified pathogen. All drugs can be divided into two large categories:
- Broad-spectrum antibiotics:
- 3rd generation cephalosporins (cefotaxime, ceftazidime, cefoperazone);
- Aminoglycosides (gentamicin, netilmicin);
- Carbapenems (meropenem, imipenem in combination with cilastatin);
- Glycopeptides (vancomycin).
- Drugs for the treatment of intracellular (atypical) pathogens:
This group includes macrolides, which are prescribed targetedly for diagnosed chlamydiosis and mycoplasmosis. Azithromycin, clarithromycin, roxithromycin, spiramycin, midecamycin, and erythromycin (administered intravenously) are used.
Prognosis and outcomes
The prognosis for intrauterine infections directly depends on the form of the disease. Generalized forms of IUI present the greatest danger. They are characterized by an extremely unfavorable prognosis for the patient's life—the mortality rate in such cases can reach 80%.
In surviving children who have suffered severe forms of infection, the consequences persist for life. As a rule, they develop severe neurological deficits, manifested by gross psychomotor developmental delays. In addition, such patients often develop severe chronic diseases of various systems and internal organs.
Class and exam questions
Is it necessary to prescribe specific therapy if the infant only has markers of IUI and no symptoms?
No. If a newborn has only laboratory markers of infection, but clinical symptoms are completely absent, the prescription of specific treatment is not indicated.
What is the difference between enriched and standard immunoglobulins?
Standard (polyvalent) preparations contain predominantly immunoglobulin G (IgG). Enriched preparations (e.g., Pentaglobin) additionally include immunoglobulins of classes M (IgM) and A (IgA), which significantly broadens the spectrum of their clinical action.
What antibiotics are used to treat chlamydiosis and mycoplasmosis in newborns?
To target these intracellular (atypical) pathogens, drugs from the macrolide group (azithromycin, clarithromycin, roxithromycin, spiramycin, midecamycin, erythromycin) are purposefully prescribed.
What else to study on this topic
- Clinical features and treatment of congenital pneumonia
- Management tactics for newborns with CNS infectious lesions
- Specific diagnostics of intracellular pathogens
- Pharmacokinetics of 3rd generation cephalosporins in newborns
- Development of neurological deficits after a generalized IUI
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