Dysbacteriosis of the intestine in newborns: signs, tests

Dysbacteriosis in a newborn is a common problem in children, although not often it is diagnosed and measures are taken on time. This can often be advocated under the guise of other pathologies that cause problems in the child. The causes and risk factors of this pathology are diverse, but for treatment the etiological principle is not so important. Therefore, if your baby has colic, a stool, he cries and worries - this may be one of the signs of dysbiosis.

[1], [2], [3], [4], [5], [6], [7], [8], [9]

Epidemiology

Statistics show that absolutely every child at a certain stage of his life meets with the problem of dysbiosis. In the newborn period, this happens in less than 10% of children. Speaking about the structure of the causes, the main use is the use of antibiotics in children of the first month of life, given the lability of the intestinal flora. In the future, about 78% of children have functional diseases of the digestive system at a young age. This proves the role of rational use of the antibiotic and the prevalence of the problem to date.

[10], [11], [12], [13], [14], [15], [16], [17], [18], [19], [20]

Causes of the dysbiosis in infants

Speaking about the causes of dysbiosis, you need to first understand the features of the functioning of the gastrointestinal tract in a child after birth, as well as with the characteristics of microflora in normal conditions. The child is born with a sterile intestine, and only after some time begins the settling of different microorganisms. This is due to the fact that in utero the baby was fed through the placenta and all the necessary nutrients passed through the vessels. The intestine had no contact with food, so there is an absolutely inert environment in terms of microflora. Immediately after the birth of the child, put the mother on the stomach, and then on the chest - and from this moment begins contact with the skin and the bacteria that are there. These bacteria are a normal environment for the mother, and therefore for her child as well. And after the first day after birth, the first sterile phase ends. On the second day the active colonization of the intestine begins with a normal microflora. It is during this period that the child is vulnerable to the development of dysbiosis, when the flora does not have the same composition as it should be.

Bacterial colonization of the small and large intestine of the newborn occurs due to the microorganisms that the mother has on the skin and mucous membranes, and also due to the external environment. Therefore, at first, the baby is dominated by the coccal flora of streptococci, staphylococci, enterococci. A few days after the start of feeding milk or artificial mixture, lactobaric and bifidobacteria are synthesized, which take part in the splitting of milk sugar. Further, the number of rods increases - Escherichia, Proteus, Klebsiella, and fungi also appear. But despite this, the number of cocci, lacto- and bifidobacteria increases in such a way that they predominate over opportunistic pathogens. In some conditions, reverse events occur, and the number of "harmful" bacteria prevails, which is the basis of the pathogenesis of dysbacteriosis. Normal colonization of the intestine happens in a healthy mother who gives birth naturally and feeds her baby, and also while eating properly. If any conditions are violated, this can cause the development of dysbacteriosis.

To date, given the complex ecological situation, many births occur not by natural, but by artificial means. This can lead to the fact that a child who does not pass through the birth canal has more contact not with the flora of the mother, but with the flora of the environment, which is one of the risk factors for abnormal colonization of microflora. Among other risk factors, it should be noted the artificial feeding of a child. After all, normal flora with a predominance of bifidobacteria and lactobacilli is formed during breastfeeding. If the child is fed with a mixture, then the microorganism composition is slightly different. And here it is also important what kind of mixture the child is fed, because if the mixture is adapted, then it has the necessary probiotics and prebiotics, which prevents dysbacteriosis. Therefore, one of the risk factors for the development of dysbiosis is artificial nutrition using unadapted mixtures. And further, speaking about the treatment of dysbacteriosis, an important role will belong to the correction of nutrition of the baby or mother if it is breastfed.

But the most common cause of dysbiosis is the use of antibiotics. Of course, not all newborns are affected by this effect, but if there are certain problems in the form of congenital pneumonia, inflammation of another localization, then the prescription of antibiotic is necessary and in sufficiently high concentrations. This leads to the fact that the microflora that is unstable still undergoes the action of antibacterial agents and increases the concentration of the opportunistic flora.

One of the causes of dysbiosis can be considered the genetic characteristics of parents in terms of functioning of the gastrointestinal tract. If one of the parents has chronic bowel diseases or functional disorders, the child may have problems beginning with the period of newborn babies precisely with the formation of an abnormal intestinal microbiocenosis. It has long been known that chronic diseases of the digestive system of an inflammatory nature in parents that are etiologically associated with Helicobacter pylori directly affect the composition of the microflora of the intestinal wall in their children. It also shows that there is a family relationship between this disease of bacterial etiology and the development of dysbiosis in children. Violations of the ratio of pathogenic, opportunistic and normal microorganisms often have a secondary character in the defeat of the digestive system. Such primary pathologies include disaccharidase insufficiency, cystic fibrosis, digestive disorders after surgery on the intestine or stomach (correction of pyloric stenosis in newborns), Meckel diverticulum, congenital liver disease or viral hepatitis, as well as pathologies of the stomach and intestines due to medications.

It should be noted and other external causes of possible effects on the formation of violations of intestinal microflora. These include environmental factors in the form of air pollution, soil, the violation of ecological biocenosis and the relationships between them, radiation and ion radiation, as well as the state of food and the right way of life. The nature of nutrition has a direct effect on the growth of a particular flora, because food that contains a lot of fiber and vitamins stimulates the active synthesis of prebiotics, and this in turn increases bifidobacteria. But more fatty food depresses all these processes and stimulates the growth of pathogenic flora. Sour-milk products support a normal amount of lactobacilli, which leads to the need for daily consumption. These and other factors confirm the role of maternal nutrition when feeding a child.

Internal factors that can influence the change in content and the ratio of flora are as follows:

• pathology of the stomach, intestines, liver, pancreas with violations of their normal secretory function and secretion function;
• inflammation of the intestinal wall during an acute intestinal infection or in chronic similar processes;
• medicamentous effects of drugs on the intestinal wall directly or indirectly by inhibiting the growth of normal flora, for example, uncontrolled intake of antibacterial drugs;
• chronic diseases in a state of decompensation, when the intestine suffers through ischemia or under the influence of toxins;
• disease with an increased content of immunoglobulins of the allergic etiology of newborn babies and children of the first year of life, a disturbance in the composition of normal microflora is due to the insufficiently coordinated work of different organs and their response to such harmful environmental factors.

Therefore, under the influence of adverse factors, children are particularly sensitive to such influences and it is necessary to identify risk factors in order to pay attention to this in advance.

[21], [22], [23], [24], [25], [26]

Risk factors

Risk factors for the development of dysbacteriosis directly depend on the age of the child.

Dysbacteriosis in the newborn especially often develops due to:

1. pathological course of pregnancy and surgical interventions in childbirth;
2. diseases of the genitourinary system in the mother in the form of cystitis, chronic infections of the ovaries;
3. the poor condition of the child after birth, which does not allow him to immediately be on his mother's stomach and contact with the skin;
4. technical manipulation or resuscitation with mucosal and skin disorders;
5. stay in intensive care after childbirth and the risk of contracting a "hospital" flora instead of a home one, as well as postponing an early attachment to the breast;
6. physiological features of a newborn child and his unreadiness for food;
7. inflammatory and infectious diseases of the baby, requiring early long-term antibiotic therapy;

The children of the first year of life have the following risk factors:

1. incorrect social conditions and violations of basic nutrition rules and the correctness of introduced complementary foods;
2. transfer to a mixture in early childhood with an unadapted composition;
3. allergic skin diseases;
4. digestive disorders due to pathology of the pancreas, liver;
5. episodes of acute respiratory diseases with antibiotic therapy without protection with probiotics;
6. concomitant diseases in the form of rickets, organic lesions of the nervous system, anemia, leukemia, immunodeficiencies;
7. children from disadvantaged families.

Risk factors in school-age children:

1. malnutrition with the predominance of harmful products and the formation of food regulations, which are subsequently laid in their children;
2. the influence of propaganda of unhealthy diet and lifestyle;
3. disorders of the sympathetic and parasympathetic nervous system with the formation of functional disorders;
4. disorders and shifts in the hormonal sphere according to the age of the baby.

It is very important to remember that dysbiosis in a child is often a secondary process that occurs when certain factors affect the normal state of the microflora.

[27], [28], [29], [30], [31], [32]

Symptoms of the dysbiosis in infants

There is a concept of "transient dysbiosis" in a newborn. It provides for cases in which in the first few days a child does not yet have a sufficient number of microorganisms and their normal composition. After all, some bacteria are populated only after two weeks or more, which is displayed on the child's chair. In the first 2-3 days after birth, the stool is green, with an unpleasant odor and thick. This is meconium, which contains particles of the epidermis, amniotic fluid that the child swallowed. Further, as the intestine becomes colonized, the feces become transitional, and then normal - mushy. And the manifestations of such changes in the nature of the stool and are a transient dysbiosis, that is, a normal phenomenon in the first weeks after birth. Next, it will be a pathological process, when it brings discomfort to the child.

Symptoms of dysbacteriosis are continuously associated with the basic functions of intestinal microorganisms. And of course, the main function is the regulation of intestinal motility. Under the influence of microflora, a large number of prostaglandins, bradykinins, are synthesized, which affect the contraction of the intestinal wall. Therefore, if this function is violated, first of all, problems with the tummy in babies in the form of spasms are observed. This leads to the fact that the child becomes restless, screams and colic can develop already against this background or as a consequence of such a violation.

The first symptom that can be alarmed in terms of the development of dysbiosis, may be a violation of the nature of the stool. It can be a constipation in a newborn or vice versa diarrhea. This is due to the fact that the process of digestion and digestion of basic food products is disrupted. When the feces become in the form of a chest - this is also considered abnormal, since for a newborn it must be mushy. But more often all the same at a dysbacteriosis the liquid chair at the kid develops, that should guard a mum. In this case, the general state of the child does not change, the body temperature remains normal.

Intestinal flora also takes part in the synthesis of vitamins and the realization of the work of bile acids on the digestion of the main food particles. If the normal function is impaired, the liver suffers again, which is accompanied by allergic manifestations. Therefore, it often happens that the newborn has been ruled out of allergens, the diet of the mother is also ideal, but the allergy still remains. In this case, you need to think that such manifestations are symptoms of dysbiosis. As a rule, this is manifested by the appearance of rashes on the cheeks of a child or spread on the body. Such rashes are classically allergic.

To other clinical displays of a dysbacteriosis it is possible to carry insufficient growth of a body weight of the child. As a violation of the biocenosis violates the absorption of basic nutrients, the child may not receive enough kilocalories from the meal and not gain sufficient weight.

[33], [34], [35], [36], [37]

Complications and consequences

The consequences of dysbacteriosis in newborn babies can manifest themselves in the future as a tendency to problems of the gastrointestinal tract of a functional nature. After all, if in the beginning the process of normal colonization of the microcenosis of the intestine is disturbed, then in the future there will be constant problems in the form of intestinal colic, functional constipation or diarrhea, a propensity to food allergies. If the girl's dysbiosis, then it often violates the composition of the flora in the genitals and, as a consequence, there may be problems with recurrent infections of fungal and bacterial etiology.

Complications of dysbiosis in terms of serious pathologies are very rare. But if there are problems with absorption in the intestine, then the child may not gain weight with the development of protein-energy deficiency.

[38], [39], [40], [41], [42], [43]

Diagnostics of the dysbiosis in infants

Most often in the newborn period, dysbacteriosis is a diagnosis of exclusion, since in children many functional diseases at this age can develop under the mask of dysbacteriosis. Therefore, there are conditions that can alert the mother, and even the doctor, in terms of a possible dysbiosis in the child. If the baby has colic that does not pass after all the elimination measures, and does not respond to the use of medications, then perhaps we should think about the problem with the gut biocenosis. Also, protracted allergic manifestations, which can not be corrected, can be caused by the same problem.

Proceeding from this, the diagnosis of dysbiosis is a bit difficult at the stage of only complaints, because they can be very diverse. But most often there are problems with the stool - it's diarrhea or constipation with a change in the nature of the stool, the appearance of solid un-etched particles or discoloration. This may be a child's bloating or rumbling, which is accompanied by his anxiety.

When you look at any special diagnostic signs it is impossible to see dysbiosis, and only additional methods of examination can accurately establish such a problem. Children with dysbacteriosis, as a primary diagnosis, externally have a healthy appearance, good weight, they are active and consistent with development by their age. If you see any problems during the examination, then it may be a question of primary organic pathologies, against which dysbiosis is already developing.

For an accurate diagnosis, laboratory feces are always necessary. The analysis of the feces is also carried out with the purpose of differential diagnosis, and therefore, a study is carried out for dysbiosis, as well as a coprogram. A coprogram is an analysis that allows you to evaluate the secretory function of the intestine. But the presence of a small amount of undigested fibers or other substances can be a normal phenomenon for a newborn due to the immaturity of its enzymatic function.

Analyzes for dysbiosis in newborns are informative only with the correct technique of delivery. How can I hand over feces to a newborn's dysbiosis? First of all, the feces must be fresh, in some cases they say warm. This is really so, because even "good" bacteria live outside their environment only for a certain time. The container for feces must be sterile, because the content of other microbes there can affect the result. Well, the technique of the fence should provide for all the rules of hygiene. These are the basic requirements for collecting such an analysis. The results of the analysis include the indication of all the microbes that are in the stool. Under normal conditions, a healthy child is determined by the total amount of intestinal flora, as well as the number of E. Coli, streptococci, hemolytic and non-hemolytic strains of staphylococci, fungi. An increase in the number of these bacteria indicates not only a dysbacteriosis, but also an active infection with a predominance of certain bacteria. Also in the analysis, the number of lactobacilli and bifidobacteria is determined, and if they are less than the norm, this indicates the benefit of primary dysbacteriosis.

Instrumental diagnosis is not carried out, because there is no organic pathology.

Differential diagnosis

Differential diagnosis of dysbacteriosis should be conducted primarily with pathologies that occur as a result of impaired absorption and are accompanied by changes in the stool of the child. Disaccharidized, primary lactase deficiency, gluten enteropathy, cystic fibrosis are diagnoses that should be excluded first of all in the baby.

Lactase deficiency can have symptoms, which in the beginning may resemble the course of dysbacteriosis. This is manifested by regurgitation, bloating, colic, diarrhea, underweight, and poor health of the child.

Therefore, it is necessary to specify whether there are special features of the stool in relation to a particular food in differential diagnosis.

Treatment of the dysbiosis in infants

A very important stage in the treatment of dysbiosis is proper nutrition. And if we are talking about the fact that the main food for the baby is breast milk, it is very important what exactly the mother eats.

Infants feeding exclusively on mother's milk develop a specific flora within the first week after birth, which becomes dominant by the end of the first month of life. The primary flora of the child is the flora of the birth canal and colon of the mother.

The combination of acid medium (lactic acid), probiotics and prebiotic factors (bifidofactor, lactoferrin, casein and nucleotides) leads to the formation of a flora in which the lactobacilli and bifidobacteria predominate by the end of the first month. Therefore, the mother's diet not only affects the quality of milk, but also on the functional activity and motility of the baby's intestines. There are certain foods that the nursing mother should exclude from her diet, which may be the only curative treatment for her child's dysbiosis even without the use of medicines. Mom must necessarily exclude all spices from the diet with salt restriction, as well as fried foods. Do not drink whole milk, at least in the first month of your baby's life. The requirements for calcium and phosphorus can be provided by cottage cheese and kefir, which should not exceed 250 grams per day. Coffee should also be excluded, tea can only be green without any additives. It is clear that chocolate and sweet bakery products should also be excluded. In the diet should be a sufficient number of vegetables, fruits. These are general recommendations on the nutrition of the mother, which the doctor can already cope with given certain problems.

In newborns that feed on milk mixtures, a large number of enterobacteria and gram-negative organisms are present in the flora. This is a consequence of the alkaline environment and the absence of prebiotic factors. That's why if a child is on artificial feeding, then he needs additional addition of probiotics and prebiotics in his food in order to avoid the development of dysbacteriosis or for correction if he has already developed.

Mixtures for newborns with dysbacteriosis must necessarily contain substances that normalize the intestinal microflora. First of all, if a child on artificial feeding and receives a mixture, then it must necessarily be adapted. This word says that it contains probiotics in sufficient quantities to prevent the development of dysbacteriosis. Adapted to the mixes include: Baby Premium, Bellakt, Frisolak, NAS, Nestozhen, Hipp. There is another aspect - if the child has already developed a dysbacteriosis, then it is better to choose a mixture with the maximum amount of prebiotics and probiotics. As prebiotics, which are most often used in mixtures include fructo-oligosaccharides and galactooligosaccharides. These substances entering the intestines of the child are the nutrient medium on which the bacterium so necessary for a child with dysbacteriosis grows.

Choosing a mixture, you need to take into account those manifestations of dysbiosis, which can be a baby. For example, if a child regurgitates, then it is necessary to take an antireflux mixture (HUMANA antireflux) and give it to the child in a small volume, for example 20 grams, at the beginning of the feeding. Then you need to give the bulk of the usual mixture.

If the baby's dysbacteriosis is manifested by diarrhea or constipation, or there are colics on the background of a dysbacteriosis, then the mixture of NAN is triple comfort.

Such nuances in choosing a mixture can be known only by a doctor, so it is important to address such a problem for the correct solution.

Drug correction of a dysbacteriosis in a newborn is, as a rule, always used, since it is very important to restore the correct composition of the microflora of the baby's intestines. There are a lot of probiotic drugs, and to understand them, you need to know the main groups of such drugs.

• Probiotics are microorganisms that, when ingested, can have a positive effect and contribute to the prevention and treatment of a particular pathological condition, in this case, dysbiosis. As a rule, they are of human origin. These microorganisms are not pathogenic and non-toxicogenic, retain their viability during storage. They survive to a certain extent when passing through the stomach and small intestine. Probiotics can create colonies on the surface of the mucous membrane outside the gastrointestinal tract, and when ingested help maintain the health of the oral cavity and the genitourinary system as well.
• Prebiotics are indigestible substances that, upon ingestion, selectively stimulate the growth and formation of colonies of beneficial probiotic bacteria, usually present in the intestine. These include fructo-oligosaccharides (FOS) - for example, chicory or inulin, as well as lactulose, lactitol, inulin.
• There are also synbiotics - a combination of prebiotics and probiotics in a single preparation. This is the most optimal combination for complex treatment.

Also, groups of probiotics are identified by generation and composition:

Monocomponent (Lactobacterin, Bifidumbacterin) for today they are practically not used because of a narrow spectrum of action.

• 2 generation is a combination of bacteria with yeast fungi and spores of bacilli (Enterol, Bisospin) - they are used in limited cases with intestinal infections.
• 3 generation - combined (Linex, Bifiform, Lactile) - most often used in antibiotic therapy and in a number of other cases.

Which combine a probiotic and activated charcoal or other substance. In pediatric practice, they are not used daily.

The main drugs that most often use the following:

1. Acipol  is a drug that belongs to a group of synbiotics. Its composition includes acidophilus bacteria and fungi. Fungi are prebiotics, as they are necessary for the normal growth of bacteria. The mechanism of action of the drug for dysbacteriosis is the activation of acid bacteria, which suppress the growth of pathogenic microorganisms. Also, the synthesis of fatty acids in the intestine is stimulated, which changes pH in the intestine and further inhibits the growth of pathogenic flora. Motility and peristalsis are also stimulated due to the active work of kefir-like fungi. This leads to normal emptying of the child and to the improvement of the whole process of digestion. The way of using the drug for the treatment of dysbacteriosis is one capsule three times a day for at least seven days. For prevention use one capsule per day for two weeks. Side effects are observed in the form of a change in the nature of the stool, the appearance of diarrhea - which requires a change in dosage. Precautions - for children in the septic state, the use of any probiotics is not recommended.
2. Biosporin  is one of the probiotics, which is most often used today. The preparation contains two main strains of living bacteria Bacillus subtilis, Bacillus licheniformis. They with dysbacteriosis in the newborn create conditions for the restoration of their intestinal flora, promote the normalization of the qualitative composition of bacteria in the intestines of the baby. In a newborn, the drug restores a sufficient amount of bifido- and lactobacilli, as well as an E. Coli for dysbacteriosis. The way of using the drug for newborns can be in the form of a sachet or in vials. The dosage of the drug for treatment is one dose (in the form of a sachet or in a vial) per day. The drug should be dissolved in a teaspoon of milk or mixture and give the child. Duration of therapy is about 10-15 days. Side effects when using the drug were not detected.
3. Enterol  is a drug that is used to treat dysbacteriosis, which develops against a background of prolonged antibacterial therapy and is accompanied by diarrhea. The composition of the drug includes yeast-like fungi Saharomycettis Bullardi, which show their antagonistic effect against many pathogenic microbes involved in the development of dysbacteriosis in the baby. Also fungi neutralize toxins that are released in the intestines and disrupt its normal functioning. The drug reduces the severity of diarrhea due to direct action. The method of using the drug for newborns is the best way to use a sachet. For a day, one sachet once for seven days. Side effects can be as manifestations of constipation.
4. Linex-baby  is a probiotic preparation, which includes bifidobacteria, which, with dysbacteriosis, act on pathogenic microbes and reduce their activity. Bifidobacteria are representatives of the normal flora of a newborn from the first hours of his life, so a sufficient number of them helps restore that flora, which is not enough for dysbiosis. The way of using the drug is most convenient in the form of a sachet. For the treatment of dysbacteriosis, it is necessary to apply one sachet per day, dissolving it in milk or a mixture for feeding. Side effects can be in children with immune reactions in the form of rashes, itching.
5. Bio-gay  is a probiotic, which is actively used to correct problems associated with dysbiosis in newborns. The composition of the drug includes active strains of the bacterium Lactobacillus reuteri, which contribute to the improvement of the intestinal state due to the synthesis of lactic and acetic acids. These acids suppress the growth of many pathogenic microbes and thus restore normal flora. The method of application of the drug - 5 drops per day, adding them to the mixture or breast milk. Dysbacteriosis is treated for ten days. Precautions - the preparation can have vitamin D in the composition, which must be taken into account already during the prevention of rickets to prevent an overdose of vitamin D.
6. Prama  is a preparation from the group of synbiotics, which contains prebiotics in the form of fructo-oligosaccharides and probiotic Lactobacillus rhamnosus GG. This drug, getting into the intestines of the baby, immediately begins to work at the expense of the prebiotic. It inhibits the multiplication of pathogenic bacteria and prevents their further growth. The method of use in newborns in the form of drops - ten drops per day, dissolving them in milk. Treatment can be carried out for two to four weeks. There were no side effects.

Vitamins in the treatment of dysbacteriosis can only be used in the diet of the mother if she is breastfeeding. After all, some vitamins are needed for normal life of the intestinal flora. For this purpose, nursing mothers can only use vitamins for pregnant women, which are checked accordingly.

Physiotherapeutic treatment of dysbacteriosis in a newborn is used only in isolated cases. Most often, when the dysbacteriosis develops after surgical interventions on the stomach or intestines of the child, then there may be a need for such therapy only in the rehabilitation period. In acute period and with primary dysbacteriosis, physiotherapy in infants is not applied.

Very often mothers are wondering whether it is possible to cure dysbiosis to a baby without using a variety of medications. After all, there are children's yoghurts, kefir, which contain natural beneficial bacteria. The answer here is unequivocal - you can prevent dysbacteriosis, but you can not cure it. All this is because, firstly, newborns should not be given anything but a mixture and milk, even children's yoghurts are allowed as complementary foods from eight months on. Secondly, they contain a very small number of bacteria that can not compete with a huge number of pathogens. For treatment should be the concentration of bacteria of a certain type in a certain amount. Therefore, the use of probiotics in the treatment of dysbacteriosis is a priority. That is why alternative methods of treatment, treatment with herbs and homeopathic preparations are not used in this case. On the contrary, these all methods can only additionally load and allergize the child's body.

Prevention

Prevention of dysbacteriosis in a newborn is primarily feeding it with breast, because breast milk contains as many prebiotics and probiotics as the baby's body needs. If all the same the kid on artificial feeding, it is necessary to choose to it a highly adapted mixture which is as much as possible approached to breast milk. It is important in the prevention of dysbiosis proper formation of the microflora of the baby immediately after birth, so you need that your mother had all the conditions for an ideal pregnancy and childbirth.

[44], [45], [46], [47], [48], [49], [50]

Forecast

Prognosis of dysbacteriosis is positive with correct correction, although it can bring a lot of discomfort to the baby. Speaking of potential risks, with a dysbacteriosis in the neonatal period, the prognosis of allergic reactions in such a child is higher than that of others, so it is important to take this into account in the future.

Dysbacteriosis in a newborn is a violation of the normal composition of the flora of its intestinal tract due to exogenous or endogenous causes. In this case, normal processes of digestion, peristalsis, absorption are disturbed, which is manifested by a disturbance of the stool, colic. Correction of such a complex state is the medication and feeding regimen of the nursing mother or the composition of the mixture for feeding the baby.

[51], [52], [53], [54], [55], [56]