Fungus navel cause. Navel granuloma in newborns treatment

When the baby is born, the umbilical cord that connects it to the mother is cut. The baby has a small fragment - a stump. When proper care it dries up and disappears after a couple of weeks. Sometimes swelling and small blisters are found in its place. This is the navel fungus in newborns, or the growth of granulation tissue.

What is navel fungus, how does it develop and why does it appear in newborns?

Umbilical fungus is the proliferation of connective tissue cells in the place of the umbilical fossa in the form of small nodules (see photo). This is called a granuloma. By itself, fungus is not dangerous for a child, but it can cause a lot of trouble: the navel gets wet, the baby is worried, there are difficulties with bathing and turning over on his stomach. The reasons for this phenomenon have not been studied. It is believed that the following factors contribute to the appearance of granulations:

Symptoms of pathology

The disease is usually discovered by the parents themselves, treating the navel of the newborn after bathing. The mother of the baby needs to be very careful when considering the place of the umbilical cord. At the very beginning of the disease, only tiny remnants of the stump are visible. Then they grow, fill the umbilical fossa and become outwardly similar to a bunch of pale pink grapes. At a later stage, the fungus leaves the area of \u200b\u200bthe umbilical ring on the surface of the abdomen. When such signs appear, you need to immediately show the baby to the doctor in order to differentiate fungus from other navel pathologies and start treatment.

Diagnostic methods

The doctor makes a diagnosis based on appearance umbilical fossa and history data collected from parent interviews. If, in addition to the formation of granulations, there are symptoms of inflammation, serous or purulent discharge, swelling, pain on palpation, malaise and anxiety of the baby, elevated temperature body, then the specialist is obliged to differentiate fungus from ophmalitis, hernia, fistula and other dangerous diseases.

For this, additional research is being carried out:

• a blood test for the presence of an inflammatory process;
• study of the separated exudate in order to identify the causative agent of inflammation;
• Ultrasound of the soft tissues of the abdomen.

Features of the treatment of fungus in newborns

When diagnosing fungus in a child, the pediatrician directs the baby to the surgeon. However, this does not mean that there is surgery... In the vast majority of cases, pathology is treated conservatively, but under the supervision of a specialist.

The therapy consists in the systematic disinfection of granulations and moxibustion. Antibiotics are prescribed only in cases of bacterial (usually staphylococcal) infection of the umbilical ring area and exclusively local application (ointments, sprays). Surgical intervention is required only in extreme cases, when the size of granulation formations exceeds the allowable one.

The surgeon, when examining the baby, gives detailed instructionshow to care for your baby's navel. In order for the fungus not to cause an infection to enter the umbilical region, it is necessary to follow the surgeon's recommendations for caring for the baby's navel:

• hygiene - twice a day, treat the umbilical wound with an antiseptic (hydrogen peroxide, brilliant green), and first the navel is washed with peroxide, and only then it is smeared with brilliant green (we recommend reading:);
• cauterize the granuloma daily until the procedure is canceled by the attending physician;
• put on diapers so that the navel area remains free and does not rub (advice from Dr. Komarovsky).

Cauterization of granulations

Moxibustion is the main treatment for navel granulomas in newborns. There are 2 methods:

Surgical intervention

Surgical surgery carried out in the case when the granulation has gone beyond the umbilical ring to the surface of the baby's abdomen, and conservative treatment to no avail. The operation is carried out in a hospital by surgical removal granulations. Then the wound is washed with antibiotics.

The use of table salt

Known old folk way treating fungus, which not every parent dares to. This is the use of table salt, which is poured directly onto the granulation and sealed with a plaster for 30 minutes. After half an hour, they are washed with water, the plaster is peeled off, the salt is washed out, and the wound is treated in the usual way. The method is effective and useful, although no surgeon will recommend it.

Consequences of the navel fungus in a child

In itself, the formation of granulations does not pose a danger to the health of the baby. However, there is a possibility of infection in the umbilical wound and the development of inflammation - omphalitis, which, in turn, against the background of insufficient immunity of the newborn, can cause sepsis - a dangerous blood infection with serious consequences.

Is it possible to prevent the appearance of pathology in children?

There is no specific prevention of the umbilical fungus, since its appearance is individual. Preventive actions should be carried out in order to prevent infectious complications in pathology. Basic rules for caring for the navel of a newborn:

• daily treatment of the wound twice a day;
• the umbilical stump should dry out and fall off by itself, so do not cover it with a plaster or cover it with clothes (we recommend reading :);
• all items with which the baby's skin comes into contact, including underwear, clothing, cotton wool, napkins, must be sterile, and clothes and diapers must be treated with a hot iron;
• the umbilical wound should not be subject to friction against the clothes, if the diapers go beyond the navel, they should be tucked up, leaving the umbilical zone free.

The birth of a child is a touching and exciting moment, which can be overshadowed by such an unpleasant and dangerous inflammatory process as the navel fungus. Before cutting the umbilical cord (no matter who will do it: the doctor or the father who is present at the birth), a special plastic clamp is placed on it to prevent bleeding. In the future, newly-made parents need to properly care for the umbilical wound, otherwise dirt, dust, infection will lead to various diseases... So, the navel fungus in newborns is not treated at home and requires the immediate intervention of doctors.

Caring for a newborn involves careful monitoring of the baby's health, especially the baby's navel

What is navel fungus?

Fungus (or granuloma) of the navel is the growth and inflammation of granulation tissue at the bottom of the umbilical fossa. Outwardly, it resembles a mushroom - a dense cap on a thick base. Such a seal can form both immediately after the umbilical cord remains falling off, and after several days, weeks, months. The inflammatory process occurs in everyone in different ways, so it is important to monitor the baby's navel at all stages of its healing. In addition, fungus can be of various sizes from millimeter to centimeter. So that such an ailment does not catch young parents by surprise, it is worth taking care of high-quality and proper care of the baby in advance. If you are ignorant and inexperienced, it is better to consult a doctor or at least experienced mothers.

Reasons for the appearance

Granuloma is not considered an infectious disease and can form due to a too wide umbilical ring. Of course, improper treatment of the wound after cutting the umbilical cord can also cause complications in the form of fungus, but such cases are less common. Basically, the disease is equated with the individual characteristics of the body, adaptation to the environment, and in some newborns it is even a kind of defensive reaction.

Despite the fact that too wide an umbilical cord and an umbilical ring are not considered a pathology, medical supervision is simply necessary. So, even a tiny fungus can lead to serious consequences, so it is important to remember that the treatment of diseases on early stages always flows easier and faster, especially for a child.

Fungus of the navel can be similar to other diseases, only a doctor can accurately determine it and prescribe the appropriate treatment

Symptoms: how does fungus manifest?

Inflammation of the granulation tissue is mainly manifested externally and is not accompanied by any symptoms. Parents can only notice a seemingly insignificant increase and inflammation of the umbilical residue inside the ring. However, in advanced cases, the tumor-like formation already spreads over the entire surface of the anterior abdominal wall... Naturally, the newborn will feel discomfort in such cases, therefore, tearfulness, bad dream, refusal breast milk should alert mom. Weakened children can sometimes have a high temperature.

It is important not to confuse the navel fungus in newborns with other diseases that are similar in symptoms. You should not self-treat without consulting a doctor, because, for example, similar symptoms can also be observed with the development of omphalitis.

Diagnosis of the disease

If the disease is incorrectly diagnosed, then the treatment may not only bring no benefit and result, but also harm it. Among the dangerous ailments similar to fungus can be distinguished such as hernial protrusion, catarrhal and purulent omphalitis, lipoma, etc. Let's consider some of them in more detail:

1. Hernia of the umbilical cord (see also:). Organs abdominal cavity intertwined with the umbilical cord. The liver and intestinal loops may even be located in its membranes. Home treatment in this case is impossible, it is necessary surgical intervention.
2. Skin navel. The umbilical residue is overgrown with skin, which eventually shrinks and bulges out on the abdomen. Doctors call this a cosmetic defect and therefore tidy it up with a cosmetic surgery.
3. Omphalitis. An infection enters the umbilical wound, resulting in bacterial inflammation of both the navel itself and the skin and vessels around it.

When detecting any changes in the child's navel, parents need to urgently seek help from a doctor

Types of omphalitis

Omphalitis, in turn, is divided into several varieties. When diagnosing, the doctor will first ask the parents about the nature and course of the disease. Forms of omphalitis:

• Weeping navel. It manifests itself as external discomfort, inflammation or temperature in the child is not observed. The umbilical wound does not heal due to the fact that pus and clear fluid are constantly secreted. Irritation appears on the tummy, and the dried crusts painfully fall off over time. As a result, bleeding sores appear in their place, and fungus appears at the bottom of the umbilical wound.
• Phlegmon of the navel. A weeping and purulent navel is protruding and has a pronounced swelling and redness of the skin, while inflamed veins are visible, the lymph nodes and arteries. The newborn suffers from fever, nausea, constantly spits up and cannot or does not want to eat. If the disease is ignored, the infection can spread to the groin and axillary region.
• Navel necrosis. Children with weakened immunity may develop peritonitis, a deep infection accompanied by inflammation of the abdominal wall.
• Umbilical sepsis. The infection enters the baby's blood and organs. This is the hardest and dangerous form a disease that requires immediate medical attention.

If an overgrowth of granulation tissue was detected in a newborn, then parents should monitor the increase or decrease in its size, the child's reaction to external stimuli or medications, and even food.

Additional symptoms indicate the presence of serious inflammation in the umbilical wound:

• serous or purulent discharge;
• redness and swelling;
• pain and discomfort in the navel area;
• heat;
• lack of appetite.

When an inflammatory process occurs in the navel, the child feels pain, while he is capricious and even refuses to eat

Delivery of analyzes

At the slightest suspicion of fungus, it is important to immediately apply for medical help, pass all the necessary tests to identify the causative agent of the disease. So, if there are inflammatory processes, be it leukocytosis or accelerated ESR, then most likely the baby has omphalitis. For accurate diagnosis, fluid or pus is taken from the umbilical wound for analysis. In difficult cases, they can additionally appoint ultrasonography soft tissues of the abdomen.

It happens that parents themselves try to determine the type of granulations that have appeared from a photo in medical reference books on neonatology. Doing this is strictly prohibited, because the wrong treatment can only aggravate the disease.

Treatment of the disease

If a navel granuloma in a newborn was noticed on time, then no traces should remain after treatment. So, without surgical intervention, a pediatrician can prescribe, as a remedy for the problem, cauterization of the umbilical wound with a lapis stick, treatment with hydrogen peroxide (brilliant green, chlorophyllipt, etc.) or the use of antibiotics, the use of ointments, creams, gels. In any case, treatment and preventive work should be prescribed individually, because children at such a tender little age are very sensitive to external factorsand some medications can simply cause allergies, rashes, or even asthma.

Treatment of the disease involves careful treatment of the navel, as well as the use of drugs and special ointments

Thorough care

Treatment of the umbilical wound usually occurs after bathing, when the baby is clean, fresh and good mood... All procedures should be carried out at least 1-2 times a day, and even more often, depending on the severity of the inflammation. So, the use of hydrogen peroxide, brilliant green with alcohol or alcohol tincture chlorophyllipt depending on the characteristics child's body and doctor's prescriptions.

The people also know the salt method, when table salt is poured into the umbilical wound for half an hour, and the top is covered with a cotton swab. However, similar folk recipes do not give 100% guarantees that the child's skin and the existing fungus will respond adequately. It is better not to experiment with the health of a newborn and consult a doctor immediately.

Immediately after childbirth, before cutting the umbilical cord, a plastic clip is placed on it to prevent bleeding. In the first days, the umbilical cord usually swells and becomes gelatinous, then begins to dry out, shrivels and disappears within 1-2 weeks. All this time, the umbilical wound must be carefully looked after. Its infection and inflammation, although in rare cases, can lead to the formation of a granuloma, or navel fungus. Such a turn of events without fail requires medical intervention and treatment.

What is navel fungus?

The name "fungus" comes from the Latin "mushroom", as its shape resembles a round, dense mushroom cap on a thick base. The pale pink surface consists of dense tissue - granulations, hence another name - navel granuloma. These terms denote the growth of granulation tissue at the bottom of the umbilical fossa. This sometimes happens shortly after the umbilical cord falls off, when the fossa becomes inflamed due to infection. In rare cases, this can also happen several months after the cord remains fall off. Fungus can be either tiny, the size of a match head, or quite noticeable - a few millimeters in size.

Fungus of the navel in newborns. Treatment

Usually navel granuloma in newborns does not even form cosmetic defects. But for this it is necessary to treat the granuloma of the navel of the child. Pediatricians most often refer with this problem to pediatric surgeon, although surgery is required only in very rare cases. Under the supervision of a doctor, the granuloma is cauterized once a day with a lapis stick, after bathing, it is treated with hydrogen peroxide, alcohol, chlorophyllipt solution, brilliant green, etc. and as directed by the doctor, they use antibiotics in the form of sprays, ointments, creams, solutions. In this case, care must be taken that the granular tissue itself is not damaged due to friction between diapers and diapers.

Thorough care

As a rule, the umbilical wound heals by 10-14 days of life. All this period, it is necessary to look after her very carefully.

To prevent infection and speed up the drying of the umbilical cord remnant, lubricate it 3 times a day with alcohol or another antiseptic, as recommended by your doctor. When the umbilical cord has fallen off, a few drops of blood can be seen in its place. Don't worry: this is how it should be. Continue to lubricate the umbilical wound with antiseptic for several more days. A sign of infection is a dime-sized red, hot, and swollen spot around the base of your belly button. For any type of inflammation of the umbilical wound, whether it be fungus or suppuration with a putrid odor, it is imperative to consult a doctor so that he can prescribe treatment.

Omphalitis ("Weeping navel") - purulent or serous (catarrhal omphalitis) inflammation of the umbilical wound, umbilical ring, PZhK and umbilical vessels... Forgetting begins at the end of the 1st or 2nd week. life. Infiltration of the PZhK around the umbilical wound is noted, the navel bulges out above the surface of the anterior br. walls, the skin around the navel is hyperemic, hot to the touch, there is an expansion of the vessels of the anterior br. walls, red stripes when lymphangitis is attached. The child is lethargic, does not suck well, does not gain or lose weight, the temperature is elevated, sometimes to febrile. In the analysis of blood: leukocytosis with a shift to the left, ESR increased. Treatment.Locally: 3-4 times a day treat with 3% solution of hydrogen peroxide, iodine or brilliant green, UFO, Vishnevsky ointment. A / b i / v or i / m (oxacillin with gentamicin or II generation cephalosporins) Fungus - mushroom-like growth of granulations and the remainder of the umbilical cord tissue, which fills the umbilical wound and rises above the edges of the umbilical ring. The presence of fungus is characteristic for newborns with a large body weight, with a thick umbilical cord and a wide umbilical ring. General state not disturbed, no inflammation, umbilical vessels are not palpable. Treatment.Local: cauterization of granulations with a lapis pencil after daily treatment of the umbilical wound. Phlebitis and arteritis of the umbilical vessels: more often in children who underwent catheterization of the umbilical vessels for therapeutic and diagnostic purposes. With thrombophlebitis, the elastic band is palpated below the umbilical ring, with the occurrence of periphlebitis and periarteritis, the skin over the affected vessels is edematous and hyperemic. With light massaging movements from the periphery of the affected vessel to the umbilical ring, a purulent discharge appears at the bottom of the umbilical wound. The phenomena of infectious toxicosis are poorly expressed or absent. Treatment. In the absence of bacterial infection and signs of intoxication, locally heparin ointment and ointment with a / b (mupiprocin, bactroban), alternating every 2 hours, treatment of the umbilical wound, physiotherapy. When a bacterial infection is attached, intravenous a / b (oxacillin with gentamicin, II generation cephalosporins); with severe intoxication - infusion detoxification therapy.

5. Diseases of the umbilical cord, umbilical wound. Working group. Fistulas and cysts of the navel. Clinic. Treatment.

Distinguish: I.Non-infectious diseases: 1) Cutaneous navel - represents the transition of the skin of the anterior abdominal wall to the sheath of the umbilical cord. The size of the skin outgrowth usually does not exceed 1-1.5 cm. It does not affect the condition of the newborn. May be regarded as a cosmetic defect that diminishes with age. No treatment required. 2) Amniotic navel - represents the transition of the amniotic membranes from the umbilical cord to the anterior abdominal wall in combination with the absence of the skin in this area. The anomaly is dangerous due to the addition of a secondary infection. Treatmentconsists in the prof-ke of infection, the imposition of aseptic dressings with epithelial preparations; recovery occurs in a few weeks; the defect disappears without residual effects. 3) Umbilical hernia - a bulging of a round or oval shape in the area of \u200b\u200bthe umbilical ring, which increases with the cry or anxiety of the child. Palpation is determined by a wide umbilical ring and sometimes a slight discrepancy of the rectus abdominis muscles. Availability umbilical hernia usually does not affect the child's condition, however, with small sizes and dense edges of the umbilical ring, pain reactions (infringement) are possible. Treatmentconsists in massage of the anterior abdominal wall and early laying out of the child on the stomach. Gluing the umbilical hernia with a plaster is undesirable, because this quickly leads to skin irritation, erosion, and if an infection enters the umbilical wound, it can contribute to the development of omphalitis. When a sharp anxiety appears and an infringement is detected, the umbilical hernia is repositioned in a bath at a water temperature of 37-38 ° C. 4) Hernia of the umbilical cord - a severe developmental anomaly, in which, through the defect of the anterior abdominal wall in the region of the umbilical ring, there is a protrusion of the org in the abdominal cavity under the amniotic membrane of the umbilical cord. Hernias of the umbilical cord are divided into small (up to 5 cm in diameter), medium (up to 8 cm in diameter) and large (over 8 cm in diameter), as well as uncomplicated and complicated. Complications include rupture of the membranes with eventration of internal org-in, infection or purulent expansion of the membranes. The diagnosis in typical cases is not difficult and is established at the time of the birth of the child. If a newborn has a thick or unusual shape of the umbilical cord, it is necessary to examine it in transmitted light to exclude a small umbilical cord hernia. Treatment.A sterile gauze pad moistened with warm isotonic sodium chloride solution, which is covered with a sterile diaper, should be applied to the anterior abdominal wall immediately after the baby is born. This manipulation prevents drying, cooling and infection of the amniotic membranes. After that, the child should be transferred as soon as possible for treatment to pediatric surgeons in a specialized department. 5) Beckwitt's syndrome - characterizes, in addition to the presence of a hernia of the umbilical cord, gigantism, visceromegaly, macroglossia, hyperplasia of the adrenal cortex, pancreas and the medulla of the kidneys. Possible hemihypertrophy, microcephaly, anomalies in the development of the superciliary arches, tumors of the abdominal cavity. In the early neonatal period, such children often develop hypoglycemia due to hyperinsulinism, polycythemia. 6) Navel fistulas - are divided into complete and incomplete. Complete fistulas -are caused by a non-closure of the duct between the navel and the loop of the intestine or the preservation of the urinary duct. In the embryonic period, the first of them connects the intestine with the yolk sac, and the second - bladder with allantois. The yolk duct is usually completely obliterated at the 3-5th month of IV development, turning into a round ligament of the liver. Complete obliteration of the urinary duct in most children does not end by the time of birth (the ligamentum vesicoumbilicalis is formed from it). Complete fistulas are characterized by persistent weeping of the umbilical wound from the moment the umbilical cord falls off. With a wide lumen of the yolk duct, the release of intestinal contents is possible, and in the area of \u200b\u200bthe umbilical ring, a bright red border of the intestinal mucosa is visible. In such newborns, with an increase in intra-abdominal pressure, invagination of the ileum is possible with symptoms of partial intestinal obstruction. With an unliterized urinary duct, urine may be released from the umbilical wound in drops.It is clinically characteristic of irritation and maceration of the skin around the umbilicus, in some children, at the bottom of the umbilical wound, polyposis formation with a hole in the center may develop. Open yolk duct occurs 5-6 times more often than a complete urinary fistula. The acidic reaction of the discharge from the umbilical wound testifies in favor of the non-closure of the urinary duct, while the alkaline reaction is more characteristic of the complete sis of the vitelline duct. The final conclusion is made after fistulography or a test with methylene blue, 1% solution of which is injected into the fistula or into the bladder and the color of urine or the color of the discharge from the fistula is monitored. Treatment of complete fistulas is operative. Incomplete fistulasthe umbilicus is due to the noninfection of the distal urinary or yolk ducts. The clinical picture corresponds to that of catarrhal omphalitis, with which diff should be carried out. diagnostics. In the case of a stratification of infection, the discharge from the umbilical wound acquires a purulent character. The final diagnosis is usually made a few weeks after birth. To confirm the diagnosis, the surgeon conducts sounding of the fistulous canal and radiopaque examination. Conservative treatment is the same as for catarrhal omphalitis. Surgical intervention is indicated only when recovery does not occur for several months, despite conservative therapy. Meckel's diverticulumrepresents noninfection of the proximal vitelline duct; diagnosed in the presence of complications - bleeding, diverticulitis (clinic of acute appendicitis), intestinal obstruction. Surgical treatment. 7) Fungus navel - mushroom-like growth of granulations and remnants of the umbilical cord tissue filling the umbilical wound and sometimes rising above the edges of the umbilical ring. The presence of fungus is characteristic for newborns with large body weight, with a thick umbilical cord and a wide umbilical ring. The child's condition is not disturbed, there are no inflammatory changes, the umbilical vessels are not palpable. There are no changes in the blood. Treatment - local, consists in cauterization of granulations with a lapis pencil after the usual daily treatment of the umbilical wound. II. Infectious diseases: 1) Catarrhal omphalitis (weeping navel) - clinically characterized by the presence of serous discharge from the umbilical wound and a slowdown in its epithelialization. In some cases, there is slight hyperemia and slight infiltration of the umbilical ring. With the formation of bloody crusts in the first days after the umbilical cord has fallen off, it is possible for an accumulation of abundant serous-purulent discharge under them. The condition of the newborn is not disturbed, the body temperature is N. There are no changes in the blood. The umbilical vessels are not palpable. Treatment -local, consists in frequent (3-4 r / day) treatment of the umbilical wound with 3% solution of hydrogen peroxide, and then either 5% solution of iodine, or 1% alcohol solution of brilliant green. The following composition has a good effect: Viridis nitentis, Methyleni coerulei aa 0.1, Spiritus aethylici 70%. You can lay ointment with bacitracin and polymyxin. Also shown is UV irradiation of the umbilical wound. 2) Omphalitis - bacterial inflammation of the bottom of the umbilical wound, umbilical ring, subcutaneous fatty tissue around the umbilical ring, umbilical vessels. Forgetting usually begins at the end of the early neonatal period or in the 2nd week of life, often with symptoms of catarrhal omphalitis. A few days later, purulent discharge from the umbilical wound appears - pyorrhea of \u200b\u200bthe navel, edema and hyperemia of the umbilical ring, infiltration of subcutaneous fatty tissue around the navel, as a result of which it bulges above the surface of the anterior abdominal wall. The skin around the navel is hyperemic, hot to the touch, there is a characteristic expansion of the vessels of the anterior abdominal wall (strengthening of the venous network), red stripes caused by the attachment of lymphangitis. Symptoms appear that are characteristic of an infectious lesion of the umbilical vessels. The patient's condition is impaired, the child becomes lethargic, suckles the breast worse, regurgitates, the weight gain decreases (its loss is possible). T body temperature is increased, sometimes to febrile. In the analysis of blood - leukocytosis with a shift to the left, increased ESR. The prognosis with a timely started complex therapy is favorable, however, the occurrence of metastatic foci of infection and generalization of the process are possible. 3) Navel ulcer - may occur as a complication of navel pyorrhea or omphalitis. The bottom of the umbilical wound is usually covered with serous-purulent or purulent discharge, after removal of which ulceration is revealed. Its development is most likely if, during the treatment of the umbilical wound, the crust that hides the bottom of the umbilical wound from the doctor is not removed. General condition in the first days of the disease m. not violated, further symptoms of intoxication join. 4) Abandonment of umbilical vessels - a high-risk group is newborns who underwent catheterization of the umbilical vessels for therapeutic and diagnostic purposes. With thrombophlebitis of the umbilical vein an elastic band is palpated over the navel. With thromboarteritis, the umbilical arteries palpable below the umbilical ring. In case of occurrence periphlebitis and periarteritis the skin over the affected vessels is edematous and hyperemic, possibly the tension of the anterior abdominal wall, determined by palpation. With light massaging movements from the periphery of the affected vessel to the umbilical ring, a purulent discharge appears at the bottom of the umbilical wound. The phenomena of infectious toxicosis in such children are typical, but might be. weakly expressed and even absent. 5) Gangrene of the umbilical cord (umbilical cord) - at the birth of a child in the obstetric institution is practically not found. Forgetting is caused by an anaerobic bacillus and begins in the first days of life. The mummification of the umbilical cord stops, it becomes wet, takes on a dirty brown hue and exudes an unpleasant putrid odor. The falling off of the umbilical cord is delayed, and a purulent discharge immediately appears in the umbilical wound. The patient's condition is impaired, the temperature of the region, symptoms of intoxication, changes in the blood test, corresponding to the severity of the infectious process. Sepsis usually develops. Treatment children with inf-mi zab-mi of the umbilical wound and umbilical cord are carried out in the departments of pathology of newborns of the children's hospital. The main condition for successful therapy was the timely administration of a / b, actively suppressing staphylococci (oxacillin with gentamicin or second-generation cephalosporins, "protected" aminopenicillins), correction is carried out after receiving information about the pathogen and its sensitivity to a / b. With severe intoxication, large loss of body weight, infusion therapy is indicated. On the background of a / b therapy, the use of eubiotics is necessary. Microwave on the umbilical wound. A course of immunotherapy is shown (with staphylococcal infection - anti-staphylococcal immunoglobulin). Treatment of patients with gangrene of the umbilical cord start by cutting it off immediately. With thrombophlebitis due to catheterization of the umbilical vein, in the absence of intoxication and other signs of bacterial infection layering, only local treatment is carried out: lubrication of the skin area above the vein with heparin ointment and ointment with a / b (optimally: mupiprocin-bactroban), alternating them every 2 hours, systematic treatment of the umbilical wounds, physiotherapy (microwave, UV irradiation, electrophoresis with a / b). Forecastif complex therapy is started in a timely manner, it is favorable, but in the future, portal hypertension may develop.

6. Diseases of the skin and subcutaneous tissue of newborns. Ritter's exfoliative dermatitis, neonatal phlegmon, vesiculopustullosis, pemphigus, abscesses. Clinic. Diagnosis. Differential diagnosis. Treatment principles.

Exfoliative dermatitis Ritter - the most severe form of staphylococcal pyoderma of newborns, which can be considered as a septic variant of the course of pemphigus. It is caused by hospital strains of Staphylococcus aureus, which produce exotoxin - exfoliatin. Clinic. Forgetting begins at the end of the first, beginning of 2 weeks of life with the appearance of redness, skin wetness and the formation of cracks in the navel, inguinal folds, around the mouth. Earlier onset is usually the most severe course of the disease. Within a few hours, bright erythema spreads to the skin of the abdomen, trunk, limbs. In the future, flaccid bubbles, cracks appear in various parts of the body, sloughing of the epidermis is observed, leaving extensive erosion. "+" Nikolsky symptom in most children. The body of a newborn has the appearance of scalded with boiling water. Against the background of the disease, other foci of purulent infection often occur: omphalitis, otitis media, conjunctivitis, pneumonia, enterocolitis, etc. sepsis develops. The condition of the patients is serious: children refuse to breast, become restless, symptoms of intoxication are expressed. Zab-nie is accompanied by febrile temperature, sudden changes in the blood test. After 1-2 weeks. from the beginning of oblivion, the entire skin of the newborn is hyperemic, and erosions are formed on large areas due to the accumulation of exudate under the epidermis, followed by its detachment, symptoms due to the appearance of exicosis join. In the case of a favorable outcome of the disease, after the erythematous and exfoliative stages, epithelialization of erosive surfaces occurs without scarring or pigmentation. Diff. diagnostics: staphylococcal scalded skin syndrome (SCS). Ritter's exfoliative dermatitis is a more severe b-n than MSS (it proceeds with a deeper lesion of the skin and is, as a rule, a manifestation or variation of the course of staphylococcal sepsis); with SSOC, the basal layers of the skin are not affected, the course is not more benign, and sepsis often does not develop. Treatment. It is very important to maintain N body temperature ("temperature protection") and fluid and electrolyte balance, gentle skin care. The first problem is solved by placing the child under a source of radiant heat or in a special frame, incubator and regularly monitoring the body temperature (every 2-3 hours), after measuring which, the ambient temperature is maintained or changed. If the child's condition allows, then 1-2 r / day he is bathed in sterile water at a temperature of 37-38 ° C with the addition of chamomile, celandine, and string infusions. Uch-ki of unaffected skin are lubricated with 1-2% aqueous solutions of aniline dyes, and compresses with Burov's liquid, sterile isotonic sodium chloride solution with the addition of 0.1% silver nitrate solution are applied to the affected, lubricated with 0.5% potassium solution permanganate. Small areas of exfoliation can be lubricated with bacitracin ointment. Emollient creams from0,1% vitamin A and others are used for drying out lesions. Sterile non-coarse diapers, care with minimal skin trauma are indispensable conditions for the treatment of all children with pyoderma. With abundant soaks, in order to adsorb serous contents and protect the skin from irritation with a diaper, use a powder from 5% zinc oxide with talc. The air in the box where the child lies is disinfected 4 times a day with a bactericidal lamp (of course, the child is covered). Necrotizing phlegmon of newborns - one of the most severe purulent-inflammatory diseases of newborns. Forgetting begins with the appearance on a small area of \u200b\u200bthe skin of a red spot, usually dense to the touch; further in its development 4 stages can be distinguished. initial stage (acute inflammatory process) - is characterized by a rapid, within several hours, spread of the lesion focus, which takes on significant dimensions. The rate of damage to the subcutaneous fatty tissue (purulent fusion) usually outstrips the rate of skin change. This is facilitated by the presence of a rich network of lymphatic vessels and wide lymphatic gaps. Alterative necrotine stage occurs after 1-1.5 days. from the beginning of oblivion, the color of the affected skin becomes purple-cyanotic, softening occurs in the center. In some cases, on palpation of the skin during the transition to the affected area, a symptom of "minus tissue" is noted. Rejection stage it is characterized by necrosis of exfoliated skin, after removal of which wound defects with undermined edges and purulent pockets are formed. Reparation stage - development of granulations, epithelialization of the wound area, followed by the formation of scars. Forgetting in most children proceeds with intoxication, which usually joins in stage II. Fever, vomiting, dyspeptic symptoms, the occurrence of metastatic foci of infection, which makes it possible to interpret this pathology as sepsis. Treatmentnewborns are carried out jointly by a pediatrician and a pediatric surgeon, who determines the indications for of various kinds drainage. Vesiculopustulosis (staphylococcal periporitis) - oblivion, which can begin in the middle of the early neonatal period: on the skin of the buttocks, thighs, natural folds, head appear small superficially located bubbles up to several millimeters in size, filled at first with transparent and then cloudy contents. The morphological substrate of the disease is inflammation in the area of \u200b\u200bthe mouths of the eccrine sweat glands. The course of oblivion is usually benign. Bubbles burst after 2-3 days after the appearance; the resulting small erosions are covered with dry crusts that do not leave scars or pigmentation after falling off. Treatment zakl-Xia in the correction of regime moments, carrying out hygienic baths (taking into account the state of the umbilical wound) using disinfectants (solution of potassium permanganate 1: 10000, decoctions of celandine, chamomile). Before carrying out a hygienic bath, the abscesses are removed with a sterile material soaked in 70% alcohol. Shown twice a day local application of 1-2% alcohol solutions of neaniline dyes or brilliant green. Xeroform powder also has a disinfecting effect. Local UV irradiation is advisable. Pemphigus newborn (pemphigus, pyococcal pemphigoid) can occur in two forms: benign and malignant. Benign form it is characterized by the appearance (against the background of erythematous spots) of bubbles and a small size of bubbles (up to 0.5-1 cm in diameter), filled with serous-purulent contents. Bubbles can be at different stages of development, have a slightly infiltrated base, a corolla of hyperemia is noted around the bubble. They are usually localized in the lower abdomen, near the navel, on the limbs, in natural folds. The blistering may last for several days. Nikolsky's symptom "-". After opening the bubbles, erosion appears. It is hard that crusts are not formed at the site of the former bubbles. Condition of newborns m. not disturbed or moderate. An increase in body temperature to subfebrile is possible. Intoxication with this form of oblivion is usually absent, however, children may become restless or there is some lethargy, decrease or absence of weight gain. With timely started active treatment, recovery occurs in 2-3 weeks. from the beginning of oblivion. Malignant form of pemphigus newborns are characterized by the appearance on the skin of a large number of flaccid blisters, mainly large ones - up to 2-3 cm in diameter (flikten). The skin between the individual blisters may slough off. Nikolsky's symptom m. "+". The condition of children is serious, symptoms of intoxication are expressed. Body temperature rises to febrile. The appearance of the child resembles that of a patient with sepsis. In the clinical analysis of blood - leukocytosis with neutrophilia and a shift to the left to young forms, increased ESR and anemia of varying severity. Forgetting often ends with sepsis. Diff. diagnosticsshould be carried out with other types of pyoderma, congenital epidermolysis bullosa, congenital syphilis, Leiner's erythroderma. Treatment: they pierce the bubbles, send the contents for sowing and bacterioscopy, after which they are treated with mupiprocin ointment (bactroban). When carrying out this manipulation, the contents of the bladder must not be allowed to enter healthy areas of the skin. General therapy moderate and severe forms of staphyloderma of newborns includes: antibacterial, infusion, symptomatic, vitamin therapy, treatment aimed at maintaining immunity. From a / b, semi-synthetic antistaphylococcal penicillins (methicillin, oxacillin) or protected penicillins (unazine, amoxiclav, augmentin), cephalosporins of the 1st generation are used, usually in combination with aminoglycosides (gentamicin, tobramycin, amikacin) (especially in the case of lincomycin addition), A good effect was obtained from specific immunotherapy (antistaphylococcal immunoglobulins, plasma). ABSCESSES. Sclerema – severe skin disease and PZhK, develops more often in premature babies or children with severe brain damage in the middle of the 1st, on the 2nd week. life. In the area of \u200b\u200bthe gastrocnemius muscle on the lower leg, face, thighs, buttocks, trunk, upper limbs there are diffuse stony stiffness of the skin and PZhK. The skin fold does not collect, when pressure is applied, the seal does not remain, the skin is cold, pale or reddish-cyanotic, sometimes with an icteric tinge. The affected parts of the body are atrophic, limb mobility is reduced, the face is mask-like. There are no seals on the soles, palms, and penis. Body temperature is usually lowered, appetite is sharply reduced, apnea attacks, low blood pressure + signs of infection are typical: pneumonia, sepsis, gastroenteritis. Treatment: 1) complex therapy infectious process; 2) warming; 3) adequate nutrition; 4) maintenance of fluid and electrolyte balance; 5) i / m vit. E (20 mg / kg / day); 6) "iodine mesh" on the lesion once a day. Skleredema - a peculiar form of edema in the thighs, calf muscles, feet, pubis, genitals, accompanied by hardening swelling of the skin and PZhK. Appears between 2-4 weeks. life. The skin in the affected areas is tense, pale, sometimes cyanotic, cold, does not gather in a fold. A fossa remains at the place of pressure. In severe cases, the entire body of the child is affected, including the palms and soles. The general condition is severe, lethargy, inactivity or immobility, no appetite, hypothermia, bradycardia, bradypnea. Treatment: 1) thorough but careful warming; 2) gentle massage; 3) a / b therapy of the underlying disease; 4) "iodine mesh" once a day, followed by (h / w 10 min) washing off iodine with 70% alcohol; 5) Vit. D and Ca are not allowed, because children under 2 months have a tendency to hypercalcemia. Adiponecrosis (focal necrosis of the pancreatic fluid): well-demarcated dense nodes, infiltrates 1-5 cm in diameter (sometimes more) in the pancreatic fluid in the buttocks, back, shoulders, extremities. They appear for 1-2 weeks. life. The skin over the infiltrate is either unchanged or cyanotic, purple-red or red, later turns pale. Sometimes the infiltrates are painful to palpation. Rarely, softening develops in the center of the infiltrates, and then an autopsy occurs with the release of a small amount of a white crumbly mass. General condition is not disturbed, temperature N. Diff. diagnosis:sclera, sclerodema, bacterial abscesses. Treatments does not require, passes on its own from several weeks to 3-5 months. Multiple adiponecrosis is characteristic for children who have peculiarities of lipid metabolism, and therefore it is desirable for them to evaluate it in a laboratory. You can prescribe thermal procedures (sollux, dry dressings with cotton wool, microwave). With a widespread process, you can assign vit. E.

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For a long time, no one argues with the assertion that the human body is a kind of autonomous system, which sometimes presents peculiar surprises, both as a miraculous cure, as well as the emergence of unforeseen diseases, the mechanism of which may be unpredictable.

Granuloma concept

The very concept of “ granuloma"Translated from latin means "grain", which already eloquently testifies to the essence of the disease - a limited focus of productive inflammation, which is characterized by the formation of nodules and are granulomas.

Education process granulomas becomes the result of the fact that cells of human tissue and blood, prone to phagocytosis, begin to grow and divide, transforming into a kind of neoplasm. In this case, the formed dense nodule does not have the character of a tumor, but is an inflammatory proliferation of tissue, in which absolutely any tissues and organs of a person can be involved.

The process of granuloma formation occurs in four stages:

1. In the future focus of inflammation, young cells accumulate, prone to phagocytosis (the process of capture and digestion of solid particles).
2. The process of proliferation of phagocytes begins.
3. There is a process of transformation of phagocytes into epithelial cells and an epithelioid cell granuloma is formed.
4. The epithelioid cells fuse together to form the final granuloma.

Based on this, all granulomas are divided into the following types:

macrophage granuloma;
giant cell;
epithelioid cell granuloma formation.

All existing granulomas are divided into two types - infectiouswhich are the result of inflammatory tissue proliferation due to the development of infection in the human body, and non-infectious, that is, those that form around any foreign bodies.

The causes of granulomas and the mechanism of their formation

The causes of this type of formation may be different, but in fact there are two of them - infectious, where all possible diseases infectious nature of origin and non-infectious causes, which may include not only specific and chronic diseases, but also various penetrations into human tissues and organs.

The very mechanism of the appearance of granulomas can be different. However, to start the process of inflammation, two necessary conditions must be present - the presence in the body of substances that stimulate the growth of phagocytes and the resistance of the stimulus that caused the transformation to phagocytes.

But the classification of granulomas depends on the nature of the neoplasm, its scale, rate of development, location and other criteria that actually characterize the process of inflammation.

Classification of granulomas and their treatment

Pyogenic granuloma

Pyogenic granuloma is vascular tumor, which was the result of the presence of a pyococcal infection in the human body.

Outwardly, such a formation resembles a rather large tumor (up to 3 cm in diameter), for example, on a finger, which most often forms at the site of damage to the skin. It can be absolutely smooth or coarse, but always bright in color. And most often, a pyogenic granuloma is located on the arm, leg or face of a person, for example, on the lip.

Removal of such a formation occurs by surgery or using a laser, cryodestruction or electrocoagulation.

Annular granuloma

Annular granuloma - chronic illness skin, which is characterized by small rashes, collected together and surrounded by a ring (hence the name).

Unfortunately, the nature of the origin of these granulomas is still not fully understood and presumably the process of their formation is associated with the presence of diabetes mellitus or disorders of carbohydrate metabolism. Often, such formations appear as a result of a violation of the integrity of the skin. At the same time, it can affect absolutely any surface of the body and most often it can be found in a child and adult woman.

Treatment of granuloma annulare consists in the introduction of corticosteroid drugs inside the focus and in the use of cryotherapy.

Tuberculous granuloma

Tuberculous granuloma looks like a direct focus of necrosis, around which epithelioid cells and lymphocytes are located. The reason for its occurrence is infectious diseases, including tuberculosis.

The insidiousness of the disease lies in the fact that, contrary to the prevailing stereotype, it can affect not only the lungs of a person, but also the lymph nodes, upper airways, skin and tissues of the genitourinary organs, while developing against the background of the underlying disease. It is with the treatment of the latter that the fight against tuberculous granuloma begins, for which they carry out intensive course antibiotic therapy.

According to statistics, granulomas are most often caused by the following diseases (in descending order):
tuberculosis, leprosy, syphilis, actinomycosis, tularemia, brucellosis, rheumatism, foreign body.

Venereal granuloma

Venereal granuloma is a chronic and slowly progressive disease, of an infectious nature of origin, as a result of which on the genitals of both men and women, as well as the area adjacent to them (groin - the so-called inguinal granuloma and perineum) formations appear that outwardly resemble a pimple - a grain. In this case, the disease is asymptomatic, but it can be sexually transmitted (less often household).

Men are more prone to the emergence and development of venereal granulomas than women, but in the latter it can cause a number of complications - narrowing of the vagina and urethra, deformation of the genitals themselves, for example, the labia, not to mention the discomfort caused, especially during intercourse.

For its treatment, a course of specially selected antibiotics is used.

Eosinophilic granuloma

The problem with this neoplasm is that its etiology has not yet been identified. It is only known that eosinophilic granuloma occurs most often in males, and in early age and leads to multiple lesions of bones (skull, pelvic bones, spine, as well as the femur and humerus hollow bones), skin and internal organs.

Often such patients experience rather contradictory symptoms - pain with and without exertion, swelling with and without the formation of a hard node. All this against the background of general lethargy and weakness of the body, quite often leads to an erroneous diagnosis and, as a result, to visible or not deformations of bones, internal organs and skin necrosis.

It also affects areas of skin and bones in cats and dogs.

For treatment, use corticosteroid hormonal drugs and medicinesreducing pain and swelling.

Postoperative granuloma

Postoperative granuloma occurs at the site of the scar when the used suture material cannot be absorbed. However, there are cases of neoplasm due to infection in the wound.

Treatment is reduced to excision, as formed postoperative scar, and the granuloma itself, with strict adherence to asepsis and instructions for processing the seam.

Subcutaneous granuloma migrans

Subcutaneous granuloma migrans is a consequence of granulating periodontitis (inflammation of the ligament that holds the tooth) or chronic osteomyelitis.

The disease is characterized by a sluggish course and is most often localized along the line lower jaw... The neoplasm itself can be of various sizes, and the skin above it has a bluish tint. Has a tendency to "crawl" from where the name came - migrating.

Treatment is reduced to eliminating the root cause that led to the neoplasm.

Odontogenic subcutaneous granuloma

Odontogenic subcutaneous granuloma is the result of a long existence of the focus of infection, from which microorganisms gradually penetrate into the subcutaneous adipose tissue of the face.
There are frequent cases of fistula formation at the site of granuloma existence.

Treatment involves the elimination of the primary focus of inflammation - tooth extraction, root apex resection, followed by excision and curettage of the granuloma and fistula cavity.

Ligature granuloma

Ligature granuloma is formed at the site of an incorrect or infected ligature - a special thread for stitching damaged tissues during operations.

As a result, a seal is formed around the ligature, which tightens the wound, which is called a granuloma.

The transience of such inflammation is quite rapid, and he himself, in order to avoid sepsis, needs urgent treatment - surgery to remove the ligature and a course of antibiotic therapy.

Tooth granuloma

Tooth granuloma is perhaps the most common manifestation of this inflammatory process.

In this case, the neoplasm itself is a small pouch around the tooth root that is filled with pus.

A possible complication of the process is the development of a cyst, when a fistula forms at the site of the granuloma, with profuse gum suppuration and edema.

Treatment of a tooth granuloma is reduced to intensive antibiotic therapy and possible surgical intervention, during which the dentist cuts the gum and installs drainage, for the free outflow of pus from the granuloma sac.

Breast granuloma

Breast granuloma is most often caused by wearing silicone implants. However, it is not uncommon for inflammatory process originates from sarcoidosis ( inflammatory disease lungs) or actinomycosis (radiant fungal disease). As a result, characteristic nodules form in the mammary gland - foci of the inflammatory process.

Treatment of the disease is necessarily complex, with the use of antibiotics and immunostimulants. Surgery is possible in which a specialist removes the affected tissue.

Navel granuloma of newborns

Umbilical granuloma of newborns is a fairly common occurrence, which is nothing more than young connective tissue at the site of umbilical cord removal, which contributes to fast healing wounds.

A navel granuloma is formed when phagocytes grow faster than a new one is formed connective tissue.

Treatment is reduced to cauterization (treatment of the site of inflammation with a concentrated solution of silver nitrate), but only a specialist can carry out this procedure, since the substance can cause severe burns on the skin surface.

Noteworthy is the fact that navel granuloma can occur in adults and the reason for this may be wearing a piercing.

Prevention and prognosis of granulomas

Since the causes of granulomas in each individual case may be different, then the very prevention of this disease is very specific and individual.

One thing is certain - compliance healthy way life and timely treatment of all possible foci of inflammation in the body, can help avoid granulomas and possible complications... As for the latter, then, as a rule, the prognosis is favorable, but only in the case of timely referral to specialists and the application of treatment. Otherwise, uncontrolled inflammation can lead to sepsis, sclerosis, or tissue necrosis.

Do not get carried away and folk remedies for the treatment of these neoplasms. Their use is possible only to relieve pain symptoms and relieve puffiness after drug treatment or surgery.