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Query: UMLS:C0020672 (hypothermia)
 17,327 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A dramatic decrease in mortality from Hemophilus influenzae meningitis has occurred in recent years. Morbidity and long-term sequellae remain significant problems. A follow-up investigation of 73 cases of H. influenzae meningitis seen over a three-year period revealed: 2 deaths, 6 children with major sequellae (retardation, spastic quadriplegia, blindness, persistent seizure disorder), 10 with minor residua, and 55 with no detectable disability. Statistical analysis of clinical parameters demonstrated a significant risk of death or major morbidity in those patients who, at the time of admission, had seizures, coma, hypothermia, shock, age less than 12 months, hemoglobin less than 11 gm/100 ml, pretreatment symptoms for longer than three days, a spinal fluid white blood cell count less than 1,000/cu mm, or a spinal fluid glucose value less than 20 mg/100 ml. Using these parameters, those patients at highest risk of having lasting major morbidity with H. influenzae meningitis can be predicted, allowing more vigorous intensive care which may reduce the mortality and morbidity further.
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PMID:Prediction of morbidity in Hemophilus influenzae meningitis. 84 May 37

We report two patients with tuberculous meningitis and hydrocephalus who developed hypothermia that reversed after inserting a ventricular shunt for the hydrocephalus. Pressure on the thermoregulatory centre in the posterior hypothalamus near the dilated third ventricle might have been responsible. One patient developed hypotension during the transient hypothermia, which persisted and proved fatal.
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PMID:Hypothermia due to transient hypothalamic dysfunction in tuberculous meningitis with hydrocephalus. 138 36

To focus attention on the problem of infant mortality in Lebanon, data were compiled on infant mortality from 1978 to 1986 at the American University of Beirut Medical Center. Causes of death are analyzed for 602 males and 398 females. 54.9% deaths occurred at 1 month of age and 77.4% died within the 1st year. Autopsies were performed on .7%. 37.7% of all neonatal deaths were due to neonatal diseases such as hyaline membrane disease, asphyxia neonatorum, immaturity, necrotizing enterocolitis, hemorrhage, hemolysis, meconium aspiration, and kernicterus. Better prenatal care would reduce this group, or the administration of corticosteroids to the mother 24-48 hours prior to delivery, as well as rapid resuscitation at birth and prevention of the 5 curses: hypoxemia, hypoglycemia, hypothermia, hypotension, and acidosis. Although unavailable in Lebanon, administration of surfactants through an endotracheal tube would also help. Infections constitute 25.1% of deaths; many are preventable through adequate public health measures and strict personal hygiene, i.e., diseases such as sepsis, pneumonia, meningitis, gastroenteritis, hepatitis, encephalitis, and 1-2 cases of the following: diphtheria, measles, peritonitis, tetanus, tuberculosis, cytomegalis inclusion, herpes, parathyphoid, pertussis, poliomyelitis, and shigellosis. Congenital diseases were 21.6%. In utero diagnosis could prevent some diseases and in utero treatment is possible for hydrocephalus and hydronephrosis. Screening programs postnatally could lead to treatment. 5.9% were malignancies such as leukemia, lymphoma, brain tumors, histocytosis, Wilm's tumor, Ewing sarcoma, and Hodgkin's disease. Early diagnosis is critical if mortality is to be reduced in this group, but medical advances are still needed. 2.9% are miscellaneous diseases such as poisoning, rheumatic diseases, marasmus, Reye's syndrome, nephrosis, rickets, and epilepsy. Most of these diseases are preventable, except for rheumatic inflammation of the heart. Recommended necessary steps to reduce infant mortality are: prenatal care, diagnosis and screening, intrauterine surgery; resuscitation and intensive care centers with modern equipment and trained personnel; national vaccination and screening programs; adequate public health measures and hygiene; parental education; and well-equipped hospitals to serve all regardless of income level.
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PMID:Pediatric mortality: an avoidable tragedy. 251 28

One hundred children with meningococcal infection diagnosed from January 1, 1985, to February 29, 1988, were reviewed. Clinical manifestations ranged from fever alone to fulminant septic shock with purpura fulminans. Twenty-nine percent of the children presented without skin lesions. Of the 55 patients with meningitis, 6 lacked cerebrospinal fluid abnormalities on initial lumbar puncture but cerebrospinal fluid cultures were positive. An overall case fatality rate of 10% was noted with the following poor prognostic indicators identified: hypothermia; seizures or shock on presentation; a total peripheral white blood cell count less than 5000/mm3; a platelet count less than 100,000/mm3; and the development of purpura fulminans. Meningococcal infections remain an important cause of morbidity and mortality in children. Infections caused by Neisseria meningitidis (including meningitis) should be considered even in the absence of skin lesions or cerebrospinal fluid abnormalities.
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PMID:Meningococcal infections in children: a review of 100 cases. 265 60

An analysis of the causes of death in the neonatal nursery of the Port Moresby General Hospital in Papua New Guinea from 1982-1985 is presented, and conclusions were enumerated. The nursery has beds for 24 babies, subdivided into intensive care, infection and growing areas. Dormitory space for 12 mothers is available, and breast feeding is encouraged, whether by sucking, cup or tube: no bottle feeding is done. Up to 9 sisters staff the unit. A total of 2948 infants were admitted, including 831 cesarean births. 343 deaths occurred. 80 deaths were previable babies less than 1000 g. The neonatal mortality was 10/1000. The most common causes of death were septicemia or meningitis (24%), perinatal asphyxia (20%), respiratory distress syndrome (15%), congenital abnormalities (12%), meconium aspiration 7%, apnea of prematurity (7%). Other causes included pneumonia, hypothermia, intrauterine infection syndrome, cerebral hemorrhage and kernicterus. Note that hypothermia can occur in tiny babies, even in the tropics. Both respiratory distress and jaundice appear to be rare in melanesians compared to caucasians. Infections were due to tetanus, E. coli, S. aureus a Strep. faecalis, rather than the Group B hemolytic Strep. more often seen in the West. It was concluded that several inexpensive measures can be put in place to markedly enhance survival: train birth attendants to prevent perinatal asphyxia; maintain body temperature by available means; feed adequately, using expressed breast milk if necessary; maintain oxygenation properly using simple equipment such as a nasal catheter or perspex head box; prevent infection by scrupulous hand washing, cord care and overall cleanliness; manage neonatal jaundice.
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PMID:Neonatal care in perspective: results of neonatal care at Port Moresby. 347 16

A patient who developed chronic hypothermia following tuberculous meningitis is described. A central defect of thermoregulation was discovered, probably due to a discrete vascular lesion in the anterior hypothalmus.
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PMID:Chronic hypothermia following tuberculous meningitis. 678 94

All adult patients (102 cases) presenting to Bellevue Hospital Medical Center over a calendar year (1978) with core temperatures less than 35 C were studied. Statistically significant correlations between hypothermia and mortality were identified according to mental status, hypoxia, hypotension, hyperamylasemia, duration and severity of hypothermia, and history of exposure and alcohol ingestion. Mortality could not be predicted on the basis of season, age (if greater than 40 years old), sex, presence of infection, or presenting temperature (if greater than 26 C). Thyroid and adrenal function were not significantly altered. Of only nine diabetic patients, four died in ketoacidosis or hyperosmolar states. There were no cases of meningitis, and the incidence of "occult" bacteremia was less than 1%. Prolonged hypothermia was uniformly associated with profound underlying medical disease. In patients presenting with temperatures less than 26 C, 50% of deaths resulted from temperature-induced ventricular arrhythmias. Alcoholics hypothermic from exposure had excellent prognoses; however, temperatures less than 26 C were associated with a marked and statistically significant incidence of death.
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PMID:Hypothermia: the Bellevue Experience. 710 59

Culture-proven cases of enteric fever (182) were studied during the period May 1991 to April 1992; 39 per cent of the children were below 3 years. There was male preponderance. Infants presented within first few days of onset of fever with severe systemic manifestation, such as repeated convulsion, puffiness of face and oedema, massive hepatomegaly, and bleeds due to thrombocytopenia. Only 49-52 per cent of the cultures were sensitive to ampicillin, chloroamphenicol, and cotrimoxazole. The infants were treated with cephalosporin such as cefotaxime or quinolones as ciprofloxacin, since 100 per cent of the cultures were sensitive to this drug. Three infants had meningitis, two interstitial nephritis, and six had marrow hypoplasia. Two children who had been treated prior to admission with ampicillin or chloroamphenicol died within 48 h of admission, one of a liver abcess and peritonitis, and the other due to meningitis. Markedly prolonged hypothermia was seen during recovery in few cases. Forty-six per cent of infants had complications as against 2 per cent in older children. Drug Resistant Salmonella typhi infection seems to have a rapidly progressive severe course with multiple organ involvement such as meningitis, liver abcess, nephritis, and marrow hypoplasia. Initiation of appropriate antibiotics depending on local sensitivity pattern is needed early in the disease to avoid mortality and morbidity.
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PMID:Patterns of resistant Salmonella typhi infection in infants. 772 33

To determine whether lumbar puncture is necessary in the evaluation of neonates with risk for infection or suspected sepsis in the first 72 hours of life, we reviewed the laboratory and medical records of 506 infants who had lumbar punctures between January 1988 and December 1990. Neonates < 72 hours of age accounted for 52% of all lumbar punctures, but no case of meningitis. This led to a policy shift from routinely performing lumbar punctures to reserving them for infants with signs of severe sepsis (i.e. lethargy, hypothermia, hypotonia, poor perfusion or apnoea), specific neurological signs or clinical deterioration. This new policy was monitored prospectively from July 1991 to December 1993. Three times fewer procedures were performed in neonates < 72 hours, and there was no diagnosed or missed case of meningitis. Given that meningitis is rare within the first 72 hours of life and the yield of lumbar puncture virtually zero, we recommend that lumbar punctures be reserved for selected infants.
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PMID:Evaluation of neonates with risk for infection/suspected sepsis: is routine lumbar puncture necessary in the first 72 hours of life? 949 Nov 9

The excitatory neurotransmitters glutamate (GLU) and aspartate (ASP) are involved in the pathogenesis of neuronal injury in meningitis. Based on past findings that the induction of moderate hypothermia (32-34 degrees C) attenuates the release of GLU in ischemic brain injury, this study was designed to detect if the application of moderate hypothermia decreases the release of excitatory amino acids (EAA) from brain tissue of animals with bacterial meningitis. Also examined was whether meningitis induces the expression of 72-kDa heat shock protein (HSP 70) in the cerebellum and how hypothermia affects it, for induction of HSP 70 has been used as a sensitive marker of neuronal stress in other forms of brain injury. Meningitis was induced by injecting Group B Streptococcus (GBS) into the cisterna magnae of rabbits. Antibiotic treatment began 16 h later. At this time the animals were anesthetized, instrumented, and randomized to normothermic (Nor) or hypothermic (Hy) conditions. Temperatures were strictly regimented for the following 10 h while maintaining stable cardiorespiratory parameters. Cerebrospinal fluid (CSF) samples were then withdrawn to measure concentrations of bacteria, protein, and amino acids. Meningitis causes CSF contents of GLU and ASP to increase significantly. Hypothermia treated animals demonstrated a 40-50% reduction in CSF GLU and ASP. Meningitis induced the expression of HSP 70 in the cerebellum while hypothermic animals experienced a significant decrease HSP 70 induction. These data demonstrate that hypothermia produces an attenuation of the release of excitatory neurotransmitters in meningitis and suggest that this treatment may attenuate neuronal stress.
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PMID:Hypothermia decreases excitatory neurotransmitter release in bacterial meningitis in rabbits. 1056 48


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