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Query: UMLS:C0036690 (sepsis)
 59,461 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The chest radiographs of 26 newborns treated with extracorporeal membrane oxygenation (ECMO) for intractable respiratory failure were reviewed. The typical radiographic appearance of the lungs in these patients is that of diffuse pulmonary opacification with variable volume loss. Air bronchograms and patchy basilar atelectasis are also common findings. Generally, decreasing ECMO requirements were reflected in improving chest radiographs with radiographic improvement lagging behind clinical improvement. Of 167 chest radiographs available for evaluation, 105 (62.8%) reflected changes in ECMO flow rates. Radiographs in patients with individual diagnoses of hyaline membrane disease, meconium aspiration syndrome and sepsis showed the best correlation with clinical improvement (95 [69%] of 137 radiographs). Those obtained in patients with congenital diaphragmatic hernia and persistent pulmonary hypertension of the newborn alone showed the poorest correlation (10 [30%] of 30 of radiographs). Neither the absolute degree of radiographic abnormality nor degree of radiographic improvement correlated well with ECMO requirements. Initial radiographs were useful in confirming the position of bypass cannulae and respiratory tubes. Routine daily examinations did not reveal unexpected abnormalities. However, radiographs taken during periods of increased ECMO requirements due to patent ductus arteriosus or volume overload showed worsening lung opacification.
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PMID:Extracorporeal membrane oxygenation: radiographic appearance of the neonatal chest. 348 68

Eight ventilator-dependent infants with bronchopulmonary dysplasia (BPD) were treated with dexamethasone (0.5 mg/kg/day). Therapy was initiated at 19.3 +/- 3.9 days of age, continued at the initial dose for 7 days, then tapered over 2 weeks. The clinical course of these infants with BPD was compared to that of 8 similar ventilator-dependent infants with uncomplicated hyaline membrane disease (HMD). At study entry, the BPD patients had significantly higher ventilator rates, peak inspiratory pressures, mean airway pressures, alveolar-arterial oxygen gradients and fraction of inspired oxygen (FiO2) values. After 7 days of dexamethasone therapy, ventilator rates, peak inspiratory pressures, mean airway pressures, FiO2 values and alveolar-arterial oxygen gradients improved significantly. At this time, ventilator rates, peak inspiratory pressures and FiO2 values were similar to those of patients with uncomplicated HMD. BPD patients were extubated after 6.5 +/- 2.4 days of therapy. The incidences of septicemia, rickets and retinopathy of prematurity were similar in the BPD and uncomplicated HMD patients. Most dexamethasone-treated patients developed arterial hypertension during the first 48 h of therapy. Blood pressures returned to normal within 7 days of stopping therapy. All BPD patients had cosyntropin responses tested 5.5 +/- 2.6 weeks after stopping therapy. Six were normal. Two had inadequate responses. At 1 year adjusted age, the dexamethasone-treated BPD infants and HMD infants had similar radiographic bone ages, similar growth patterns and similar scores on the Bayley infant development scale. Dexamethasone was useful in the treatment of early BPD. Used as short-term therapy, the drug had minimal complications and no long-term sequelae.
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PMID:Short-term dexamethasone therapy for bronchopulmonary dysplasia: acute effects and 1-year follow-up. 358 71

One hundred twenty-five infants underwent surgical intervention for necrotizing enterocolitis between 1972 and 1984. Sixty-three infants, who survived more than 30 days postoperatively, were evaluated for long-term complications. There were 28 girls and 35 boys (mean birth weight 1,725 +/- 890 g; gestational age 32 +/- 4 weeks). Associated problems included hyaline membrane disease (43), cardiac anomalies (25), and trisomy 21(2). Thirty-six survivors required long-term ventilatory support. Fifty-nine infants underwent bowel resection and enterostomy, 3 decompressing enterostomies without resection, and 1, exploratory laparotomy only. Enterostomies were closed at four months. Twenty four had short bowel syndrome. Fifteen infants subsequently died for a late mortality rate of 23%. Mortality was related to sepsis (3), respiratory failure (5), cardiac anomalies (3), cardio-respiratory arrest (2), and TPN related liver failure (2), and was common with gestational age less than 31 weeks and birth weight less than 1,000 g. Medical problems included cholestasis (17), TPN induced cirrhosis (3), meningitis (3), seizures (8), and nutritional rickets (6). Significant developmental and intellectual delays were observed.
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PMID:Long-term follow-up after surgical management of necrotizing enterocolitis: sixty-three cases. 372 6

The charts of all newborns at the University of the East Medical Center in the Philippines were obtained and were matched with the mother's charts in a study designed to identify the causes of perinatal morbidity and mortality and to analyze the factors that lead to such results. There were 4219 deliveries of 28 weeks and later or 1000 grams and more during 1980-82; only 4057 were available for study. There were 39 neonatal deaths from 4015 live births giving a neonatal death rate of 9.7/1000 live births. Late fetal deaths or stillbirths occurred in 42 fetuses out of 4057 total births with a stillbirth rate of 10.3. There were in all 81 perinatal deaths from 4057 total births with a perinatal mortality of 19.99. There were 250 morbid babies out of 4015 live births giving a morbidity rate of 62.3/1000 live births. Compared to national statistics, the results at this institution are expectedly lower, due to fewer patients with more facilities and personnel. The most common cause of neonatal mortality in the 39 cases was sepsis, which occurred in 21 cases or 53.8%. This was followed by prematurity with hyaline membrane disease in 13/39 or 33.3% of cases and asphyxia in 4/39 or 10.3%. Lethal congenital anomalies occurred in only 1/39 or 2.6% of cases. Stillbirth or late fetal deaths occurred in 42 cases or over 1/2 of total perinatal mortality cases. In 23 of the 42 cases or 54.8%, the cause was cord accidents. In 11/42 or 26.2% of cases, the cause of fetal death was severe asphyxia due to abruptio placenta, severe toxemia giving rise to placental insufficiency, or obstructed labor. In 3/42 or 7.1%, lethal anomalies was the cause; in 5/42 or 11.9% the cause was unknown. Of the total causes of fetal deaths, only those due to asphyxia may be preventable to some extent; these cases comprise only 26.2% of the whole group. Perinatal morbidity was identified in 250 live births. Review of the maternal conditions giving rise to a 25% or more rate of neonatal morbidity shows that multiple pregnancy was foremost with a 60% rate, fetal distress with a 43% rate, premature rupture of membranes with a 38% rate, chronic toxemia with a 31% rate, and placenta previa with a 28% rate. Morbidity and mortality can be lowered markedly with improved prenatal care and early detection and treatment of complications which interact with socioeconomic status and other social differentials.
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PMID:Perinatal morbidity and mortality in the Philippines. 377 13

This study was undertaken to determine the effects of clinical amniotic fluid infection on the neonate in terms of bacterial infection, hyaline membrane disease, asphyxia, and mortality. A retrospective chart review was made of 107 mothers with clinical amniotic fluid infection and their infants at this institution over a 3-year period. The next live-born infant with a birth weight within 100 gm and gestational age within 2 weeks was chosen as a control for each study patient. The rate of prematurity in the study group was 71%. When prematurity was controlled for, there was no significant difference in regard to asphyxia, hyaline membrane disease, bacterial sepsis, and death between the study and control groups. These findings suggest that the adverse outcome for infants delivered to mothers with clinical amniotic fluid infection at this institution was related primarily to their prematurity.
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PMID:Clinical amniotic fluid infection and its effect on the neonate. 398 66

Some newborn infants with either primary or secondary persistent pulmonary hypertension (PPHN) remain hypoxemic, hypercarbic, and acidotic despite therapeutic efforts. In autopsies of 23 infants who had PPHN, diffuse platelet-fibrin thrombi were present in the pulmonary microcirculation of eight (15.2 +/- 18.1 thrombi/cm2 lung tissue) and absent in 15 (0.2 +/- 0.3 thrombi/cm2 lung tissue), (P less than 0.004). Diagnoses in group A (thrombi) were pneumonia and sepsis (four patients), meconium inhalation (3), and primary PPHN (1); and in group B (no thrombi) pneumonia and sepsis (4), meconium inhalation (4), primary PPHN (4), hyaline membrane disease (2), and diaphragmatic hernia (1). The only significant differences between the two groups were the response to tolazoline infusion as assessed by changes in partial pressure of arterial oxygen (PaO2) and the platelet counts. Group A responded less favorably to tolazoline (14.8 mm Hg vs 83.6 mm Hg; P less than 0.05) and had lower platelet counts (51,000/microliter vs 128,000/microliter) (P less than 0.01) than group B. No significant differences could be detected in Apgar scores, duration or mode of mechanical ventilation, oxygen requirements, arterial blood gas tensions or pH, systemic arterial blood pressure, coagulation profile, amount of blood product transfusions, or intravascular catheter use. Pulmonary microthrombi should be added to the list of mechanisms for PPHN and may explain why some infants do not respond well to therapeutic efforts aimed at vasodilation. Thrombocytopenia and failure to respond to pulmonary vasodilators might suggest the diagnosis.
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PMID:Pulmonary microthrombi syndrome in newborn infants with unresponsive persistent pulmonary hypertension. 682 42

The short-term outcome with survival rate, causes of death and neonatal complications in a 6-year material comprising 253 infants treated with intermittent positive pressure ventilation (IPPV) in the neonatal period has been analyzed in relation to different primary disorders necessitating IPPV treatment. The total survival rate was 53%. For the different diagnoses the survival rates were: hyaline membrane disease (HMD) 41%, apnoea repetens of immaturity 85%, severe birth asphyxia 46% and septicemia 59%. The total rate of pneumothorax during IPPV was 15% but occurred more often in the HMD group (28%). Trends in survival rates over the study period are discussed as are measurements for improvements.
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PMID:Evaluation of mechanical ventilation in newborn infants. I. Techniques and survival rates. 698 51

Group B Beta Hemolytic streptococcal infection among newborn infants has recently grown in importance. The pathological changes in the early onset cases appear to be confined to the lung. In our patients, hyaline membranes with peripheral atelectasis was unusual, although fibrin deposited in areas without accompanying atelectasis may lead to confusion with hyaline membrane disease. The clinical features and pathologic changes caused by GBS had some differences from those due to other organisms giving rise to fatal pneumonia in the newborn. The lungs of GBS-infected babies in our autopsy series were not as heavy, had more alveolar fibrin deposition, but not more hyaline membrane disease than in nonstreptococcal cases. Alveolar inflammation was more marked in nonstreptococcal cases, but the GBS cases had more interstitial inflammation. Massive alveolar bacterial growth was more common in the GBS cases. Chronic thymic involution was less marked in the GBS cases, while acute splenitis was more common. Meningitis was present in four of our nonstreptococcal cases, but in none of the GBS cases. The clinical courses of GBS and nonstreptococcal fatal pneumonias differed. The mothers of infants with GBS infection were less febrile and ahd an increased frequency of prolonged rupture of the membranes, while the infants had a decreased duration of life, compared to those with nonstreptococcal sepsis.
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PMID:Group B beta hemolytic streptococcal sepsis in the newborn. 703 18

A retrospective analysis of infants with necrotizing enterocolitis was done to evaluate the effects of preoperative abnormalities upon anaesthesia and mortality. Mortality was significantly increased in infants weighing less than 1500 grams (p less than .001). Sixty-nine per cent of the infants had hyaline membrane disease and 35 per cent had platelet counts less than 50 X 10(9) cells/litre (50,000/mm3). Perioperative problems include peritonitis, sepsis, hypovolaemia, acidosis, and prematurity. Other ramifications of prematurity and anaesthesia are discussed.
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PMID:Anaesthetic implications of neonatal necrotizing enterocolitis. 707 4

Almost all types of newborn respiratory failure are reversible. However, supportive treatment (oxygen and positive airway pressure) can damage the lung, and newborn respiratory failure remains a major cause of morbidity and death in infants. Prolonged extracorporeal membrane oxygenation (ECMO) provides life support while allowing the lung to "rest." We have used ECMO in 45 moribund newborn infants; 25 survived. Neonatologists referred patients who were unresponsive to maximal therapy. The right atrium and aortic arch were cannulated via the jugular vein and carotid artery. Heparin was infused continuously to main activated clotting time at 200 to 300 seconds. Airway oxygenation and pressure were reduced to low levels. Primary diagnoses were hyaline membrane disease, 14 (6 survived, 8 died); meconium aspiration, 22 (15 survived, 7 died); persistent fetal circulation including diaphragmatic hernia, 5 (3 survived, 2 died); and sepsis, 4 (1 survived, 3 died). Growth, development, and brain and lung function are normal in 20 of 25 survivors. ECMO decreased newborn respiratory failure mortality and morbidity rates in this phase I trial. A controlled randomized study is underway. The results suggest that ECMO may be effective in older patients if used before irreversible lung damage occurs.
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PMID:Extracorporeal membrane oxygenation for newborn respiratory failure: forty-five cases. 710 Nov 33


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