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

To obviate any limitation in abdominal volume, the girth in 44 neonates was increased significantly by the insertion of either Marlex mesh or Prolene mesh as a permanent midline fascial prosthesis. Concomitant primary wound closure was then accomplished through mobilization of laterally based skin flaps. Without exception, the resultant coelom was adequately spacious, as reflected postoperatively by both ventilation and venous return being unimpaired. Four babies died, three as a result of antecedent cerebral hypoxia complicating diaphragmatic herniation and one as a result of sepsis. Indications for the procedure were a massive omphalocele in 31 infants, gastroschisis in nine and a huge diaphragmatic hernia in four. Wound dehiscence with exposure of the fascial prosthesis occurred twice, once because of a cautery burn of the skin and after minor wound infection in the second. Revision of the initial abdominal wall repair was required in both of these babies as well as for incomplete extrusion of Marlex mesh in three older children. Prolene is now preferred for fascial prostheses. Prime advantages of the technique include immediate enlargement of the peritoneal capacity, rare necessary for ventilatory support, maintenance of abdominal support by a fascial gusset, elimination of infectious complications attending more delayed closures of wound and peritoneum and the uncommon need for later operative revision.
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PMID:Immediate permanent fascial prosthesis for gastroschisis and massive omphalocele. 645 68

During the decade from July 1970 through June 1980, 57 patients with omphalocele and 64 with gastroschisis were treated at the Childrens Hospital of Los Angeles. Among the patients with omphalocele, the mortality was not significantly different between those with an abdominal wall defect smaller than 4 cm (5 of 24 patients) and those with a larger defect (6 of 33 patients); between those with a birth weight of less than 2,500 g (3 of 13 patients) and those with a higher birth weight (8 of 44 patients); between patients who had part of their liver in the omphalocele sac (6 of 29 patients) and those who did not (5 of 28 patients); and between patients who had primary fascial closure of the abdominal wall defect (3 of 24 patients) and those who had staged closure (4 of 25 patients). The overall mortality of 19 percent (11 of 57 patients) is not significantly different from that seen in patients treated during the preceding decade, 1960 through 1970 (23 percent, 5 of 22 patients), in our institution. Major chromosomal and other associated anomalies adversely affected the survival rate in these patients. In contrast, the overall survival rate of gastroschisis patients has markedly increased over the past two decades (91 percent in 1975 to 1980). In these patients, the difference in survival between those who had primary fascial closure (73 percent) and those who had staged closure by skin flaps or silon chimney (81 percent) was not statistically significant. Prematurity, bowel complications, and candida septicemia associated with the use of total parenteral nutrition contributed to the mortality.
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PMID:Omphalocele and gastroschisis. Trends in survival across two decades. 649 61

Over a ten-year period 21 children with gastroschisis were treated either with a direct full-layer closure or with a silastic sac closure of the abdominal wall defect. No mortality or longterm morbidity resulted from either form of therapy in the group of patients that had no anatomical interruption of the gastro-intestinal tract. Silastic sac closure did, however, result in a higher incidence of septicemia. In the group of patients that presented with an anatomical interruption of the G.I. tract, considerable mortality and morbidity resulted. The outcome in these patients was determined by the associated bowel lesion rather than by the gastroschisis as such.
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PMID:Gastroschisis: factors affecting prognosis. 728 53

Sepsis secondary to bacterial translocation is common in infants with short bowel syndrome (SBS). Although early feeding is advocated to enhance adaptation in SBS, the effects of feeding on sepsis in SBS patients have not been examined. Twenty-one infants and children (aged 2 months to 3 years) with SBS (< 80 cm small bowel length) from a variety of causes (15 necrotizing enterocolitis, 2 atresia, 2 gastroschisis, 2 volvulus) had follow-up prospectively for septic episodes before and after feedings were initiated, while still receiving total parenteral nutrition. The incidence and number of septic episodes and microbiology (blood cultures) were tabulated and compared with those of 20 patients with similar ages, and diagnoses without SBS. Statistically significant differences among infants with SBS were noted with respect to sepsis incidence (6 of 21 [29%] NPO v 16 of 21 [76%] feeding) number of septic episodes (1.3 +/- .2 NPO v 4.2 +/- .4 feeding), and presence of gram-negative rods causing bacteremia (1 of 6 [17%] NPO v 13 of 16 [81%] feeding) (all: P < .05). There were similar differences between SBS and non-SBS infants. These data show that enteral feeding increases the incidence and number of episodes of sepsis in SBS infants, but not in matched non-SBS patients. The predominance of gram-negative organisms in sepsis in SBS suggests increased gut bacterial translocation in these patients, implying that selective gut decontamination may reduce the episodes of bacteremia.
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PMID:Enteral feeding increases sepsis in infants with short bowel syndrome. 747 38

Before the introduction of the "silo" for gastroschisis, the main goal of surgery was to cover the defect with skin. Since the silo has been used, the goals have been (1) to cover the defect with SILASTIC sheets and return the extraabdominal contents to the abdominal cavity by progressive plication of the silo and (2) to eventually close the defect by fascia-to-fascia approximation, before 1 month of age. In many series, early definitive abdominal wall closure resulted in mortality rates of 10% to 30%, usually because of bowel necrosis and resulting sepsis. At the author's institution, 20 newborns with large omphaloceles or gastroschisis have been treated, and fascial closure was obtained by the second week in 10 infants. In ten babies it was impossible to obtain early fascial closure without tension, and these children were managed differently. A nonaggressive two-stage approach was used, in which the goals were (1) early return of contents to the abdominal cavity and (2) only skin and granulation coverage of the defect (without aiming for early fascial closure or partial fascial closure) with a small central SILASTIC patch. Stage 1 is reduction of abdominal contents to the abdomen, through plication of the silo, over a 9 to 14 day period. Stage 2 is removal of the silo and closure of the ventral abdominal wall defect using a SILASTIC patch to close most of the defect, after approximating fascia in the superior and inferior portions. If the skin cannot be closed, the patch usually separates in 14 to 21 days, the pellicle remaining becomes completely epithelialized in 1 to 2 months, and further surgery has not been necessary.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Is early fascial closure necessary for omphalocele and gastroschisis? 772 22

BACKGROUND--Familial cases of gastroschisis are exceptional. CASE REPORT NO. 1--A boy was admitted at birth suffering from gastroschisis. Surgical repair was done but the patient died on day 24 with septicemia. CASE REPORT NO 2--Fifteen years later, gastroschisis was discovered by ultrasonography in a male fetus (GA = 26 weeks). Successful surgical repair was done just after the birth at a normal term. Mothers of both cases were sisters. CONCLUSIONS--The rare familial cases of gastroschisis have been seen in sibships. This is the first familial case seen in first cousins.
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PMID:[Laparoschisis: a familial form]. 783 39

Increased intraabdominal pressure (IAP) has been demonstrated to cause intestinal and renal ischemia in both animals and humans. Neonates undergoing closure of anterior abdominal wall defects are at risk for these complications from markedly increased IAP, which are putatively responsible for a 13% to 20% mortality. In an effort to decrease morbidity and mortality we performed a 4-year prospective clinical study to determine if monitoring IAP using bladder pressure (BdP) measurements would significantly improve perioperative care in infants with abdominal wall defects. Forty-two consecutive infants with gastroschisis (28) and omphalocele (14) were prospectively studied. Intraoperative and serial postoperative measurements of BdP were obtained from an indwelling bladder catheter using a standard pressure transducer. Methods of initial closure, as well as manipulations in sedation, paralysis, and silo reduction, were selected to keep BdP < 20 mm Hg. Bladder pressure monitoring significantly altered the management of 64% of our patients, particularly those with gastroschisis (74%). Thirteen patients with gastroschisis underwent staged closure; in 7 (54%) this decision was based on high BdP even though bowel reduction was mechanically possible. Elevated BdP influenced the closure method and timing of silo reductions in 5 of 14 (42%) infants with omphalocele. There were no episodes of renal failure or refractory oliguria. There were three patients in a single cluster who developed uncomplicated, nonsurgical necrotizing enterocolitis late in their respective courses. One patient whose bowel was placed in a silo had severe hypotension associated with group B streptococcal sepsis and subsequently developed necrotic bowel despite low BdP.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Bladder pressure monitoring significantly enhances care of infants with abdominal wall defects: a prospective clinical study. 826 3

From 1984 to 1993, 25 neonates with gastroschisis were treated at Chianghua Christian Hospital (CCH). Twenty-one patients were outborn, and only four were inborn babies. Eighteen patients were treated by primary fascial closure of the abdominal wall defect and seven, by the silastic sac technique. One patient required creation of intestinal stomas for ileal atresia; Two patients received further operation because of pus formation and intestinal obstruction. Four patients (16%) had associated anomalies, including one ileal atresia, two malrotations and one deformity of the hand. Seven (28%) patients were small for their gestational age. Eight patients died (32%); 17 survived (68%). Nine patients (36%) were hypothermic upon arrival at the hospital, with body temperatures of 32.5 degrees C to 35.8 degrees C. Among those, three died of intractable metabolic disorders related to hypothermia and two who were hypothermal and acidotic, developed sepsis and expired. Six patients (24%) developed sepsis and only one survived. Metabolic acidosis related to hypothermia and sepsis were the major causes of death in this study (P values of 0.024 and 0.01 respectively). It is no doubt that an experienced pediatrician is essential for immediate neonatal care to prevent unnecessary insults.
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PMID:Hypothermia and sepsis: the major causes of mortality in gastroschisis. 860 56

Infants with omphalocele and gastroschisis represent a challenging group of patients. Antenatal diagnosis may affect management by stimulating a search for associated anomalies, and by changing the site, mode, or timing of delivery. During the neonatal period, great care must be taken to minimize fluid and heat loss, and to prevent bowel distension. Although the goal of the surgeon is to accomplish abdominal wall closure in a single stage, a number of options exist where this is not possible. Other considerations include prevention and control of sepsis, nutritional support, respiratory status, and dysfunction of the liver, kidneys, and intestine because of increased abdominal pressure. Long-term outcome, in the absence of major chromosomal and structural anomalies, is excellent.
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PMID:Gastroschisis and omphalocele. 913 11

47 children with gastroschisis were operated at the Hannover Medical School between 1980 and 1995. The average gestation period was the 36th week of pregnancy with an average birthweight of 2370 gr. A primary layered closure of the abdominal wall was performed on 46 children. A multi-sided closure of the abdominal wall defect using Gore-Tex was necessary in only one case. Post-operative intubation lasted for an average of 56 hours. The children were fed by parenteral nutrition for an average of 32 days, with oral feeding starting on the 15th post-operative day. The average weight on discharge was 3035 gr. 18% of the children had post-operative problems such as sepsis, necrotic enterocolitis and ileus. A death rate of only 2% is proof of the progress that has been made in prenatal care of the newborn child suffering from gastroschisis and suggests that primary closure of the abdomen is the operative method to be aimed for.
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PMID:[Experiences with primary fascia closure of the abdomen in gastroschisis--a 16 year review]. 948 Jun 11


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