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

We examined the effects of early administration of polymorphonuclear leukocyte (PMN) transfusions in neonates with sepsis by prospectively randomizing 35 consecutive critically ill infants with sepsis, 21 of whom received PMN transfusions in addition to supportive care, one transfusion every 12 hours for a total of five transfusions. Each transfusion consisted of 15 mL/kg containing 0.5 to 1.0 X 10(9) PMN with less than 10% lymphocytes, and was subjected to 1500 rads. PMNs were obtained by continuous-flow centrifugation leukopheresis. Pretreatment values that did not significantly affect survival included weight, gestational age, sex, prematurity, C-reactive protein, initial hematocrit, platelet count and absolute granulocyte count (AGC less than or equal to 1500/mm3), IgM, IgG, IgA, neutrophil supply pool depletion, hypoxia, acidosis, and hypotension. Postnatal age was significantly lower in the nontransfused group than in the transfused group; 2.3 +/- 0.6 vs 6.1 +/- 2.2, (P less than 0.001). Positive blood cultures were obtained in 80% of both groups. Low circulating levels of total hemolytic complement were associated with a poor outcome and higher mortality: 56 +/- 4.0 IU in survivors vs 31 +/- 4.4 IU in nonsurvivors (P less than 0.01). Survival was significantly greater in the PMN transfused group than in the nontransfused group: 20 (95%) of 21 vs nine (64%) of 14 (P less than or equal to 0.05). No untoward effects were attributable to PMN transfusions, either during the study or on subsequent follow-up visits. These preliminary data suggest that early treatment with PMN transfusions improves survival in neonates with overwhelming sepsis. In addition, depleted or low circulating levels of complement may influence prognosis and thus future treatment strategies for neonatal sepsis.
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PMID:Role of circulating complement and polymorphonuclear leukocyte transfusion in treatment and outcome in critically ill neonates with sepsis. 358 10

Chest radiographs and clinical records of 58 newborns with pulmonary interstitial emphysema (PIE) were reviewed to determine the diagnostic and prognostic significance of this finding in the first 24 hours of life. Thirty-nine infants developed PIE before 1 day of age (early PIE). In the absence of infection, early PIE was associated with younger gestational age, lower birth weight, lower 1 and 5 minute Apgar scores, and higher mortality, as compared with patients in whom air leak occurred later. Survival in infants with PIE seemed to be influenced mainly by coexisting risk factors such as extreme prematurity, birth asphyxia, and perinatal infection. Most cases of early PIE in newborns less than 30 weeks gestational age occurred at peak ventilation pressures less than 25 cm H2O, and probably reflect increased sensitivity of the underdeveloped lung to barotrauma. In infants older than 30 weeks gestational age, early PIE was strongly associated with bacterial sepsis. These data indicate that the occurrence of PIE in the first 24 hours of life is a particularly ominous sign, and is frequently associated with clinical conditions which carry a poor prognosis.
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PMID:Early pulmonary interstitial emphysema in the newborn: a grave prognostic sign. 359 42

We treated eight children, aged 7 weeks to 17 years, for lung abscess. Each abscess followed an episode of aspiration or a bacterial pneumonia. Associated conditions were leukemia, congenital immune deficiency, endocarditis, cerebral palsy, and prematurity. Seven of the 8 children had polymicrobial infections, usually containing both aerobic and anaerobic bacteria. The success of medical treatment by antibiotics and chest physiotherapy was age related; 3 of the 8 children, aged 10 to 17 years, recovered on this regimen, whereas five children, aged 7 weeks to 7 years, required catheter drainage or resection for cure. Drainage by catheter pneumonostomy was performed for solitary peripheral bacterial abscesses. A large intercostal catheter was inserted into the cavity, either operatively or percutaneously. Wedge resection was performed for multiple, central, or fungal abscesses. Pneumonostomy was curative in 3 of 4 children. One chronic abscess recurred after pneumonostomy and required resection. Wedge resection was curative in the two children who came to thoracotomy; lobectomy was not necessary. Although all eight children recovered from their lung abscesses, three of them died within a year of sepsis. Lung abscess today occurs in immunocompromised children who are vulnerable to fatal infections. Chest physiotherapy is unlikely to achieve good drainage in children under 7 years of age. Medical failures can be identified within the first week of treatment. Early and aggressive surgical treatment is indicated in such children, and may be lifesaving.
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PMID:Drainage of pediatric lung abscess by cough, catheter, or complete resection. 373 40

This retrospective review of 83 infants undergoing CPR in the neonatal ICU of a teaching hospital found that 12 (14%) patients were discharged from the hospital and seven (8%) were alive at least 1 yr after discharge. Of these seven, five appeared neurologically intact. From another perspective, 41% (12/29) of the patients who survived at least 24 h after CPR were discharged alive. Factors significantly (p less than .05) associated with poor outcome included sepsis, oliguria 24 h before and/or after arrest, prematurity, and intraventricular hemorrhage. Variables significantly (p less than .05) related to good outcome were the need for intubation during resuscitation and the diagnosis of major congenital anomalies. Intraventricular hemorrhage was the single most powerful variable in the regression analysis. Outcome statistics from this study were strikingly similar to currently available adult data.
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PMID:Outcome of cardiopulmonary resuscitation in the neonatal intensive care unit. 374 95

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

Perinatal and infant mortality during the year 1985 was analyzed through a prospective study conducted in 12 Anganwadis (total population of 13,054) located in slum areas of India's Jabalpur city. Overall, the infant mortality rate was 128.7/1000 live births and the perinatal mortality rate was 88.5/1000 live births. 58.5% of deaths occurred in the neonatal period. Causes of neonatal deaths included prematurity, respiratory distress syndrome, birth asphyxia, septicemia, and neonatal tetanus. Postneonatal deaths were largely attributable to dehydration from diarrhea, bronchopneumonia, malnutrition, and infectious diseases. All mortality rates were significantly higher in Muslims than among Hindus. Muslims accounted for 28% of the study population, but contributed 63% of stillbirths and 55% of total infant deaths. This phenomenon appears attributable to the large family size among Muslims coupled with inadequate maternal-child health care. The national neonatal and postneonatal mortality rates are 88/1000 and 52/1000, respectively. The fact that the neonatal mortality rate in the study area was slightly lower than the national average may reflect the impact of ICDS services.
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PMID:Perinatal and infant mortality in urban slums under I.C.D.S. scheme. 380 6

Amniocentesis has recently been advocated as a useful diagnostic adjunct in the management of the patient with preterm premature rupture of membranes (PROM). Although studies are limited, transabdominal inspection of amniotic fluid for a mature phospholipid lung profile or evidence of incipient sepsis appears helpful in reducing the risk of prematurity and infection in the gravida and neonate. In addition, amniocentesis in this group of patients is technically feasible if ultrasound is used concomitantly. Limitations to this procedure include the inability to identify neonates at risk for nonpulmonary complications of prematurity such as intraventricular hemorrhage. Physicians should be aware of their individual laboratory and nursery limitations along with current infectious morbidity statistics before initiating this management protocol.
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PMID:The use of amniocentesis in preterm premature rupture of membranes. 388 66

Assessment of placental pathology and its relationship to historical data, initial laboratory parameters, and outcome was undertaken in 22 cases of early-onset group B streptococcal sepsis of the neonate. Fourteen (64%) of the placentas demonstrated chorioamnionitis, six (27%) funisitis, and in nine (41%) gram stain demonstrated organisms within the membranes. Focal villous edema was observed in five (23%) cases and diffuse villous edema in four (18%). No placenta demonstrated chorangiosis. Placental inflammation was significantly (p less than 0.05) associated with prematurity, prolonged rupture of membranes, and onset of symptoms at less than 3 hours of age. No placental change was significantly associated with outcome or with neutropenia, which was the only parameter assessed that appeared to have prognostic value.
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PMID:Significance of placental findings in early-onset group B streptococcal neonatal sepsis. 388 54

A 14-month-girl presented with an asymptomatic posterior mediastinal mass. She had a history of prematurity, umbilical artery catheterization, and sepsis. The diagnosis of aortic aneurysm was made by dynamic computed tomography. The aneurysm was successfully resected.
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PMID:Aortic aneurysm secondary to umbilical artery catheterization. 388 16

TPN-associated cholestasis (TPNAC) is a common problem in neonatal surgical patients. Of the 222 infants admitted to the neonatal surgical intensive care unit between January 1982 and June 1983, 46 patients received parenteral nutrition for over 14 days. Cholestasis occurred in 16 of these patients (35%), while 30 patients remained jaundice-free. Clinical characteristics associated with the development of TPNAC, included primary diagnosis, low birth weight, duration of TPN administration, the interval before enteral feeding was initiated, sepsis, central venous catheter infection, and the number of operative procedures. Factors which did not appear significant in the development of conjugated hyperbilirubinemia were prematurity, sex, gestational age, average daily weight gain, and the specific components of the nutritional intake. Mortality was high in the children with cholestasis (31%) as compared to the "normal" neonates (3%) and two of the five deaths were directly related to progressive hepatic dysfunction. This report confirms the high incidence of TPNAC in the newborn surgical population and discusses the critical risk factors associated with development of the syndrome.
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PMID:TPN-associated hyperbilirubinemia: a common problem in newborn surgical patients. 393 Jun 93


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