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

Fifty (13%) of 375 infants who weighed 1500 g or less at birth had necrotizing enterocolitis (NEC). Haematological changes suggestive of sepsis occurred in 83% and positive bacteriological cultures were found in 38%, the most common organism isolated being Clostridium perfringens. Complications included intestinal perforation in six patients and recurrence of NEC in five, of whom one subsequently developed an intestinal stricture. Five of the eight nursery deaths were secondary to peritonitis and overwhelming sepsis from NEC. In spite of the discontinuation of milk feeds for prolonged periods, satisfactory caloric intake and weight gain were achieved with parenteral nutrition in the survivors. Of the 41 long-term survivors, six (15%) were found to have a disability at 2 years of age, corrected for prematurity, compared with 48 (20%) of 241 very low birthweight survivors from the same study period who did not have NEC. None had evidence of gastrointestinal dysfunction. Six (15%) children remained below the 10th percentile for both weight and height. This study showed that early diagnosis and therapy for NEC in very low birthweight infants were associated with a favourable short- and long-term outcome.
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PMID:Necrotizing enterocolitis in very low birthweight infants: a four-year experience. 646 13

This report concerns 60 children with documented Staphylococcus epidermidis sepsis. There were 34 boys and 26 girls, ages 2 weeks to 15 years. The primary diagnosis included malignancy (13), congenital (13) or acquired (11) gastrointestinal disorders, prematurity (7), cardiac defect (5), hydrocephalus (2) and miscellaneous (9). Clinical presentation included fever (54), tachycardia (15), lethargy (20), hypotension (8), irritability (6), increased gastric residuals (6) and apnea/bradycardia (3). A documented source of sepsis was noted in 56 patients, including percutaneous central venous catheters (23), Broviac catheters (17), umbilical arterial catheters (6), wound (3), V-P shunt (2), cardiac defect (2), cholangitis (1), chest tube (1) and peripheral arterial line (1). There were six sepsis-related deaths, four in premature infants. Two of six infected subclavian catheters were treated successfully with vancomycin. Infection was successfully cleared in 20 of 23 infected Broviac catheters with vancomycin through the line. However, six were eventually removed for tract infection (1), persistent fever (2), and Candida sp. infection (3). Although once considered a non-pathogenic skin contaminant, S. epidermidis has emerged as a serious pathogen in hospitalized, immunosuppressed, premature and malnourished pediatric patients. Indwelling catheters enhance the likelihood of infection in these patients. Aggressive antimicrobial therapy is vital in this potentially lethal infection. Vancomycin proved efficacious in this series.
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PMID:Staphylococcus epidermidis sepsis in pediatric patients: clinical and therapeutic considerations. 648 77

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

Morbidity and mortality patterns were examined among 968 pediatric patients on the island of Dominica. These children, whose ages ranged from newborn to 13 years, were seen by the consulting pediatrician at Princess Margaret Hospital during a 9-month period in 1978-79; 852 children were seen as inpatients. A total of 477 cases of infectious disease were diagnosed among inpatients alone. Stool examination in a subsample of these children revealed parasites (mostly Trichuris) in roughly half. Also found was a relatively high prevalence of chronic health problems, especially rheumatic heart disease (34 cases), mental retardation (28 cases), epilepsy (31 cases), and sickle cell anemia (21 cases). Examination of the hospital records of 100 of the inpatients ages 6 months-5 years demonstrated that 34% were low weight-for-age according to the World Health Organization classification. There were 34 deaths (9 pediatric patients and 255 newborns). The high neonatal mortality is attributed to an unusually high incidence of immaturity and prematurity, irregular and insufficient hospital oxygen supply, and a septicemia epidemic. Although these findings reflect patterns of the more serious diseases, they could be useful in planning preventive health measures. The high prevalence of malnutrition points to a need for nutrition education, promotion of breastfeeding, promotion of vegetable growing, and the introduction of a home-based growth chart. The high incidence of diarrhea, typhoid fever, and helminthiases highlights problems with general hygiene, latrines, and water supply. There is also a need for follow-up facilities for children with rheumatic heart disease, epilepsy, and sickle cell anemia. It is suggested that hospital care could be improved by dividing pediatric and neonatology wards into 5 units: isolation ward, malnutrition ward, semi-intensive care unit, general pediatrics, and pediatric surgery.
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PMID:Morbidity and mortality patterns among pediatric patients in Dominica (West Indies). 662 10

Yellow staining of central nervous system (CNS) nuclei occurs in the brains of some neonates, despite low levels of serum bilirubin. Two conditions appear to be important in the evolution of this form of kernicterus: prematurity and asphyxia. In a seven year retrospective study of a large neonatal autopsy population, 102 cases had kernicterus as indicated by selective macroscopic yellow staining and microscopic damage within specific CNS nuclei. Neuropathological study disclosed minor variations and numerous similarities in the manifestations of kernicterus in the asphyctic premature neonate with low levels of serum bilirubin, as compared to kernicterus in the full-term neonate with high levels of serum bilirubin. Acidosis, hypoxia, hyperoxia, hypothermia and sepsis have been considered significant risk factors, but recent comparative clinical studies have not defined predictive indices. Analysis of this disorder is difficult because of the concurrence of other complications of asphyxia and its pathological correlates in premature infants. Diagnostic difficulties are also compounded by variations in the definitions of kernicterus as used by different investigators.
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PMID:The neuropathology of kernicterus in the premature neonate: diagnostic problems. 669 27

Two hundren sixty-seven neonates who received parenteral nutrition were monitored for signs of liver dysfunction. Cholestatic jaundice occurred in we infants, with a higher incidence in the more immature infants. There was an inverse correlation between severity of jaundice and the degree of prematurity. Infants with cholestasis remained without gastrointestinal feedings and received parenteral nutrition for periods of time significantly higher than infants without cholestasis. The incidence of this complication did not seem to correlate with the amount of protein infusate (amino acid solution). A higher incidence of sepsis was noted in infants who were affected by cholestasis. Close monitoring for signs of liver dysfunction in all neonates receiving parenteral nutrition is strongly recommended.
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PMID:Hyperalimentation-induced cholestasis. Increased incidence and severity in premature infants. 679 7

The risks to the infant following prolonged premature rupture of the amniotic membranes are those of prematurity and infection. After the 36th week of pregnancy, healthy infants of healthy mothers may be treated as uninfected neonates, as their risk of infection does not appear to be significant. Before this gestational age, infants should receive a complete laboratory evaluation for infection, including blood culture and spinal fluid examination, and antibiotic therapy should not be withheld until these laboratory tests are reported to the clinician. While the indiscriminate use of antibiotic treatment should be avoided, sepsis in the newborn can be a rapidly progressive disease, with minimal physical and laboratory findings at its onset. Therefore, until some method of laboratory evaluation that will detect all cases of neonatal sepsis rapidly, and leave no infected infant unidentified, the clinician must be alerted to the presence of an infant delivered after PROM and institute the appropriate evaluation and treatment as soon as possible.
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PMID:Premature rupture of the membranes (PROM): a neonatal approach. 683 7

In the past 40 years, the predominant organisms responsible for neonatal sepsis have changed. Whereas Group A betahemolytic streptococci were originally most common and staphylococci later became the major pathogens, Group B beta-hemolytic streptococci have become increasingly important in recent years. Predisposing factors include premature rupture of membranes, prolonged difficult labor, prematurity and congenital anomalies. The causes and clinical features of early-onset infection (in the first week of life) and late-onset infection are different.
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PMID:Group B beta-hemolytic streptococcal sepsis in the neonate. 699 62

Twenty-nine cases of neonatal septicemia from Saudi Arabia are described. A high incidence of prematurity (45%) and congenital malformations (45%) were found as predisposing factors. The mortality was 45%, mainly due to severe malformations and late referrals. Thirty-one percent of the cases grew Salmonella enteritidis species and one case of Bacteroides fragilis septicemia and meningitis is reported. Only two of the organisms isolated were sensitive to ampicillin. The importance of doing studies on neonatal septicemia on a local basis is stressed.
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PMID:Neonatal septicemia in Riyadh, Saudi Arabia. 703 58

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


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