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

A 14-month prospective study of patients with premature rupture of the membranes was performed. The purpose of the study was to determine the effect of different therapeutic regimens for management of premature rupture of the membranes (PROM) on perinatal morbidity and mortality, as well as on maternal morbidity. Maternal and fetal risk factors and predictive factors in pregnancy outcome were prospectively defined. In patients with PROM whose gestational age was 34 weeks or more, induction within the first 12 hours of membrane rupture resulted in minimal maternal and fetal morbidity and mortality. Patients with gestational age of less than 34 weeks had an improved maternal and fetal outcome if left alone until spontaneous labor or 34 weeks' gestation was reached unless signs of sepsis developed. Respiratory distress syndrome (RDS) was the leading cause of morbidity and mortality in the infants of patients who delivered prematurely due to premature rupture of the membranes. Incidence of fetal infection was significantly less than that of RDS as a cause for fetal morbidity and mortality.
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PMID:Management of premature rupture of the membranes. 68 24

Acute RDS is a clinical and pathologic phenomenon with many causes. Some of the pulmonary problems are iatrogenic, resulting from the overuse of blood, crystalloids, oxygen, vasopressors, sedation, and immobility. Some are related to the blast effects of injuries at sites distant from the thorax. Other causative factors are metabolic, secondary to diminished peripheral perfusion. The pulmonary capillary bed is a principal target organ in shock--affected by the toxic action of vasoactive substances, gastric aspirates, and fat; by the obstructive action of platelet, fibrin, and leukocyte clots; and by changes in balance between perfusion pressures and oncotic pressures. The rationale of prevention and therapy presented here has resulted (except in those patients with prolonged sepsis) in almost complete disappearance of RDS as a cause of death in our institution.
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PMID:The respiratory distress syndrome. 124 60

Natural surfactant (Surfactant TA, Survanta, CLSE, SF-RI 1, Curosurf and human surfactant obtained from amniotic fluid) therapy for RDS in very premature infants has been evaluated in 17 controlled clinical trials. Uniformly intratracheal surfactant administration caused a decreased intensity of mechanical ventilation during the first hours (reduced inspiratory pressure, reduced oxygen requirements) as an immediate effect of surfactant administration. Metanalysis reveals barotraumatic pulmonary complications mainly, pneumothorax and pulmonary interstitial emphysema to occur less frequently in surfactant-treated infants in virtually all trials; an increased incidence of survival without bronchopulmonary dysplasia following surfactant treatment was observed in 10 controlled clinical trials. The incidence of other complications of prematurity (intracranial hemorrhage, patent ductus arteriosus and necrotizing enterocolitis) was unchanged following natural surfactant treatment. Dosing of natural surfactant is still under investigation, however recent data indicate that the initial dose should not be less than 100 mg/kg b.w. and retreatment should be given to infants with unsatisfactory response (i.e. fraction of inspired oxygen (FiO2) > 40%). Timing of surfactant treatment still remains controversial. Prophylactic treatment shortly following birth has been compared with rescue-treatment, i.e. surfactant administration to infants suffering from manifest RDS in most studies 4-8 h after birth. Conflicting data from 5 controlled trials may be interpreted as follows: prophylactic treatment seems to be favourable for extremely premature infants (GA < or = 26 weeks) and rescue treatment seems to be adequate for infants of 27-30 weeks of gestation. Intratracheal surfactant instillation in very premature infants did not result in an improved lung function for 24 h to 48 h in all patients. Ten--25% of study infants were reported to be "non-responders", i.e. infants without sustained decrease in oxygen requirements (i.e. FiO2 > 40%). Various factors may be operative including congenital bacterial infections (sepsis or pneumonia), lung hypoplasia and cardiac failure. Inactivation of surface properties of natural surfactant caused by a leakage of proteins across the alveolar-capillary membrane was observed in experimental and clinical studies. Current investigations focus on a combination of postnatal steroids and surfactant treatment to improve lung function and outcome in "non-responders". As long as any controlled clinical studies are being published, this approach remains experimental. Up to now, any controlled clinical trials have been performed to assess different modes of artificial ventilation (e.g. high frequency oscillating ventilation versus conventional ventilation) combined with surfactant therapy. Data obtained from premature animals given natural surfactant indicate any advantage with respect to gas exchange and lung histology to result from high frequency ventilation.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Natural surfactant for neonatal respiratory distress syndrome in very premature infants: a 1992 update. 129 66

We administered teicoplanin as specific antibiotic therapy for nosocomial "ICU specific" infections with methicillin-resistant Staphylococcus aureus and epidermidis (MRSA-MRSE). The above mentioned drug has been given to 20 patients (15 newborns and 5 not-newborns) admitted into intensive care unit during the years 1988, 1989, 1990 with MRSA-MRSE localized and/or systemic infection, affected by severe disease (RDS, pulmonary edema, congenital cardiac disease, cystic fibrosis) undergoing invasive procedures which presented high nosocomial infective risk (tracheal intubation, mechanical ventilation, venous and arterial cannulation, total parenteral nutrition, etc.). Complete recovery from systemic or localized infection (sepsis, low respiratory tract infection, high respiratory tract infection) occurred in 19 out of 20 patients, with a rate of success of 95%. Teicoplanin treatment lasted from a minimum of nine days to a maximum of thirty days. The dose was 5-6 mg/kg/die in one administration for the first three days, then 4 mg/kg/die. The tolerability of teicoplanin has proven satisfactory, since we had no major side effects during treatment and follow up.
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PMID:[Teicoplanin therapy in neonatal and pediatric intensive therapy]. 138 7

The premature rupture of the membranes is still a cause of concern due to the related risk of infection and respiratory disorders. The study included sixty-two neonates whose mothers had ruptured their membranes for at least 48 hours (group A) and 42 neonates with a high risk of infection (low birth weight, prematurity) (group B) in order to assess whether antibiotic prophylaxis used in pregnant women with premature rupture of the membranes is sufficient to reduce the risk of severe neonatal infection. The results obtained show that there is an increased frequency of RDS, jaundice and mortality in group A, whereas in group B there was a greater frequency of sepsis and urinary tract infections. Antibiotic prophylaxis therefore allows the frequency of neonatal infections following the rupture of membranes to be reduced, thus enabling the birth to be delayed in order to induce pulmonary maturity.
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PMID:[Neonatal infections and premature rupture of fetal membranes]. 179 5

The case records of 2177 newborn infants admitted in the Neonatal Intensive Care Unit (NICU) from January, 1989, through July, 1990, with positive blood cultures for coagulase-negative staphylococci (C-NS) were evaluated. Seventy four (3.4%) neonates yielded C-NS in blood cultures during the study period. Of these, 58 (2.7%) infants had clinical and hematological features compatible with the diagnosis of septicemia. Remaining 16 babies with positive cultures had no evidence of sepsis, and were designated as "C-NS bacteremia". The age at which positive cultures were obtained differed between the bacteremic and septicemic groups. In bacteremic group, the onset occurred between one to four days of age. In contrast, in septicemic group the range was 6-20 days, with a mean of 10.22 (+/- 3.53) days. More than two third of total cases of C-NS sepsis were premature and low birth weight (LBW). Prominent clinical features included lethargy, poor feeding and fever. Besides this apneic spells were seen predominantly in babies weighing less than 1500 g. Further, before the diagnosis of C-NS sepsis, more than half of neonates had received prolonged intravenous fluid therapy, a quarter had undergone umbilical catheterization and a further quarter needed a ventilator support. Overall mortality in C-NS sepsis was 17.24%, distinctly higher in neonates with RDS and those requiring mechanical ventilation (p less than 0.05). Only 1.34% C-NS isolates were resistant to all routinely used antibiotics and sensitivity was maximum with newer cephalosporins, ciproflox and amikacin.
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PMID:Coagulase negative staphylococcal septicemia in newborns. 180 44

The neonatal morbidity was studied in 7015 neonates born at the All India Institute of Medical Sciences Hospital, New Delhi. The incidence of low birth weight babies was 26.7 per cent; one seventh (13.5%) of the series were preterm (less than 37 wk), while 6.6 per cent were 'small-for-dates'. Birth asphyxia of varying severity developed in 5.9 per cent infants. Respiratory distress syndrome was diagnosed in 5.7 per 100 live-births; most being due to hyaline membrane disease (33.5%), which affected 14.1 per cent of preterm babies. Neonatal hyperbilirubinemia occurred in 5.9 per cent, most of whom were premature. In nearly one-fifth, the cause of jaundice could not be identified after detailed investigations. Minor bacterial infections (conjunctivitis, pyoderma, oral thrush, umbilical sepsis) were observed in 1.8 per cent while major infections (septicemia, meningitis, diarrhoea) in 3.0 per cent. The overall incidence of major malformations was 2.3 per cent. Reasons for low incidence of bacterial infections and common occurrence of hyaline membrane disease in premature infants, are highlighted.
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PMID:A four year study on neonatal morbidity in a New Delhi hospital. 193

During the last 9 years, 25 extremely premature infants (less than 1,000 g, mean gestational ages of 26.6 weeks, mean birth weight of 838 g) underwent ligation of PDA in operating room. There were no deaths related to surgery. Nineteen (76%) of these infants with RDS were discharged from the hospital, but five died of sepsis, and one died with poor nutrition. In nineteen survivors, 12 infants (63%) with gestational ages under 28 weeks had complicated bronchopulmonary dysplasia (BPD) but all developed normally with good nutrition due to sufficient lactation and fluid therapy after PDA ligation. Results indicate that PDA ligation in extremely premature infants is a safe and effective procedure, because it will prevent the development of BPD and give these infants body weight gain with good nutrition.
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PMID:[Surgical treatment of patent ductus arteriosus in extremely premature infants]. 207 82

Records were reviewed of all patients with premature rupture of the membranes (PROM) at or less than 34 weeks estimated gestational age (EGA) who delivered at University Hospital of Jacksonville, Florida, during 1987. That year 132 patients were identified, 3.1% of all deliveries. The mean time from membrane rupture to delivery was three days, and the duration of PROM seven or more days in 9% of cases. Chorioamnionitis was diagnosed in 20% of the mothers. Delivery was by cesarean section in 30% of cases, twice the primary rate at University Hospital for 1987. Sixty-five percent of infants were male, and 13 males and four females of the 132 infants died before or after birth, the majority due to prematurity. Respiratory distress syndrome (RDS) was found in 35 infants and in 80% of these cases the membrane ruptured at 30 weeks or less. Intraventricular hemorrhage (IVH) was diagnosed in 8% of cases. Neonatal sepsis was a common diagnosis (41% of deliveries) with incidence being similar at all gestational ages. The length of membrane rupture was not statistically significant when compared with neonatal sepsis (P = 0.39).
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PMID:Premature rupture of membranes prior to 34 weeks gestational age. One year experience at a tertiary center. 261 60

A commercial latex agglutination test (Wellcogen Strep B) has been prepared for testing body fluids. This test does not require a special equipment and is very easy to handle. Results are established within few minutes. We examined this method in unconcentrated urine specimens of 98 pre- and full term neonates suffering from RDS. In all 48 cultural proven cases of strep. B sepsis LAT was positive, the test was performed 2.5 h-19 h after onset of RDS. Four times we could not exclude false positive results definitively, but no false negative results were found.
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PMID:[Identification of group B streptococcal infection by the latex test]. 329 75


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