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

Streptococcus pneumoniae is an unusual pathogen during the neonatal period. Two cases of neonatal early-onset sepsis, one of them associated with meningitis, are reported. Positive cultures for Strep. pneumoniae were obtained from both newborns and their mothers. Both newborns were full term with birth weights in the normal range. In one of them, amniorrexis occurred 18 hours before the delivery and the amniotic fluid was meconium stained. Significant clinical findings consisted in fever and respiratory distress. There was leucopenia and in one case the chest radiography was abnormal. Both neonates had an uneventful recovery after starting antibiotic treatment and no long term sequellae were detected. The incidence of neonatal sepsis caused by Strep. pneumoniae and its pathogenesis are reviewed.
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PMID:[Neonatal sepsis caused by Streptococcus pneumoniae. Report of two cases]. 157 5

Sepsis may initiate acute respiratory distress syndrome which may be accompanied by an increased pulmonary epithelial-endothelial permeability. In this study, sepsis was induced by an intraperitoneal implantation of gelatine capsules containing Escherichia coli/Bacteroides fragilis/adjuvant substance. The importance of bacteria in sepsis-related lung injury was studied in rats given an intraperitoneal injection of E. coli or in rats given the adjuvant substance alone in capsules intraperitoneally. Rats with empty capsules were used as controls. The rats were intratracheally instilled with bovine serum albumin (BSA) directly after the capsule implantation or the injection of E. coli, and the passage over the lower respiratory tract was assessed as blood plasma levels of immunoreactive BSA. The plasma BSA levels in the control rats increased continuously up to 24 h after intratracheal instillation. This increase was significantly augmented already 1 h after the septic challenge, i.e. before any clinical symptoms were observed, in both the septic rats and the rats with the E. coli injected intraperitoneally. Furthermore, the time required to obtain maximal plasma BSA levels was shorter in septic, adjuvant-exposed and in E. coli-injected rats than in the controls. The plasma levels and the total BSA passage over the lower respiratory tract was significantly higher (p less than 0.001) in the septic and in the E. coli-injected rats than in the adjuvant-exposed and the control rats.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Increased passage of bovine serum albumin over the respiratory tract after intratracheal instillation during septic shock in rats. 158 99

A total of 2248 infants born at All India Institute of Medical Sciences Hospital, New Delhi were selectively screened for hypoglycemia over a period of 15 months. Hypoglycemia (blood glucose less than 30 mg/dl) was diagnosed in 107 cases (4.8%). Preterm babies had three times increased risk (12.8%) as compared to term babies (3.6%). Small-for-dates (SFDs) and large-for-dates (LFDs) infants were at increased risk of manifesting hypoglycemia (7 and 10 times, respectively) as compared to the appropriate-for-dates (AFDs) babies (2.7%). Approximately two-thirds of the hypoglycemic babies (67.3%) had one or more risk factors including birth asphyxia (24.2%), diabetic mothers (23.8%), respiratory distress (13.9%) and septicemia (11.6%). A total of 59.8% cases were asmyptomatic while the rest had one or more symptoms. The most common symptom observed was lethargy (81.4%), followed by jitteriness (67.4%), respiratory abnormalities (41.9%), hypotonia (39.5%) and seizures (30.2%). The amount of glucose (mg/kg/min) needed to maintain a stable blood sugar in various categories of hypoglycemic babies was observed to be in the following decreasing order of amount; symptomatic babies with seizures (Gp IV), IGDM's/IDM's and symptomatic babies with other features (Gp III), SFDs and LFDs (Gp II) and AFDs (Gp I). Such a categorization of hypoglycemic babies will help to treat them more precisely.
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PMID:Neonatal hypoglycemia--clinical profile and glucose requirements. 159 96

Data on 329 consecutive very low birth weight (VLBW) (=or 1500 g) neonates born at the Kuala Lumpur Maternity Hospital in Malaysia were analyzed between January 1989 and April 1990 to determine causes of morbidity and mortality so the hospital could pinpoint priority areas to improve outcome in the time period before the hospital would actually upgrade its facilities. 95.7% of these newborns were born prematurely. The incidence of VLBW newborns was 9.9/1000 live births. The stay in the hospital after birth ranged from 1-127 days (mean 19.3 days). The mortality rate for the VLBW neonates was 59.6% (196). VLBW deaths made up 60% of all neonatal deaths in this hospital. Mortality risk factors included a birth weight of at most 1000 g (p .001) and gestational age less than 33 weeks (p .01). The 3 most frequent causes of death of the VLBW neonates included respiratory distress syndrome (33.2%), septicemia (29.6%), and intraventricular hemorrhage (17.9%). 67% of the VLBW infants with septicemia acquired the infection through poor hospital practices, as indicated by the fact that the most common pathogens were multiresistant Klebsiella (52.3%) and multiresistant Acinetobacter (14.7%). Overcrowding of the special care nursery and shortage of nurses contributed to these suboptimal practices. Further, 71,1% of the VLBW newborns with septicemia died and most of them (89.1%) weighed more than 1000 g at birth. These results indicated the need for this hospital to take steps to improve the staffing situation and to provide an adequate number of incubators and ventilators.
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PMID:Outcome of very low birthweight neonates in a developing country: experience from a large Malaysian maternity hospital. 159 5

Gram-negative sepsis has dramatically increased in frequency throughout the twentieth century in the United States. Currently, approximately 200,000 patients develop gram-negative sepsis each year in this country. Of these, about one-quarter develop the adult respiratory distress syndrome (ARDS). Among these critically ill patients, mortality is estimated at 60%-90%. In the complex series of events leading to acute lung injury in gram-negative sepsis, endotoxin is the proximal mediator. Although endotoxin may be capable of causing direct injury to the pulmonary endothelium, its primary role is as a trigger activating inflammatory agents, including complement, neutrophils, and platelets, and inducing the production of cytokines and arachidonic acid metabolites. The end results are impairment of the endothelial barrier, diffusely increased capillary permeability, and adherence of neutrophils to the endothelium with subsequent migration into the tissues. The consequent clinical syndrome is one of acute respiratory distress with pulmonary edema, poorly compliant lungs, and refractory hypoxemia. Endothelial injury often becomes widespread, leading to the failure of multiple organs, including the kidneys, brain, intestine, and liver. Conventional therapy consists of supplemental oxygen, positive end-expiratory pressure, inotropic agents, fluid management, and antibiotics aimed at the offending pathogen. Recent discoveries regarding the mediators of sepsis as well as the expansion of the biotechnological armamentarium have provided clinicians with a plethora of new tools with which to manipulate the host's inflammatory response. The challenge for the next decade will be to ensure the safety, efficacy, and cost-effective use of these expensive but potentially lifesaving immunomodulators, singly or in combination, as adjuvant therapy.
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PMID:Gram-negative sepsis and the adult respiratory distress syndrome. 162 78

A total of 1509 singleton neonates (849 males and 660 females) were admitted into the Special Care Baby Unit at the University of Port Harcourt Teaching Hospital in Nigeria between January 1984 and December 1987. Of these, 29 (1.9%) were extreme low birth weight (ELBW); 86 (5.7%) were very low birth weight (VLBW), 40 of whom survived; 406 (26.9%) were low birth weight (LBW); and 988 (65.5%) were normal birth weight (NBW) babies. Survival rates in the 4 groups were 10.3%, 46.5%, 89.2%, and 94.7%, respectively. Higher mean birth weight (p .01), longer mean gestation (p .001), and lower incidence of birth asphyxia (p .02 with Yates's correction) significantly more mature for their gestational age (p = .008, Fisher's exact probability test) than those who died. Among infants who survived, one each had idiopathic respiratory distress syndrome (RDS) and septicemia. Among the infants who died there were 2 cases of RDS and 1 each of aspiration pneumonia and septicemia. Survival of babies with birth weights under 1000 gm improved very little over the 4-year period, while the survival rates stayed constant at 90% in babies with birth weights of 1500 gm and above. The overall survival rate in the Unit improved from 86.1% in 1984 to 91.4% in 1987. There were relatively fewer cases of birth asphyxia in the VLBW category than in the rest of the babies resulting in better survival. The survival of LBW infants was distinctly reflected by that of VLBW infants whose survival could be improved by instituting measures such as prompt resuscitation of the asphyxiated neonate and prevention of sepsis.
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PMID:Survival in very low birthweight infants at the University of Port-Harcourt Teaching Hospital, Nigeria. 163 36

Hyperbilirubinaemia in newborn infants is generally regarded as a problem, and bilirubin itself as toxic metabolic waste, but the high frequency in newborn infants suggests that the excess of neonatal bilirubin may have a positive function. To investigate the hypothesis that bilirubin has a role as a free-radical scavenger, the rate of rise in serum bilirubin in the first few days of life was measured in 44 infants with five illnesses thought to enhance free-radical production and in 58 control infants. The infants were selected from 2700 consecutive births by exclusion of those with factors known to affect bilirubin metabolism, including enteral feeding. The control infants were those who seemed to be ill and received treatment, including restriction of enteral feeds, but in whom no illness, or disorders not related to free-radical production, were found. The mean serum bilirubin rise was significantly lower in the combined illness group than in the control group (36.1 [95% Cl 26.9-45.3] vs 66.7 [55.9-77.5] mumol.l-1.day-1; p less than 0.0001). In subgroup analyses the mean rises in infants with circulatory failure, neonatal depression/asphyxia, aspiration syndromes, and proven sepsis were significantly lower than in controls matched for gestational age and birthweight, but rises in infants with respiratory distress and their matched controls did not differ. These findings are consistent with the hypothesis that bilirubin is consumed in vivo as an antioxidant. Such consumption may operate in vivo in addition to the standard pathways for bilirubin metabolism (production, isomerisation, and excretion).
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PMID:Variation of initial serum bilirubin rise in newborn infants with type of illness. 167 69

Gram-negative septicemia remains one of the most serious forms of hospital-acquired infection. The most consistently virulent component of the gram-negative lipopolysaccharide (endotoxin) appears to be lipid A. Elucidation of the structure-function relationships of lipid A and the biochemical configurations required for endotoxicity makes possible the design of lipopolysaccharide antagonists and/or the production of poly- or monoclonal antibodies that may abrogate the biologic effects of endotoxin. The mechanisms of activity of lipopolysaccharide and the pathophysiologic events it triggers are now better understood than in the recent past. Lipid A triggers the release of mediators such as cachectin (tumor necrosis factor), thereby initiating a cascade of potentially lethal events. Although recent studies indicate no routine role for corticosteroids in gram-negative septic shock or acute respiratory distress syndrome, considerable progress has been made in the development of effective antibiotics. Recent studies of septicemia in neutropenic patients show survival rates significantly higher than those reported more than two decades ago.
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PMID:University of California/Davis Interdepartmental Conference on gram-negative septicemia. 168 79

Continuous positive airway pressure (CPAP) administered as a mixture of oxygen and compressed air via nasal prongs has dramatically improved survival rates and lessened the frequency of barotrauma and bronchopulmonary dysplasia in the premature infant with respiratory distress syndrome. Associated with the increased use of nasal CPAP has been the development of marked bowel distension (CPAP belly syndrome), which occurs as the infant's respiratory status improves and the baby becomes more vigorous. To identify contributing factors, we prospectively compared 25 premature infants treated with nasal CPAP with 29 premature infants not treated with nasal CPAP. Infants were followed up for development of distension, defined clinically as bulging flanks, increased abdominal girth, and visibly dilated intestinal loops. We evaluated birth weight, weight at time of distension, method of feeding (oral, orogastric tube), and treatment with nasal CPAP and correlated these factors with radiologic findings. Of the infants who received nasal CPAP therapy, gaseous bowel distension developed in 83% (10/12) of infants weighing less than 1000 g, but in only 14% (2/14) of those weighing at least 1000 g. Only 10% (3/29) of infants not treated with nasal CPAP had distension, and all three weighed less than 1000 g. Presence of sepsis and method of feeding did not correlate with occurrence of distension. Neither necrotizing enterocolitis nor bowel obstruction developed in any of the patients with a diagnosis of CPAP belly syndrome. Our study shows that nasal CPAP, aerophagia, and immaturity of bowel motility in very small infants were the major contributors to the development of benign gaseous bowel distension.
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PMID:Benign gaseous distension of the bowel in premature infants treated with nasal continuous airway pressure: a study of contributing factors. 172 37

Neonatal mortality rate is perhaps the most reliable indicator of perinatal outcome. An assessment of perinatal outcome can be made through knowledge of causes of death. This study was undertaken to evaluate the neonatal deaths in the Neonatal Division, Lady Hardinge Medical College. Livebirths (n=7309) and deaths (n=328) during a 6-month period were retrospectively analyzed. These were grouped into nonpreventable and potentially preventable causes of death. The single most important factor contributing to mortality was respiratory distress (29.3%), followed by sepsis (24.4%), and birth asphyxia (16.2%). The nonpreventable causes of mortality (e.g., lethal congenital malformations, extremely low birthweight) accounted for 10.4% of the total mortality. The idealized neonatal mortality rate was 4.6/1000 livebirths, while the salvageable death rate was 40.2/1000 livebirths. Mortality increased significantly if the birthweight fell below 2 kg. The salvageable deaths could perhaps be prevented through better antenatal and intranatal care, ventilatory support, and sepsis prevention.
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PMID:Neonatal mortality patterns in an urban hospital. 180 Mar 43


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