Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0036690 (sepsis)
 59,461 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A multicenter, prospective randomized controlled trial was performed comparing the efficacy of a single intratracheal dose of modified bovine surfactant extract (Survanta, 100 mg/kg, Abbott Laboratory, North Chicago, IL) with air placebo in preventing respiratory distress syndrome. Infants were enrolled if they were estimated to be between 24 and 30 weeks' gestation, weighed between 750 and 1250 g, and were intubated and stabilized within 15 minutes after birth. A total of 160 infants were treated (79 with surfactant, 81 with air placebo) between 4 and 37 minutes after birth (median time 12 minutes). Of these, 5 infants were excluded from the final analysis. The 72-hour average values for the arterial-alveolar oxygen ratio, fraction of inspired oxygen, and mean airway pressure were calculated from the area under the curve of scheduled values measured throughout 72 hours. Clinical status was classified using five ordered categories (no supplemental oxygen or assisted ventilation, supplemental oxygen only, continuous positive airway pressure or assisted ventilation with intermittent mandatory ventilation less than or equal to 6 breaths/min, assisted ventilation with intermittent mandatory ventilation greater than 6 breaths/min, death). Chest radiographs at 24 hours were graded for severity of respiratory distress syndrome. Infants receiving Survanta had less severe radiographic changes at 24 hours of age and decreased average fraction of inspired oxygen (31% vs 42%, P = .002) compared with control infants. No differences were noted in the average arterial-alveolar oxygen ratio, mean airway pressure, or clinical status on days 7 and 28. A beneficial effect was noted in the incidence of pneumothorax (P = .057) and an increase was noted in the incidence of necrotizing enterocolitis (P = .052). No differences in incidence of patent ductus arteriosus, intraventricular hemorrhage, sepsis, or bronchopulmonary dysplasia were seen. According to results of a secondary analysis, there was improvement in the fraction of inspired oxygen and a greater number of survivors without bronchopulmonary dysplasia in the subgroup of infants weighing less than 1000 g who were treated with surfactant. It was concluded that a single dose of Survanta given shortly after birth resulted in decreased severity of chest radiographic findings 24 hours after treatment and improved oxygenation during 72 hours after treatment, but did not improve other acute measures of disease severity or clinical status later in the neonatal period. The group at highest risk for respiratory distress syndrome (infants with birth weights between 750 and 999 g) may benefit the most from preventive therapy.
 ...
PMID:Multicenter trial of single-dose modified bovine surfactant extract (Survanta) for prevention of respiratory distress syndrome. Ross Collaborative Surfactant Prevention Study Group. 218 76

Fibronectin is a large-molecular-weight glycoprotein present on most cell surfaces, in extracellular fluids, and in plasma. Both cell-associated and soluble fibronectin are thought to have important roles in the inflammatory response and host defense and may contribute to the maintenance of microvascular integrity during septic episodes. Newborn infants have levels of fibronectin in plasma that are one-third to one-half those found in the healthy adult. In addition, neonates with respiratory distress syndrome, perinatal asphyxia, bacterial sepsis, intrauterine growth retardation, or postnatal malnutrition have a further depression in their plasma levels of fibronectin. The low plasma concentration of fibronectin in newborn infants may contribute to the hypofunction of the neonatal reticuloendothelial system and predispose to the development of sepsis. Rates of synthesis of plasma fibronectin are diminished in the neonate, and an inverse correlation between fibronectin half-life and gestational age exists. The role of fibronectin in treatment or prophylaxis of neonatal sepsis remains to be determined.
 ...
PMID:Role of fibronectin in diseases of newborn infants and children. 219 69

The use of antibiotics in the management of preterm, premature rupture of membranes remains controversial. By use of a prospective randomized double-blind design we investigated the maternal-fetal benefits associated with antibiotic therapy in 85 women with premature rupture of membranes at 34 weeks' estimated gestational age. In the treatment group 40 patients received intravenous mezlocillin for 48 hours followed by oral ampicillin until delivery. In the control group 45 patients received intravenous and oral placebo. Patients who received antibiotics had chorioamnionitis and endometritis less frequently than the control group (p less than 0.01 and p less than 0.05). Pathologic examination of the placentas showed a lower incidence of chorioamnionitis in the treatment group (p less than 0.05). The period from premature rupture of membranes to delivery (latency) was prolonged with antibiotics (p less than 0.05) and resulted in significant weight gain in the infants in the antibiotic group (p less than 0.0001). These infants also had higher 1- and 5-minute Apgar scores. Clinically suspected sepsis, respiratory distress syndrome, intraventricular hemorrhage, perinatal death rate, and prolonged hospitalization (greater than 30 days) were also increased in the control group.
 ...
PMID:Antibiotic therapy in preterm premature rupture of membranes: a randomized, prospective, double-blind trial. 220 65

The effects of a single dose of surfactant TA were assessed in premature neonates (birth weight 750 to 1749 g) with respiratory distress syndrome (RDS) in a multicenter, double-blind, randomized clinical trial. Only neonates with surfactant deficiency and without ultrasonographic evidence of intracranial hemorrhage greater than or equal to grade II were enrolled. Fifty-four patients received surfactant (100 mg of phospholipid per kilogram of body weight) and 46 patients received an air placebo within 8 hours of life. Treatment with this surfactant resulted in a significant reduction in the severity of RDS with a concomitant increase in the proportion of neonates with mild disease. The frequency of pulmonary interstitial emphysema and of pneumothorax was significantly lower in treated neonates compared with control neonates (2% vs 26%, P = .0008, and 7% vs 39%, P = .0004, respectively). The frequency of intracranial hemorrhage was significantly lower in the surfactant group compared with the control group (20% vs 54%, P = .0008) and was also reduced for the smallest neonates in the surfactant group (13% vs 73%, P = .00008). When categorized according to severity of intracranial hemorrhage and severity of bronchopulmonary dysplasia, the surfactant group was at a significant advantage (adjusted Cochran-Mantel-Haenszel X2 = 10.72, P less than .001 and X2 = 4.43, P = .036, respectively). The proportion of neonates surviving without intracranial hemorrhage and/or bronchopulmonary dysplasia was 63% in the surfactant group vs 26% in the control group (P = .0004); as for the smallest neonates, it was 58% in the surfactant group vs 4% in the control group (P = .0002). There were no differences between the groups with respect to the frequency of patent ductus arteriosus (46% vs 37%), pulmonary hemorrhage (6% vs 7%), necrotizing enterocolitis (0% vs 2%), sepsis (4% vs 2%), retinopathy of prematurity (13% vs 22%), or death (15% vs 22%). It is concluded that treatment with the single-dose surfactant regimen used in this study reduces the severity of respiratory distress during the 48 hours after treatment and decreases the major pulmonary morbidity and intracranial hemorrhage in premature neonates with RDS. Further studies are needed to determine whether (1) treatment at birth or as soon as after RDS is diagnosed and (2) the use of multiple dose of this surfactant would result in any additional benefits.
 ...
PMID:Surfactant replacement therapy with a single postventilatory dose of a reconstituted bovine surfactant in preterm neonates with respiratory distress syndrome: final analysis of a multicenter, double-blind, randomized trial and comparison with similar trials. The Surfactant-TA Study Group. 223 30

We performed clinicopathological studies on early-onset sepsis (5 infants, less than 72 hours of life, EOS) and late-onset sepsis (15 infants, greater than 72 hours, LOS) of very low birth weight, less than 1500 g (VLBW). In EOS, the clinical features mimic the respiratory distress syndrome and hematological changes were not observed. The lungs showed slight interstitial pneumonia with structural immaturity, hyaline membranes, hemorrhage, and minimal infiltration by polymorphonuclear neutrophils (PMNs). The pathogen was group B streptococcus or weakly gram-negative bacilli. In LOS, pneumonia proceeded to sepsis and neutropenia with elevated numbers of circulating immature neutrophils, and increased levels of C-reactive protein were observed at the onset of sepsis. Severe pneumonia with infiltration of numerous PMNs and bacterial colonies and polymicrobial infection by nosocomial pathogens such as Staphylococcus aureus and Pseudomonas aeruginosa were common. The thymus and spleen weights varied but retained normal structure in EOS. The thymus was depleted of lymphocytes, and the spleen was hypertrophic but poorly reactive against infection in LOS. The pathogenesis of EOS is regarded as being more closely correlated with lung immaturity and circulatory disorder in early life, whereas that of LOS is associated with immunological defenses of the host, potency of the pathogens, and terminal multiple organ failure.
 ...
PMID:Clinicopathological differences between early-onset and late-onset sepsis and pneumonia in very low birth weight infants. 223 61

The symptoms of right-sided diaphragmatic hernia (RDH) rarely occur in the newborn period. The present report described a two-day-old neonate who presented with symptoms of respiratory distress and sepsis. Early onset group B beta-hemolytic streptococcal (GBBS) infection was diagnosed and RDH was found subsequently. A defect with smooth margin, sized 3 x 5 cm, located in posterior-lateral aspect of right diaphragm was observed during operation. After having been given antibiotics and surgical treatment, the infant recovered and was discharged in good condition. He has normal development at the age of one year. Possible pathogenesis is discussed in this report.
 ...
PMID:[Neonatal group B streptococcal pneumonia and right-sided diaphragmatic hernia: report of one case]. 226 Apr 69

During February to June 1987, one hundred and sixty one babies admitted to Harare Neonatal Unit had positive blood cultures, giving a sepsis rate of 21/100 live births at Harare Hospital. The case records of these 161 babies were reviewed and compared with records of 50 babies admitted from the same catchment area and during the same time period but who had negative blood cultures. Babies with early (less than 48 hr) onset or late onset sepsis tended to have lower birth weights and shorter gestational ages than controls. Significant risk factors in maternal history were poor antenatal care and prolonged rupture of membranes. Hypothermia, respiratory distress, jaundice and hypoglycaemia were all common findings in babies with sepsis. Staph. aureus and Group B streptococci (GBS) were the most common isolates in both early and late onset sepsis, with Esch. coli and Klebsiella sp. being more common in early than in late onset disease. Cultures from the genital tract were obtained from 28 of the mothers whose babies developed sepsis. Only rarely, however, was an organism with similar identity and antibiogram to that isolated from the blood culture of the baby obtained from the mother. Nevertheless mothers of blood culture positive babies showed high carriage rates of GBS, B. melaninogenicus and Klebsiella. The overall mortality in sepsis cases was 28.5 pc, but mortality was discouragingly high where coliforms or Staph.epidermidis were isolated.
 ...
PMID:Neonatal septicaemia in Harare Hospital: aetiology and risk factors. The Puerperal Sepsis Study Group. 226 31

A 42-year-old woman presented with a 25-week pregnancy and stage IV breast cancer with metastases in the skeleton and liver and a T-4 primary tumor. She was treated with two cycles of doxorubicin, methotrexate, and vincristine. Spontaneous labor resulted in a normal female infant, who was successfully treated for sepsis and mild respiratory distress. The placenta showed diffuse chorioamnionitis. There was no doxorubicin demonstrated in the placenta, blood, or fetal lymphocytes 3 weeks after the last treatment. Maternal and fetal chromosomal analyses were unremarkable. The child is functioning normally 2 years after delivery. The literature on anthracycline treatment during pregnancy is reviewed. Adriamycin has been shown to cross the blood-placenta barrier, but has not led to specific fetal abnormalities when given during the second or third trimester. Experience during the first trimester is still limited.
 ...
PMID:Combination chemotherapy and radiation for stage IV breast cancer during pregnancy. 229 17

The authors reviewed the initial presentation of seven infants with acute myocarditis. All patients presented with respiratory distress including tachypnea (respiratory rate greater than or equal to 40) and intercostal retractions. Other findings included tachycardia (heart rate greater than or equal to 120) (7/7) and grunting (6/7). Lungs were clear to auscultation in six out of the seven patients. Cardiomegaly was seen in five of the initial chest roentgenograms. Each initial electrocardiogram had abnormal findings. Initial diagnoses were sepsis and shock in three patients, pneumonia and asthma in two, and congestive heart failure in two. Six patients required tracheal intubation. All required admission to the Pediatric Intensive Care Unit (ICU). Two patients died. Myocarditis should be suspected in a child presenting with severe respiratory distress, tachycardia, cardiomegaly, and/or an abnormal electrocardiogram. Prompt stabilization and admission to a pediatric intensive care unit for further evaluation and treatment is essential.
 ...
PMID:Acute myocarditis in infants. Initial presentation. 230 4

Premature infants with respiratory distress commonly receive evaluation for sepsis, including a lumbar puncture, within a short time after admission to a neonatal intensive care unit. We questioned the use of the lumbar puncture during the early sepsis evaluation, and since 1979, have omitted this procedure as part of the initial evaluation for sepsis (within 6 hours of birth) of premature infants. We monitored this policy to detect any change in the incidence of meningitis, and now report results accumulated over a 7-year period. From 1979 to 1986, 1390 inborn premature infants of 34 weeks' gestation or less were evaluated for early sepsis within 6 hours of birth. Thirty-two infants (2.3%) were diagnosed with sepsis. Fifteen of these infants died in the first 24 hours of life. Meningitis was not demonstrated by autopsy evaluation. The surviving 17 infants diagnosed with sepsis did not have meningitis. One hundred twenty-three infants whose initial blood cultures were negative developed infection later in their hospital course. Eleven of these 123 infants had infections with perinatally acquired organisms; two had group B streptococcus (GBS) meningitis. Their cases were not compatible with missed meningitis. The remaining 112 infants developed nosocomial infections of which 38.3% developed meningitis without associated bacteremia. These results suggest that the omission of the lumbar puncture in the early sepsis evaluation of the premature infant did not result in any missed meningitis and spared many infants the procedure shortly after birth. The lumbar puncture, however, continues to be vital in the assessment of late infections of the neonate.
 ...
PMID:The role of the lumbar puncture in the admission sepsis evaluation of the premature infant. 231 95


<< Previous 1 2 3 4 5 6 7 8 9 10 Next >>