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Query: UMLS:C0243026 (sepsis)
 52,417 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

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

Ventriculoatrial shunts were first developed in the 1940s and shortly thereafter became the treatment of choice for noncommunicating hydrocephalus. Although the mortality rate for noncommunicating hydrocephalus has fallen from 80% to 20%, ventriculoatrial shunts continue to have major life-threatening complications such as thromboemboli, infection, and shunt malfunction. This report presents the cases of two adult hydrocephalic patients who developed pulmonary emboli and sepsis after being treated with ventriculoatrial shunts. One patient, whose complications were not recognized until late in the course, died of pulmonary hypertension and right heart failure despite removal of the shunt and aggressive medical therapy. Complications in the second patient were discovered early, the shunt was removed, and intravenous antibiotics were used for weeks to combat sepsis and bacterial endocarditis.
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PMID:Thromboembolic complications of ventriculoatrial shunts. 649 51

A prospective study of 54 infants with birth weights of 1,000 gm or less was conducted over a period of two years. Of the 26 infants who survived, 24 weighed between 750 and 1,000 gm; two infants died after discharge and one was lost to follow-up, leaving 23 in whom serial observations were made over 18 months to 3 years of age. The incidence of neurologic deficit in these infants was 17% and of intellectual deficit, 13%. Of the four who were abnormal neurologically, two had spastic quadriparesis, one static encephalopathy, and one hydrocephalus secondary to intraventricular hemorrhage. The three with intellectual deficit had a developmental quotient less than 85. Of the perinatal factors examined, only birth asphyxia correlated significantly with both neonatal mortality and subsequent morbidity. Six (26%) of the surviving infants had mild, nonblinding retrolental fibroplasia; only one of them had a significant refractive error that required corrective lenses for vision. Sepsis was a significant contributor to neonatal mortality in ten of 28 infants who died, but was detected in only one survivor. Although the prognosis for the infant weighing 1,000 gm or less at delivery has improved significantly, there is promise for still further improvement by reducing perinatal asphyxia.
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PMID:Mortality and morbidity in infants less than 1,001 grams birth weight. 689 64

Fifty-five infants participated in a double-blind study of indomethacin therapy for the closure of patent ductus arteriosus. Seventeen infants died. There was no significant difference in autopsy findings between the groups with respect to pneumonia, disseminated intravascular coagulopathy, necrotizing enterocolitis, sepsis, intraventricular hemorrhage, hydrocephalus, kernicterus, brain softening, and renal damage. For those infants who survived and returned for follow-up at approximately 1 year of age, there was no significant difference between the control (n = 17) and indomethacin (n = 13) groups with respect to physical growth, Bayley scores, respiratory infection, abnormal eye ground, neurological defects, and abnormal EEG. Four in the control group (24%) and three in the indomethacin group (23%) had moderate to severe neurological defects and/or scored less than 80 on the Bayley Mental Development Index or Psychomotor Development Index. It appeared that indomethacin therapy did not have a long-term adverse effect on premature infants.
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PMID:Intravenous indomethacin therapy in premature infants with patent ductus arteriosus. Causes of death and one-year follow-up. 711 4

An evaluation of continuous intracranial pressure (ICP) monitoring in 42 hydrocephalic infants and children helps to establish the role of this method in comparison with other clinical techniques for estimating the occurrence of progressive hydrocephalus. Transducer monitoring via ventricular catheters in term and premature infants revealed average ICP in the 5--12 mm Hg range. The higher values were recorded from patients with noncommunicating hydrocephalus but did not correlate with the extent of ventriculomagaly. The method has very litte predictive value in estimating the progressive nature of infantile hydrocephalus. In older children ICP monitoring provides a useful adjunct in decisions for shunting after intracranial surgery and in suspected 'normal pressure' hydrocephalus. Monitoring from shunt reservoirs in cases of suspected shunt obstruction, although accurate in most situations, is probably inferior to clinical examination and serial computed tomography considering the expense and the risk of introducing shunt sepsis.
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PMID:A critical evaluation of continuous intracranial pressure monitoring in pediatric hydrocephalus. 738 39

This study was designed to identify risk factors for mortality and morbidity of extremely premature infants born in the surfactant era. The study cohort included 194 infants born at < 29 weeks' gestation at one regional tertiary center between 1983 and 1986. Forty-one infants died. Blinded neurodevelopmental assessments were performed on 149 of 153 (97%) survivors at a mean age of 52 months. Thirty-one (21%) survivors had major impairments: 15 had mental retardation, 8 had multiple impairments, 7 had cerebral palsy, and 1 was blind. Logistic regression analysis identifies five significant risk factors for mortality: grade III or IV intraventricular hemorrhage, birth weight < 800 gm, 5-minute Apgar score < or = 3, male sex, and absence of surfactant therapy. Significant risk factors for any major impairment included sepsis (relative risks [RR] = 6.4), male sex (RR = 3.1), and nonwhite race (RR = 2.8). Hydrocephalus requiring shunting was a significant risk factor for cerebral palsy (RR = 16.4) and neonatal retardation (RR = 16.0). Nonwhite race (RR = 7.3), sepsis (RR = 6.8), and male sex (RR = 3.7) also were significant risk factors for mental retardation. Confirmation of these risk factors should facilitate development of targeted interventions for optimizing long-term outcome.
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PMID:Multivariate risks among extremely premature infants. 816 77

The case of a female baby with microgastria, duodenal atresia, asplenia, hydrocephalus and many other anomalies is reported. She underwent repair of the duodenal atresia at the age of 3 days and died of sepsis at the age of 5 months. Twenty-nine cases of microgastria found reported in the literature are reviewed.
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PMID:Microgastria--case report and a review of the literature. 829 82

Catabolites of purine nucleotides were measured in the cerebrospinal fluid (CSF) of newborn infants with sepsis, seizures and hydrocephalus using isocratic reversed-phase HPLC. The inosine levels in the CSF of the infants with any of the illnesses were significantly higher when compared with the controls. There was a tendency for hypoxanthine levels to be higher in the group of children with hydrocephalus. No significant differences in the concentrations of xanthine, adenine and uric acid were found. The inosine concentration in the CSF is proposed to be a more sensitive indicator of brain injury than the levels of other CSF purines. The levels of all purine metabolites measured in the CSF showed large individual variations. The ratio between hypoxanthine (as an indicator of ATP breakdown) and uric acid (as a scavenger of oxygen free radicals) concentration is proposed as a new criterion to be used in the evaluation of brain injury.
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PMID:Concentration of purine compounds in the cerebrospinal fluid of infants suffering from sepsis, convulsions and hydrocephalus. 856 8

During July 1993 to June 1994, in Zambia, 32 pregnant women aged 15-46 years suffered from uterine rupture at Mansa General Hospital, a referral center for Luapula province. Adolescent women were significantly more likely to have had a uterine rupture than all women delivering (38% vs. 17%; p 0.01). Nulliparity was more common among the uterine rupture cases than among all women giving birth (44% vs. 27%; p 0.05). Multiparity was just as common. 63% of uterine rupture cases had had no prenatal care. In 94% of cases the rupture occurred during labor. Some identified contributing factors for uterine rupture were cephalopelvic disproportion (24 cases), previous cesarean section (3), and oxytocic stimulation and assisted breech delivery with undiagnosed mild hydrocephalus (2). 44% of the women died postoperatively. Sepsis was the leading cause of death (79%). Mortality was associated with nulliparity (79%), adolescence (71%), and anemia, sepsis, and shock on admission (64%). Sepsis and maternal death increased with time since rupture and distance between patient's home or referring center and hospital. Prenatal care did not affect maternal death. All the babies died. These findings emphasize the need for health education of rural residents, training and supervision of traditional birth attendants, and available transportation. In cases of uterine rupture, later marriage, family planning use, and obstetric care may improve maternal prognosis.
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PMID:Rupture of the uterus: a review of 32 cases in a general hospital in Zambia. 863 65

Fifty three Codman Medos programmable valves were implanted in 50 patients (28 men and 22 women) aged 5 to 77 years, from April 1992 to February 1994. They presented with a hydrocephalus 43 times, an arachnoid cyst three times and a CSF leakage four times. The aims of this study were: a) to test the reliability of this equipment, in current use as well as its eventual advantages, inconveniences and restraints, b) to determine its best indications. Follow-up ranged from 12 to 36 months (average = 22 months). Five patients were lost for follow-up. One patient died from a post-operative sepsis. Four died from their disease. Infectious complications concerned 6 patients (11%). A radio-clinical overdrainage syndrome appeared in 9 patients with slit-ventricles, 5 of them associated with sub-dural collections. All these cases were treated with shunt reprogrammings. While 43 pressure settings over 53 were satisfactory in the immediate post-operative period, it appeared that only 38% of shunts had required one only setting when the study period was over. A certain number of pressure adjustments malfunctioned: 6 times, post-operative X-ray controls showed pressures significantly different from the figures which had been selected (difference from -30 mm H2O to + 70 mm H2O); pressure readjustments were effective and accurate for five of them, but one shunt had to be changed; 15 deprogrammings were detected during long term follow-up, 9 of them after MR1. Pressure programming was readjusted only on patients presenting with clinical signs, i-e mainly for those having a pressure difference > +/-30 mm H2O. As a conclusion, the authors consider that such a shunt can be very useful in some precise indications as: NPH, multioperated hydrocephalus, arachnoid and porencephalic cysts, some spontaneous or iatrogenic CSF leakages, temporary shunts necessitating a progressive withdrawal. Because of a) the cost of this equipment, b) the specific restraints (X-rays controls, programmer), and c) the specific incidents (spontaneous and/or post-MR1 deprogramming), it seems difficult to generalize indications to all cases of hydrocephalus. On the other hand, these shunts have the great advantage of simplifying the treatment of overdrainage by avoiding, in all cases, a reoperation for changing the shunt and/or removing a subdural hematoma. Consequent economies due to a significant diminution of the duration of hospitalisation, could justify an enlargement of indications.
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PMID:[The Codman Medos programmable shunt valve. Evaluation of 53 implantations in 50 patients]. 908 40


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