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

Clinicopathologic correlations for 71 cases of fatal pneumonia in children were determined. The mechanism of death for these patients was multifactorial. Severe pneumonia alone accounted for 11 deaths (15.5%). Pneumonia associated with sepsis occurred in 42 children (59.2%). Heart failure (8.5%), hypovolemia (4.2%), and nosocomial infection (12.6%) were also seen in children with fatal acute lower respiratory tract infection. Extensive consolidation, squamous metaplasia, and hyaline membranes were present in the lungs of these children. Patients with severe disease must receive, in addition to antibiotics for acute episodes, individualized intensive respiratory and supportive care. Since these types of care are not available in poor communities, vaccination against measles and vitamin A supplementation for malnourished children may ameliorate the conditions that appear to predispose these children to severe or fatal disease.
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PMID:Clinicopathologic studies of children who die of acute lower respiratory tract infections: mechanisms of death. 227 Apr 5

To focus attention on the problem of infant mortality in Lebanon, data were compiled on infant mortality from 1978 to 1986 at the American University of Beirut Medical Center. Causes of death are analyzed for 602 males and 398 females. 54.9% deaths occurred at 1 month of age and 77.4% died within the 1st year. Autopsies were performed on .7%. 37.7% of all neonatal deaths were due to neonatal diseases such as hyaline membrane disease, asphyxia neonatorum, immaturity, necrotizing enterocolitis, hemorrhage, hemolysis, meconium aspiration, and kernicterus. Better prenatal care would reduce this group, or the administration of corticosteroids to the mother 24-48 hours prior to delivery, as well as rapid resuscitation at birth and prevention of the 5 curses: hypoxemia, hypoglycemia, hypothermia, hypotension, and acidosis. Although unavailable in Lebanon, administration of surfactants through an endotracheal tube would also help. Infections constitute 25.1% of deaths; many are preventable through adequate public health measures and strict personal hygiene, i.e., diseases such as sepsis, pneumonia, meningitis, gastroenteritis, hepatitis, encephalitis, and 1-2 cases of the following: diphtheria, measles, peritonitis, tetanus, tuberculosis, cytomegalis inclusion, herpes, parathyphoid, pertussis, poliomyelitis, and shigellosis. Congenital diseases were 21.6%. In utero diagnosis could prevent some diseases and in utero treatment is possible for hydrocephalus and hydronephrosis. Screening programs postnatally could lead to treatment. 5.9% were malignancies such as leukemia, lymphoma, brain tumors, histocytosis, Wilm's tumor, Ewing sarcoma, and Hodgkin's disease. Early diagnosis is critical if mortality is to be reduced in this group, but medical advances are still needed. 2.9% are miscellaneous diseases such as poisoning, rheumatic diseases, marasmus, Reye's syndrome, nephrosis, rickets, and epilepsy. Most of these diseases are preventable, except for rheumatic inflammation of the heart. Recommended necessary steps to reduce infant mortality are: prenatal care, diagnosis and screening, intrauterine surgery; resuscitation and intensive care centers with modern equipment and trained personnel; national vaccination and screening programs; adequate public health measures and hygiene; parental education; and well-equipped hospitals to serve all regardless of income level.
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PMID:Pediatric mortality: an avoidable tragedy. 251 28

A significant proportion of the illness and death of diarrhoeal diseases in the developing world is estimated to be due to the diarrhoea associated with measles. During February 1983-January 1984 a prospective study of measles in a hospital in Northeastern Thailand was conducted. A total of 550 cases of measles were studied. Diarrhoea was the most frequent complication of measles, occurring in 233 cases (42.4%). The largest proportion (46.2%) of cases with diarrhoea occurred in May-July. Children with measles aged 6-11 months had the highest frequency of diarrhoea (65.7%). Cases aged 1 year and 0-5 months had diarrhoea rates of 60% and 57% respectively. The proportion of measles cases with diarrhoea decreased with increasing age. Only 9.1% (9/99) of stools sent for bacteriological culture were positive. In three of these Shigella spp. were isolated. The rest were non-typhoid Salmonella (2), enteropathogenic Escherichia coli (2), Vibrio cholera (1), and Vibrio parahaemolyticus (1). Other complications among measles cases were pneumonia in 168 (30.5%), otitis media in 28 (5.1%), convulsion in 13 (2.4%), croup in 9 (1.6%), encephalitis in 4 (0.7%), and sepsis in 1 (0.2%). Seven cases (1.3%) died, 4 from pneumonia, 2 from encephalitis, and 1 from sepsis.
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PMID:Measles-associated diarrhoea in northeastern Thailand. 373 7

We have reviewed 107 cases of staphylococcal bacteraemia in order to assess the current clinical spectrum of serious staphylococcal sepsis in Zimbabwe, where staphylococcal bacteraemia is common. Infection was hospital-acquired in 35 cases and community-acquired in 72 cases. The mortality rate was 28%. Most patients were young, with predisposing conditions such as prematurity, protein-caloric malnutrition and measles. The length of the prodromal illness tended to be short and a primary site of infection, usually the lungs or skin, was obvious in 66% of patients. In 30% there was evidence of metastatic spread, usually to meninges, bone, joint and muscle, but endocarditis was uncommon. Metastatic infection was rare when infection was acquired in hospital. Death appeared to be associated with measles, protein-caloric malnutrition, acquisition of infection in hospital, absence of an obvious focus of infection and with inappropriate antibiotic therapy. Aggressive treatment with antibiotics intravenously was the rule. A combination of penicillin and an aminoglycoside was favoured until the nature of the infecting organism was established. Of those patients who died, 38% had received less than 72 h antibiotic therapy. Multiple antibiotic resistance is now widespread in Zimbabwe.
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PMID:Staphylococcal bacteraemia in Zimbabwe 1983. 403 14

The purpose of this work was to review the literature about the newborn neurological pathology and to compare it with our results starting from the observation of 650 children who born at the Clinical Hospital of Porto Alegre from September 1979 to June 1980. Out of these, 100 presented with neonatal neurological pathology. These newborn were studied as to the age of the mother at the birth time, Apgar rate, weight and cephalic perimeter at the birth time, probable etiologies, and clinical picture and evolution. These newborn were compared to control groups and the results were discussed on the grounds of literature. Out of 100 newborn with neurological pathology, 65% presented with pathological neurological examination and 35% with normal neurological examination. The 65 newborn with pathological neurological examination had hypotonia, decreased deep tendon reflexes, decreased or absence of superficial reflexes in 40 cases. Hyperactivity, hypertonia and tremors were observed in 25 cases. Coma was present in 6 of these newborn with apathy and hypotonia. Seizures were present in 41 cases. EEG was performed in 29 of these 41 cases in the first five days of life. The EEG was normal in 15 (51.7%) newborn and it was pathologic in 14 (48.3%) newborn. The 100 newborn had the following diagnosis: 37 birth anoxia, 13 hemorrhages, 24 meningitis, 14 metabolic seizures, 4 sepsis, 1 kernicterus, 2 chromosomopathies, 3 malformation, 1 cerebral palsy, and 1 congenital rubeola. Out of the 37 newborn with birth anoxia, 20 (54.1%) had a good evolution, 7 (18.9%) had sequela and 10 (27.0%) died. Out of 13 newborn with hemorrhages 2 (15.4%) had a good evolution, 5 (38.5%) had sequela, and 6 (46.1%) died. Out of 24 newborn with meningitis, 18 (75.0%) had a good evolution, 5 (20.8%) had sequela, and 1 (4.2%) died. Out of 58 newborn with a good evolution, 30 had normal newborn neurological exam, and 28 had transient alterations. Out of 23 newborn who presented with sequela later on, only 5 had normal newborn neurological exam. All the 19 who died, had pathological newborn neurological exam.
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PMID:[Neurological pathology in the newborn infant]. 653 54

Pharmacokinetic and clinical studies on cefotetan (CTT), a new cephamycin antibiotic, were carried out and the following results were obtained. Pharmacokinetic study Two patients, 7 years and 10 months of age (22 kg of body weight) and 9 years of age (28 kg of body weight), were administered 20 mg/kg of CTT by 30 minutes intravenous drip infusion. Serum levels of CTT were 148 micrograms/ml and 92 micrograms/ml immediately after the end of drip, 118 micrograms/ml and 63 micrograms/ml at 1 hour after the drip infusion. 76 micrograms/ml and 39 micrograms/ml at 2 hours after, 34 micrograms/ml and 18.2 micrograms/ml at 4 hours after and 18 micrograms/ml and 8.2 micrograms/ml at 6 hours after. Serum half-lives calculated were 1.92 hours and 1.78 hours respectively. Clinical study CTT was administered to a total of 14 patients, 3 with pneumonia, 2 with acute pyelonephritis, 2 with acute enteritis, each one with acute tonsillitis, acute bronchitis, acute bronchiolitis, sepsis, acute lymphadenitis, stomatitis and measles. Because that stomatitis and measles, however, were not indications of CTT, 2 cases with those diseases were excluded. CTT was administered at daily dose of 40 to 73 mg/kg in 2 to 4 portions for 3 to 5.5 days by intravenous drip infusion. Marked response was seen in 2 cases, moderate response in 9 and no response in 1, thus effectiveness rate was 91.7%. Neither side effects nor abnormal clinical laboratory findings were observed.
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PMID:[Clinical evaluation of cefotetan in pediatrics]. 658 29

Pleural sepsis in children is common in most developing countries. It may present as total pyothorax, pyopneumothorax, or localised thoracic empyema. In most cases, it follows an attack of bronchopneumonia, but other debilitating conditions such as measles, malnutrition, and sickle cell anaemia form part of the clinical syndrome. In a review of 60 cases of pleural sepsis in children aged between 1.5 months and 16 years, there were 40 cases of pyothorax, 15 of pyopneumothorax, and five of localised empyema. Treatment with chemotherapy only was given in 22 cases of whom eight died. Twenty-three patients had chemotherapy and tube drainage of the pleural contents; five died. Fifteen children had excision of the pleural disease, and decortication of the lung; none died. In view of the chronicity of the pleural sepsis by the time the child is seen in the hospital, and also the low mortality and shorter period in hospital, thoracotomy and decortication is recommended as the treatment of choice.
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PMID:Management of pleural sepsis in Nigerian children. 728 Oct 96

An estimated 8 million infants and 2 million children and adults may die from tetanus during the 1990s despite efforts by the World Health Organization (WHO) to eliminate it by 1995. Vaccination to prevent postabortal and maternal tetanus has been neglected. The immunization of preschool children and of pregnant women has omitted adolescent girls, who are therefore at risk. Data collected on 1101 cases of maternal tetanus in developing countries between 1958 and 1990 indicated that 27% were attributed to postabortal and 67% to postpartum sepsis. In southeastern Nigeria where abortion rates are high, a high proportion of girls were also seronegative for tetanus antibodies. Many unvaccinated pregnant women cite the lack of money for obtaining vaccination when obtaining prenatal services. The WHO is promoting vaccination of women of reproductive age by screening their tetanus toxoid status, but adolescents are poorly covered because they are not regular attenders. Expressly targeting girls would be feasible, as it would require 5 injections providing protection for life. Even 4 injections may protect for 20 years if delivered at the end of primary school. Thus a school health service delivering tetanus vaccination may improve the vaccination of adolescent girls. This could be combined with distribution of vitamin A and antihelminthics whereby the response to the vaccine could be improved significantly. In addition, it has also been suggested that a late dose of an acellular pertussis vaccine and a second dose of measles vaccine given in adolescence would reduce the pool of susceptible girls, just as girls have been targeted for rubella vaccination. Implementation of tetanus vaccination would require local schools vaccination days, immunization cards, high potency primary vaccination, and tetanus boosters free of charge with a system to monitor antibody responses.
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PMID:Protecting adolescent girls against tetanus. 754 4

Community information based on causes and circumstances of death in infants and young children in Malawi was obtained in a prospective cohort of babies delivered to women enrolled in a malaria-prevention-in-pregnancy study. Vital status information was obtained through home visits every two months; for children who died, questions were asked concerning age and date of death, symptoms preceding death, care sought, location of death (home versus facility), and duration of illness. Of 3,274 liveborn singleton infants, 181, 397, and 152 deaths occurred in the neonatal, postneonatal, and second year of life, respectively. For neonates, proportionate mortality was greatest for sepsis/tetanus (16.7%) and fever (8.6%); however, for more than half of neonatal deaths evaluated the cause was not identified. Up to 30% of neonatal deaths may have been related to prematurity. In the postneonatal period, gastrointestinal illness (39.6%), fever (18.3%), and respiratory illness (14.7%) were the leading causes. Most postneonatal illnesses lasted 1 week or less. Two-thirds of postneonatal deaths occurred outside of a health care facility, although 80% were brought to a facility for care during their illness. Infectious disease syndromes continued to be important in the second year of life, with gastrointestinal (31.6%), fever (23.5%), and measles (20.6%) the most commonly reported causes of death. In this area of rural sub-Saharan Africa, neonatal mortality contributes substantially to infant mortality, and prematurity is considered to be an important component of early neonatal deaths; infectious disease syndromes predominate in the postneonatal and second year of life. Strategies to reduce infant deaths in sub-Saharan Africa must consider these factors, as well as the observations that most children who died had brief illnesses, were taken to a health care facility before death, yet died at home.
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PMID:Infant and second-year mortality in rural Malawi: causes and descriptive epidemiology. 870 42

This article discusses the reasons for the decline of child health resulting in the increasing rate of child mortality in rural Papua New Guinea. The mortality rate among children under 5 years old in this country is more than twice that of the overall East Asia and Pacific region (54/1000 live births) in 1999. The major causes of child mortality are pneumonia, malnutrition, measles meningitis, low birth weight, and neonatal sepsis. Factors contributing to this increase in child mortality include the lost of health services, aid posts in the remote villages due to the unavailability of vehicles, deterioration of roads, and inadequate assistance and support from local administrators. Low vaccine coverage, the discontinuance of the tuberculosis control programs, and inadequate medical training of the health workers and staffs also worsens the situation. Possible solutions to this problem would be the re-establishment of community-based health services, rebuilding of aids-post, regular maternal and child-health patrols, and the re-establishment of vaccine cold chain. In addition, semiformal training of village women in the basics of child health would increase community involvement in health and broaden knowledge of health care issues. Clinical undergraduate medical training should also be given in urban and rural hospitals, health centers, and communities.
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PMID:Decline in child health in rural Papua New Guinea. 1052 Jun 51


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