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

The impact of implementation of the National Health Insurance on the outcome, cost, and length of hospitalization of very-low-birth-weight (VLBW) infants is not clear in Taiwan. These data are important for the planning of medical care and regionalization in this area. This study was an attempt to examine these questions. We retrospectively collected mortality, morbidity, and length and cost of hospitalization data of VLBW (BW < 1500 g) infants between March 1995 and February 1998. There were totally 162 patients enrolled. The overall mortality rate was 21.6%; the birth weight (BW)-specific mortality rate was 72%, 31%, 19%, and 3% for infants with BWs of < 750 g, 750-999 g, 1000-1249 g, and 1250-1499 g, respectively. The incidence of morbidities were: respiratory distress syndrome (74%), patent ductus arteriosus (36%), necrotizing enterocolitis (9%), sepsis (42%), intraventricular hemorrhage (15%), retinopathy of prematurity (31%), failure to pass auditory brainstem response (ABR) (34%), and chronic lung disease (17%). The average length of hospitalization was 67.2 days, and the cost per infant was 62 x 10(4) NT dollars; 108 +/- 38 days, 73 +/- 32 x 10(4) NT dollars if BW < 750 g; 94 +/- 15 days, 99 +/- 35 x 10(4) NT dollars if BW 750-999 g; 66 +/- 23 days, 64 +/- 36 x 10(4) NT dollars if BW 1000-1249 g; and 43 +/- 14 days, 39 +/- 37 x 10(4) NT dollars if BW 1250-1499 g. In conclusion, VLBW infants are associated with high mortality and morbidity rates. They have long lengths and high costs of hospitalization, and therefore deserve attention in the implementation of the National Health Insurance and regionalization.
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PMID:Mortality, morbidity, length and cost of hospitalization in very-low-birth-weight infants in the era of National Health Insurance in Taiwan: a medical center's experience. 1119 36

Birthweight-specific neonatal mortality for Alaska Natives is higher than for non-natives for the years 1987-1996. We investigated the reasons for this based on Level III Neonatal Intensive Care Unit information available from 1991-1996. We also investigated whether differences in mortality extended to measures of morbidity. There were less Native patients born at the tertiary care center for babies with birthweight < 1500 grams and 1500-2499 grams (64% for Natives and 87% for non-natives, p = .000). Differences in antenatal referral were only apparent for the population residing within the Anchorage/Mat-Su area. There were also less cesarean deliveries for Native infants that were born outside of the tertiary care center for both birthweight categories (25% for Native vs. 53% for non-native infants < 1500 grams, p = .01; 27% for Native vs. 48% for non-native infants 1500-2499 grams, p = .01). For Alaska Native babies < 1500 grams there was more necrotizing enterocolitis (13% in Native vs. 4.9% in non-native, p = .01), more severe retinopathy of prematurity (12% in Native vs. 4.6% in non-native, p = .01), and more bronchopulmonary dysplasia (49% in Native vs. 34% in non-native, p = .04). For Alaska Native babies 1500-2499 grams that needed ventilatory assistance there was more intraventricular hemorrhage (19% in Native vs. 7.4% in non-native, p = .003), more severe (grade 3-4) intraventricular hemorrhage (9.5% in Native vs. 0.9% in nonnative, p = .001), and more acquired sepsis (7.1% in Native vs. 1.7% in non-native, p = .02). Differences in access to Level III perinatal care and intrapartum care (cesarean delivery rates) are likely factors that contribute to the worse outcomes in the Alaska Native population.
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PMID:Racial differences in newborn intensive care morbidity in Alaska. 1143 33

With improving survival of very low birth infants in India, Retinopathy of Prematurity (ROP is likely to emerge as a significant problem. The most important risk factor in the pathogenesis of ROP is prematurity. Other factors like frequent blood transfusions; sepsis, apnea and problems with oxygenation have also been implicated in the causation of ROP. Essentially asymptomatic in the initial stages, a good screening program is essential for the early detection and treatment of this condition. Description of the various stages and threshold ROP has been included in the protocol. Guidelines regarding the procedure of dilatation, ophthalmic examination and treatment (if required) has been provided in the protocols. Close cooperation between the ophthalmologist and neonatologist is essential for a successful program.
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PMID:Retinopathy of prematurity. 1187 27

The aim of this study was to determine the evolving trends of retinopathy of prematurity (ROP) at a tertiary neonatal intensive care unit. In an ongoing screening programme for ROP, we estimated the incidence of ROP among at-risk neonates in a tertiary care unit. We compared our data over the last 12 months (1999-2000; period II) to the previously published data (1993-94; period I) to study changes in the spectrum of the disease. The overall incidence of ROP in period II was not significantly different from the incidence in period I (32 vs. 20 per cent, p > 0.05). However, a decreasing trend in the proportion of severe ROP (stage III) from 46 to 21 per cent in the later period was noted. The need for cryotherapy also dropped significantly compared with the earlier period (8 vs. 46 per cent respectively, p < 0.05). On multivariate analysis, apnea (p < 0.001; RR = 12.5; 95 per cent CI, 3.03-50.9; clinical sepsis (p < 0.001; RR = 5.7; 95 per cent CI, 1.6-20.7); and male sex (p < 0.001; RR = 6.3; 95 per cent CI 1.6-25.5) emerged as significant risk factors. Although the incidence of ROP is static, the more severe form of the disease (stage III) is showing a decline. Our data suggests that efficient management of apnea and sepsis may be crucial in further minimizing the risk of ROP.
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PMID:Changing profile of retinopathy of prematurity. 1220 Sep 87

Premature delivery is common in pregnancies complicated by maternal diabetes. However, the outcome of very-low-birth-weight infants (VLBWI) born to mothers with diabetes is not known. Employing a matched double-cohort design, we investigated the influence of maternal diabetes on the outcome of VLBWI born in Winnipeg from 1988 to 1994. We compared mortality rates and early and late morbidity rates in VLBWI born to mothers with diabetes mellitus (DM) (cases, n = 43, 23 with gestational DM and 20 with pregestational DM) and without DM (controls, n = 539). Controls were matched for gestational age (GA), sex, and the year of birth. All subjects were enrolled in the Newborn Follow-Up Program. Relative risks and 95% confidence limits were calculated for each variable and Chi 2 analysis, Student t-test, and Mann-Whitney test were used as appropriate for analysis. Diabetes mellitus control was assessed by conventional criteria. There were no differences between cases and controls in mode of delivery, birth weight (mean +/- SD, 1,160 +/- 25 g vs 1,110 +/- 26 g), GA (29 +/- 2.8 wk vs 29 +/- 2.4 wk), smallness for gestational age (35% vs 30%), head circumference (26.5 +/- 1.9 vs 26.2 +/- 2.2 cm), length (38.8 +/- 2.8 vs 37.5 +/- 3.7 cm), Apgar score < 4 at 1 min (42% vs 40%) and < 7 at 5 min (37% vs 42%). Incidence of hyaline membrane disease (60% vs 71%), bronchopulmonary dysplasia (33% vs 31%), patent ductus arteriosus (30% vs 43%), necrotizing enterocolitis (12% vs 12%), sepsis (23% vs 25%), acute renal failure (9% vs 10%), intraventricular hemorrhage--all grades (74% vs 64%), retinopathy of prematurity--all stages (30% vs 26%), median days on ventilator (4 vs 4 days), and median days on supplemental oxygen (46 vs 42 days) were similar in both groups (p = NS, 95% confidence limits included 1 for all of these variables). There was no significant difference in mortality (21% vs 15%) or the incidence of major congenital anomalies. Weight, head circumference, and length at 6, 12, and 18 months were similar in both groups. There were no group differences in developmental quotients, prevalence of neurodevelopmental impairments, respiratory morbidity, or number of hospitalizations up to the last follow-up (18 months). Our data suggest that with contemporary perinatal care there is no significant increase in mortality rates or early and late morbidity rates between VLBWI born to mothers with DM and VLBWI of nondiabetic mothers. It seems that with reasonable diabetic control, prematurity rather than the diabetic state determines the neonatal outcome, and this knowledge can be useful in parental counselling.
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PMID:Outcome of very-low-birth-weight (< 1,500 grams) infants born to mothers with diabetes. 1236 10

Retinopathy of prematurity (ROP) was first described by Terry in 1942. ROP is considered a multifactorial disease. Low gestational age, low birth weight and oxygen therapy are recognized as risk factors for this condition. Other risk factors including multigestational pregnancy, white race, sepsis, NEC, BPD, intraventricular hemorrhage, lung maturation, steroid treatment, blood transfusions and light exposure were identified by multiple studies. We aim to review these studies in order to identify the independent risk factors for the development of ROP. The reviewed studies confirm that low birth weight, low gestational age, prolonged oxygen treatment and blood transfusions are statistically significant risk factors for the development of ROP. The incidence of all stages of ROP is similar for Caucasian and black infants, although the occurrence of threshold ROP was found higher in the Caucasian group. No relationship was demonstrated between light exposure and the development of ROP. The studies reviewed show decreased frequency and severity of ROP in neonates of mothers who had received antenatal steroid therapy. The findings concerning the influence of postnatal steroid treatment on the incidence of ROP are controversial.
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PMID:[Retinopathy of prematurity--risk factors]. 1253 6

We report the morbidity and mortality in extremely low birth weight neonates (ELBW) from a tertiary care hospital over seven years (1994-2000). Data regarding maternal and neonatal details was obtained from old records, computer database and medical files. Of the 12,807 live births during this period, 137 (1.07%) were ELBW infants. All of them were managed without surfactant. Overall, 67 infants (48.7%) survived to discharge. The most commonly encountered morbidities were hyperbilirubinemia(65%), respiratory distress(65%), sepsis(52%), intraventricular hemorrhage(29%), pneumonia (25%) and retinopathy of prematurity(24%). Need for resuscitation, pulmonary hemorrhage, seizures, acute renal failure, sclerema and air leak syndromes were significantly associated with mortality. Sepsis accounted for 41% of all deaths while immaturity was the second most important cause, accounting for 24% deaths. The average length of stay for survivors was 49 days (SD +/- 15.9 days)
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PMID:Survival and morbidity in extremely low birth weight (ELBW) infants. 1262 27

We studied the maternal and neonatal profile and outcome of extremely low birth weight (ELBW) babies at the level III neonatal intensive care unit (NICU) in Delhi. Case records of ELBW inborn babies delivered between August 2000 and August 2001 were analysed by using a pre-set proforma. A total of 52 ELBW babies were admitted to the NICU in the relevant period, of whom 30 (57%) survived. Maternal anaemia, previous preterm delivery and pregnancy-induced hypertension (PIH) were the common predisposing factors for preterm delivery. Mean gestational age was 27.8 weeks and mean birth weight was 831 g. The highest mortality (55%) was seen in babies with 26-28 weeks'gestation and those in the birth weight category of < 800 g. Neonatal hyperbilirubinaemia (78%) and hyaline membrane disease/respiratory distress syndrome (65%) were the most common causes of morbidity. A total of 25 babies were mechanically ventilated while 24 (46%) received total parenteral nutrition. Sepsis, pulmonary haemorrhage, intracranial haemorrhage and necrotizing enterocolitis accounted for the deaths in the study population. Retinopathy of prematurity screening was performed in 35 babies (68%), of whom 22 were found to be normal. According to the International Classification of Retinopathy of Prematurity, most babies (72%) had involvement of zone 3 and stage I (63%). The incidence was highest in 26-28 weeks'gestation babies (71%) and the < 800 g birth weight category (62%). Maternal risk factors such as anaemia and PIH commonly predispose to preterm delivery. There is an alarmingly high mortality in this population. Effective steps are required not only to avoid extreme prematurity but also to reduce morbidity and mortality of all newborns weighing <1000 g at birth.
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PMID:Maternal and neonatal profile and immediate outcome in extremely low birth weight babies in Delhi. 1526 50

Recent clinical outcomes for the Newborn Intensive Care Unit (NICU) at Providence Alaska Medical Center based on Alaska Neonatology's Clinical Outcomes Database are presented. There has been a decrease in overall mortality, with much of the improvement occurring in babies from 22 to 25 weeks gestation in the years 1998--2002. There has also been a decrease in the incidence of severe intraventricular hemorrhage / periventricular leukomalacia. Earlier discharge of babies has also been documented, as measured by post conceptual age at discharge. No improvement in the incidence of retinopathy of prematurity and nosocomial sepsis were seen. Rates of chronic lung disease and babies going home in oxygen have increased. Outcomes that have failed to improve are the focus of quality improvement initiatives. Clinical outcome information systems such as the NICU outcomes database are essential for assessing clinical performance and provide the foundation and focus for quality improvement initiatives.
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PMID:Clinical outcomes for newborn intensive care in Alaska. 1556 29

The aim of this study was to assess the effectiveness of active intervention with antenatal maternal corticosteroid and antibiotics therapy in infants delivered between 24 and 28 weeks of gestation after premature rupture of membrane. This retrospective study included pregnant women complicated by preterm delivery at the Dong-A University Hospital from 1998 to 2002. Patients were divided into labor induction group 1 (n=20), observation group 2 (n=19), and medication group 3 (n=20). We evaluated the effects of prolongation of pregnancy and intervention with maternal corticosteroids and antibiotics therapy on perinatal and neonatal outcomes. Each group did not have a significant difference (p<0.05) in neonatal outcomes, such as respiratory distress syndrome, intraventricular hemorrhage, necrotizing enterocolitis, retinopathy of prematurity, pneumonia, bronchopulmonary dysplasia, and sepsis. The mean latency period was 4.7 days and 7.6 days in groups 2 and 3, respectively. Therefore, this study was unable to demonstrate any beneficial effects of corticosteroids in improving neonatal outcomes and prolongation of the latency period with antibiotics.
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PMID:Effect of antenatal corticosteroid and antibiotics in pregnancies complicated by premature rupture of membranes between 24 and 28 weeks of gestation. 1571 10


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