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

When the body temperature of a small neonate falls below 35 degrees C, lassitude can be noted; severe derangements of cardiovascular, renal, hepatic, immunological, and hematological systems may also occur depending in part on the duration and severity of hypothermia. Diagnosis requires a low-reading thermometer, lacking which the diagnosis can be suspected, but most often is missed. Fatal cases of diagnosed cold injury commonly have terminal pneumonia or sepsis. Prevention involves identification and home visits to high-risk infants; intensive care of those with the diagnosis at Soroka Hospital Medical Center has reduced the case-fatality rate from 30% in 1971 to 3% in 1988-1989. During the same period in our region, the proportion of neonatal deaths occurring in winter months of December, January, and February has dropped from 55 to 27%. The expected proportion is 25%. We hypothesize that excess neonatal mortality during winter months, especially due to pneumonia and sepsis or sudden infant death syndrome (SIDS) is an indicator of missed cold injury syndrome. A preliminary evaluation was made form U.S. data by state, provided by the National Center for Health Statistics, which records no fatalities from cold injury during 1986. Contrasted with this are 26 cold injury deaths in Israel for 1977-1980. In the U.S., though, excess winter neonatal deaths in 1986 from SIDS, pneumonia, and sepsis are reported.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Preventability of neonatal cold injury and its contribution to neonatal mortality. 195 41

The immune response to polysaccharide Ag as present in the capsule of certain virulent bacteria has been demonstrated to be related to a functionally intact spleen. This immune response is almost completely defective in infancy. Because of this the development of cellular compartments in the human spleen was studied immunohistologically in frozen and paraffin tissue sections of 32 infant spleens (less than 2 y of age) and 6 spleens from children. Six cases of sudden infant death syndrome and 7 cases of infection or sepsis which were included showed no significant differences compared to the other cases. Whereas all other cellular compartments have completed their maturation to an adult-type immunophenotype and morphology within the first 5 mo, the infant marginal zone B cells show essentially different features compared to the adult situation. The main characteristics of the infant marginal zone B cells are the absence of CD21-(C3d/EBV-R) expression and the high percentage of cells strongly coexpressing IgM and IgD. As the marginal zone is supposed to be the site of the initiation of the immune response to polysaccharide Ag, there is a remarkable coincidence between the first appearance of MZ B cells with adult features, and the time of acquisition of the ability to mount an immune response to polysaccharides, including encapsulated bacteria.
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PMID:Immaturity of the human splenic marginal zone in infancy. Possible contribution to the deficient infant immune response. 247 21

Outcome of cardiac arrest (CA) is very much influenced by pre-CPR conditions. To assess the importance of these pre-CPR factors, an analysis of the Belgian CPCR registry was made according to some pre-CPR conditions. In this registry, several variables related to pre-arrest, arrest, CPR and post CPR period have been recorded in 4548 patients. The pre-CPR conditions studied were: age, witnessed event or not, pre-arrest health state, underlying disease, site of cardiac arrest, type of respiratory arrest and type of cardiac arrest. Age did not influence outcome significantly. The importance of witnessing is very significant. Severe pre-arrest disability reduces chances on long-term survival (LTS) to half and overall health status longterm survivors is clearly less. Intoxication and metabolic origin of CA have good prognosis (LTS, 21%). Trauma/exsanguination, drowning, SIDS and sepsis have bad prognosis (LTS, 1-3%). Cardiac (LTS, 12%) and respiratory (LTS, 14%) origin have similar outcome, although significant difference exists in occurrence of cerebral failure, suggesting that post-ischemic encephalopathy is more severe in respiratory than in cardiac origin. The most frequent site of CA, the home of the patient, has poor outcome results (LTS, 5%). Gasping is significantly related to successful outcome. In the out-of-hospital setting the type of CA was 25% VF (LTS, 77%), 65% asystole (LTS, 4%) and 10% EMD (LTS, 3%). Outcome of the subgroup out-of-hospital, witnessed, VF is comparable to other reports. This sub-group seems to us the most appropriate for clinical trials.
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PMID:Pre-CPR conditions and the final outcome of CPR. The Cerebral Resuscitation Study Group. 255 Oct 6

Apnea and worsening bronchopulmonary dysplasia as well as recurrent aspiration pneumonia have been found to be consequences of gastroesophageal reflux in infants and young children. Antireflux procedures are effective in preventing gastroesophageal reflux; however, the effect of this operation on the course of these respiratory problems in very young patients is not known. We reviewed the results in 51 patients 2 years of age or less who underwent an antireflux fundoplication for pulmonary problems attributable to severe gastroesophageal reflux unresponsive to medical treatment. Twenty-eight patients had recurrent episodes of aspiration pneumonia, 14 had nonimproving or worsening bronchopulmonary dysplasia, and 9 had unexplained apneic episodes. Seventy-three percent of these patients had coexisting congenital anomalies or acquired problems. No operative deaths and no major surgical complications occurred. There were eight late deaths occurring between 1 and 25 months postoperatively: three were due to associated congenital anomalies or acquired problems, three to sepsis, and two to sudden infant death syndrome. Of the 43 surviving children, 91 percent with preoperative recurrent aspiration pneumonia had no additional episodes after Nissen procedure. Eighty-eight percent of the infants with unexplained apneic episodes showed marked benefit and 83 percent of those with bronchopulmonary dysplasia had clinical improvement. There were no late problems attributed to the operation even when it was performed in preterm infants. Therefore, we recommend fundoplication for patients 2 years of age or less who have a persistent pulmonary problem attributed to gastroesophageal reflux that does not respond to medical therapy.
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PMID:Treatment of pulmonary manifestations of gastroesophageal reflux in children two years of age or less. 292 62

We report the case of 5-week-old male infant who presented as a 'near miss cot death'. He had the immunodeficient syndrome of defective neutrophil mobility and delayed umbilical cord separation. He was shown to have staphylococcal endocarditis with a large vegetation on the mitral valve, and acute obstruction of the mitral valve flow may have accounted for the suddenness of his presentation. Death resulted from overwhelming sepsis with widely disseminated micro-abscesses.
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PMID:Obstructive endocarditis in an immunodeficient infant. 381 60

Most seemingly well infants who die suddenly and unexpectedly have no adequate cause of death found on thorough postmortem examination. Respiratory and enteric viruses are often present, especially in the upper respiratory tract, but the infective process seems, of itself, insufficient to cause death. In the remainder of the cases, a variety of lesions will be discovered, including viral myocarditis, bronchiolitis, and sepsis. We report a case of sudden and unexpected death in a 5-week-old male infant due to acute anterior poliomyelitis. This case illustrates the importance of a thorough postmortem examination, including histologic studies of the brain stem and spinal cord in cases of sudden infant death syndrome.
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PMID:Sudden infant death syndrome caused by poliomyelitis. 674 69

In some cases of sudden infant death syndrome (SIDS) the intestinal flora was found to be dominated by Candida albicans. Microbiologic investigations of the various organs showed the occasional presence of different Candida species, but not in the form of massive growth as in sepsis. There is no basis to assume that the activity of yeasts, first of all of Candida albicans, is a contributory factor in the occurrence of SIDS. Candida albicans was shown to produce alcohol from glucose at a rate of maximally 1 mg of alcohol per gram of intestinal content per hour. It is concluded that the intestinal production of alcohol in vivo from cases showing a Candida albicans dominated intestinal flora will not be able to surpass the normal alcohol metabolizing capacity of the liver. Thus, measurable concentrations of alcohol in the blood from such cases cannot be expected.
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PMID:Endogenous alcohol production by intestinal fermentation in sudden infant death. 676 Jun 4

There exists great variability in the literature as to the percentage of cases of sudden and unexpected infant death in which definable causes can be identified. Review was undertaken of the clinical and family histories, death scene features including parental interviews, and pathological and microbiological features of 361 consecutive cases presenting as sudden and unexpected infant death with minimal preceding symptoms and signs to the Adelaide Children's Hospital over a 10-year period from 1983 to 1992. Three hundred and twenty-nine cases of SIDS were identified. Nine cases (2.5%) were attributed to accidental asphyxia based partly on death scene examination. This left only 23 cases (6.4%), which were due to a variety of other diverse entities including sepsis, volvulus with sepsis, congenital cardiac disease, probable metabolic disorders, heat stroke, and unclassifiable disorders. This relatively low figure lends support to definitions of SIDS that emphasize the importance of death scene investigation and clinical history review prior to postmortem examination.
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PMID:How useful is postmortem examination in sudden infant death syndrome? 780 80

The role of the autopsy in verifying clinical diagnosis and as a quality assurance tool in pediatric emergency medicine has not been studied. We reviewed the charts of all children who died soon after arriving at to the pediatric emergency department between October 1985 and December 1989. Opinions as to clinical diagnoses and cause of death were obtained by presenting a summary of patient data, in a blinded fashion, to three emergency pediatricians. Clinical diagnoses were then compared with autopsy diagnoses using the Class Error System. Major diagnostic errors (Class I, Class II) were examined to determine if the autopsy was more useful in any particular patient group. There were 69 children: 36 (52%) were female, and 30 (43%) were infants. Autopsies were performed on 52 (75%) patients. Autopsy diagnoses were categorized as follows: sudden infant death syndrome (SIDS) 14 (27%); underlying disease 15 (29%); trauma 13 (25%); sepsis 8 (16%); and aspiration 2 (4%). No errors were made in 67% of cases. The autopsy confirmed the major clinical diagnosis in 85% of patients. There were no Class I errors. Class II error rate was 15%. Most Class II errors occurred in patients between one and five years of ate (57%), and in patients who had sepsis or underlying disease (95%). Our data show that autopsy is useful in determining the cause of death and may be useful for education and quality assurance in pediatric emergency medicine.
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PMID:The utility of autopsies in a pediatric emergency department. 802 13

The data were provided by a search in the National Statistical Service of Greece (NSSG), and covered the period from January 1, 1979 through December 31, 1987, for all infant deaths in Greece. Data on live births were taken from the annual statistical reports of NSSG. Statistical analysis was done by means of the Edward's method. The seasonal patterns of the number of deaths and death rates (per 1000 live-born) were almost identical for the 2 parts of the period studied, for the years 1979 and 1987. 1979-83 and 1984-87 were treated separately for the neonatal period and for the postneonatal period. The number of neonatal and early neonatal deaths did not show significant seasonality in the total period, in either the urban or the rural areas, although the peaks for early neonatal deaths in 8 out of 9 studied years were in the spring and summer. The maximum number of postneonatal deaths was observed during January-February, representing a 60-90% increase compared to the minimum number of deaths, and the difference was more evident in the rural areas of residence in 1979-83. Neonatal deaths from prematurity showed statistically significant seasonal variation with a peak in May, more prominent in urban areas. Postneonatal deaths from infections showed statistically significant seasonal variation with a peak in February more prominent in rural areas and in the 1979-83 period. Postneonatal deaths from pneumonia showed very significant seasonal variation, with a peak in February more prominent in rural areas and in the 1979-83 period. Neonatal deaths from sepsis showed increased occurrence in May, whereas postneonatal deaths from sepsis and from enteric infections did not show significant seasonality. Deaths from injuries showed a statistically significant peak during January-February, in both urban and rural areas, in the postneonatal period. Neonatal and postneonatal deaths from sudden infant death syndrome were more common during the winter (December-January-February) in urban areas.
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PMID:Seasonal variation of neonatal and infant deaths by cause in Greece. 802 71


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